Thursday, October 25, 2012

How UPMC Hepatitis C Scare Happened

Our law firm in a joint effort with class action expert, James Pietz, esquire, of the Pietz Law Office have filed a class action lawsuit against The University of Pittsburgh Medical Center (UPMC) and Maxim Staffing Solutions.  While class action specific discovery has not yet gotten under away, UPMC has admitted that radiology technician, David Kwiatkowski was caught stealing Fentanyl, an opiate one hundred times stronger than heroin, in a UPMC operating room.  It is believed that Kwiatkowski was not authorized to access this schedule II narcotic.  If that is the case, it means that the drug security measures required of UPMC were not properly implemented.  As a result, Kwiatkowski was able to gain access to Fentanyl, inject himself with it, replace it with a different fluid and place the medication back in circulation where patients were then exposed to the dirty syringes.

This method of drug theft is known as Diversion by Substitution.  The Joint Commission Resources and American Society of Health System Pharmacists state that in about one fifth of investigations of diversion offenses by nurses and other hospital personnel, drug substitution is found to be the method of diversion.  This is the worst type of diversion, because it completely deprives patients of drugs they need for pain relief while at the same time, in many cases, causes them to be exposed to dirty medical instruments.  Typically, a substitute for the prescribed drug, such as saline or tap water, is injected, and the syringe with the active drug is pocketed.

Another method of substitution is by tampering with the original container.  The individual cuts the backing off the plastic trays that hold the narcotic syringes.  He/she removes the syringes from the package without disturbing the security tabs found on the opposite end, removes the controlled substances fromt eh end, and repalces it with a substitute fluid.  The syringe is then returned to the plastic tray, and the box isreturned to the origninal area.

Syringes can also be switched at the bedside or from the back-stands in the surgical areas.  The use of multidose vials of narcotics is generally discouraged outside the pharmacy due to the ease with which narcotics could be substituted.  Ampules can be a target, as individuals drill a small hole in the bottom, or break them along their scoring, replace the contents, and flue them back together.

A refractometer can be helpful here as it measures the refractice index of the light passing through the drug and can determine if the drug has been altered.  Because the OR is a popular target for diversion, all narcotic waste from teh OR should be returned  to teh pharmacy for random refracometirc analysis. Although the two most common narcotics found in substitution inciednts are morphine and meperidine, fentanyl is often seen as well.  As a result, wasted fentanyl syringes should be sent to the laboratory for analysis, because fentanyl will not produce a refractometric reading.

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