A nurse in the Billings Clinic Cath Lab has been dismissed from the hospital for stealing narcotics intended for catheter lab patients.
The nurse is accused of swapping out fentanyl, a narcotic used in a sedative mixture prescribed to patients before they undergo a catheter insertion procedure. The nurse was replacing the fentanyl with saline.
The discovery was made earlier this month. A colleague of the nurse noticed irregularities with the automated secure cabinet in which hospitals store controlled substances.
The colleague informed his supervisor, and the nurse was pulled in for an interview.
"Actually, he was very forthcoming," said Camilla Saberhagen, a doctor and the chief quality and patient safety officer at Billings Clinic.
With the nurse's admission of the fentanyl theft, hospital officials informed state and federal authorities and then conducted an internal investigation to gauge the impact of the theft on its catheter lab patients and evaluate the systems and procedures in place to prevent narcotic thefts.
As officials went back and examined records from the automated secure medicine cabinet, investigators discovered possible irregularities beginning in October.
Staff compiled a list of 341 patients who could have been impacted by the theft and sent letters out to them Monday, expressing concern and telling them who they could talk to if they had questions. Officials then called them all starting Tuesday morning to make sure the patients had all gotten word of the incident.
They were informed that the fentanyl would be removed from their bill. It also let patients know they're at no risk for contracting hepatitus C and HIV. The hospital tested the nurse for the two diseases and then let patients know that the nurse was not infected.
What was surprising was how long the suspected nurse evaded detection.
"No one noticed any unusual behavior," Saberhagen said.
The nurse was popular with his colleagues and worked well with the patients. So far no patients have reported that they felt any unusal discomfort during the procedures.
Catheter insertion uses what's known as conscious sedation, meaning the patients are awake during the procedure but don't feel the pain. Saberhagen said the physicians would be the ones most likely to detect a patient's discomfort because it would have made the procedure more difficult.
And they noticed nothing, she said.
In the wake of the discovery, hospital officials have worked with the nurse's colleagues as they deal with "competing emotions." They feel a sense of betrayal by one of their own, officials said, and they feel deep-seated concern for their patients, many of whom they form relationships with.
"This was tough for our staff," Saberhagen said. "They care about these patients."
Moving forward, the hospital will look at the procedures and processes it has in place to better prevent thefts of this kind, known as diversion. A diversion is when a staff member diverts a drug meant for a patient and either takes it or passes it off to someone else.
Officials said staff are openly talking about it, making sure employees are aware of the issue and that they're vigilant about spotting potential irregularities in the system.
The hospital is also taking a look at how to better parse the data collected by the automated secure medicine cabinet, known as an omnicell. Every time staff pulls a medication from the omnicell, it records what was taken, when and by whom.
"It produces a ton of data," Saberhagen said. "It's a challenge to review it all."
In this particular case, Saberhagen said the hospital needed about four weeks of data to see the pattern established by this nurse's behavior.
Diversion has been a longstanding problem faced by hospitals, Saberhagen said. The more they can be open and transparent about it, the better all hospitals can combat the issue.
In the last decade and a half, Billings Clinic has dismissed two nurses for stealing narcotics, once in 2003 and again in 2010, according to Gazette archives.
In July 2010, Jennifer Asay lost her license after she was accused of stealing narcotics. A nurse supervisor reported Asay to the state nursing board in July 2009 after a secure narcotics container was tampered with on two occasions.
In April 2003, Jenny Laughery, also known as Jenny McCann or Jenny Williams, admitted she stole the painkillers Percocet, Dilaudid and Demerol. She also admitted to altering medication distribution sheets in an attempt to hide the thefts.
She was sentenced to probation in U.S. District Court.
In the letter sent to patients on Monday, the hospital also informs them that they've set up a dedicated phone line for people to call in with concerns and questions. The number is 406-657-4355 or toll free at 844-830-3590.