SALEM — In the year since the discovery that a Beverly Hospital pharmacy technician was able to steal approximately 18,000 pills, undetected, over the course of a year, state officials say they are taking steps to address concerns about drug thefts from health care facilities.
The thefts, or diversions, of medications are required to be reported by pharmacies and health care facilities under state and federal laws.
But officials acknowledged earlier this year that while the reports are reviewed and then, when required, referred to law enforcement and licensing entities, there was no system in place that specifically tracked health care facilities.
On Wednesday, Lisa Tillman, 51, of Salem, pleaded guilty to obtaining drugs by fraud. She received a suspended 21/2 year jail sentence and three years of probation, with a year to be spent on house arrest.
Prosecutors said that for 13 months, until her thefts were discovered in March 2018, Tillman was repeatedly able to alter computer records in the automated dispensing machines that are used to store and control medication inventory in hospitals, marking bottles of pills as “expired” and then taking them out of the machine.
The theft was the largest diversion from a health care facility in at least a decade in Massachusetts.
Investigators questioned how the high number of pills being marked as expired, or the need to replace those pills, did not come to the attention of hospital administrators, and concluded that the machines were generating reports that went mostly unread.
“The Department of Public Health’s Drug Control Program is currently developing a fully automated drug incident and investigation system and has added two new enforcement investigators,” said Ann Scales, a spokeswoman for the DPH.
“After learning of the depth of the Beverly Hospital diversion, the efforts that were already underway to improve system reporting, measurement and monitoring of potential diversions were escalated and accelerated,” said Scales.
“The new investigators will be added to the enforcement team that investigates diversion of controlled substances at health care facilities in Massachusetts,” said Scales. That will give the agency the ability to respond to reports more quickly.
State Rep. Paul Tucker, D-Salem, said Thursday that lawmakers are willing to give the Department of Public Health an opportunity to see if the changes and two other initiatives are successful in identifying drug diversions or patterns of possible abuse before resorting to any new legislative response.
One of the programs, e-prescribing, mandates that by 2021, all new prescriptions for controlled substances must be electronic, meaning doctors must send the prescription directly to a pharmacy.
Tucker said the agency believes that electronic records will be easier to audit and can be watched more easily for “red flags” that might indicate abuse.
The agency is also rolling out a quality improvement program, said Tucker, which will include a more robust monitoring system that will look at trends, such as numbers of prescriptions, that will also set up a flag when something seems out of the ordinary.
“The intent of these technical enhancements is to have all possible related data points in one easy-to-use system,” said Scales. “This will improve coordination between investigations and licensing, and serve as a case management tool,” for the agencies responsible for oversight of licensed professionals and the Drug Control Program. “This will allow us to see trends and spot possible issues earlier,” she said.
“Do we need a legislative fix? We still may at some point along the way, but I do think DPH is addressing this with these two programs,” said Tucker. “Once they’re rolled out we’ll see if they’re working.”
Data provided by the DPH in response to a Salem News public records request earlier this year found that the vast majority of drug diversions reported by hospitals involved small amounts of drugs consistent with personal use, such as single doses of painkillers or other commonly-abused drugs that disappeared, usually between the time they were taken from an ADM drug cabinet and the time they were supposed to have been given to a patient.
Multiple other reports involved intentional “wasting” of drugs — where a hospital staff member such as a nurse reports that a medication has been damaged or lost but instead was taken by the staffer.
Tucker said that in most cases, the goal is to provide rehabilitation to a professional, like a nurse, doctor or pharmacist, who has become dependent on a substance, giving them an opportunity to return to their profession whenever it’s appropriate.
“With criminal justice reform, there is definitely a thought to, whenever possible, using less punitive measures,” said Tucker. “This is where individualized justice comes into play, to make sure somebody gets the appropriate treatment.”
But in cases where the quantity of diverted drugs is high enough, as is more often seen at pharmacies or drug warehouses, to be consistent with distribution or trafficking, “that’s a game changer.”
However, even as of August, when the DPH submitted its annual report on investigatory and disciplinary investigations by the Board of Registration in Pharmacy to the Legislature, the data appeared to be marked by inconsistencies in collection and recording, something that electronic data collection might address.
For example, a spreadsheet of reports for 2018 that was attached to the report, identifies the Tillman case, in the category of “drug violations,” but indicates that information about criminal prosecution was “not available.”
Beverly Hospital was not penalized as a result of the incidents, said Scales.
The DPH conducted an administrative review of the hospital’s controlled substance policies and procedures, which found weaknesses, including with regard to access to the Pyxis drug dispensing cabinets.
As a result of that review, Scales said, the hospital worked to address those problems, including upgrading their systems to improve oversight and bringing in a consultant and an auditing program to monitor the supply and usage of drugs in the hospital.
Courts reporter Julie Manganis can be reached at 978-338-2521, by email at firstname.lastname@example.org or on Twitter at @SNJulieManganis.