BMH officials are tracking the meds

MUNCIE, Ind. – Stealing controlled substances from IU Health Ball Memorial Hospital appears to be an increasingly perilous task.

In the wake of three recent arrests of BMH nurses accused of stealing medications – and ingesting those drugs while on duty – officials in a recent interview detailed the technological advances that allow them to monitor the dispensation of controlled substances in the Muncie hospital.

While the nurses’ arrests have no doubt resulted in heartache for the defendants and those who care about them, and created the kind of publicity any hospital would prefer to avoid, they would also appear to indicate BMH’s drug security system is working.

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Chief Deputy Prosecutor Zach Craig – who filed the recent charges against the nurses, and handled a similar case against a BMH anesthesiologist – said the hospital’s narcotics-monitoring system is “one of the best in the state.”

Tracking the meds

Tina Love, BMH director of pharmacy, said the hospital has been doing “proactive diversion monitoring” since 2003.

The hospital has a Pyxis system consisting of more than 40 “automated (medicine) dispensing cabinets” located throughout the facility, and a C-II safe in the pharmacy, Love said.

“All those Pyxis machines can talk to each other,” she said, and the system produces reports on what medications each machine has dispensed.

“We used them to verify activity for our pharmacy staff, when they go to refill all of these machines, and removal activity for the nursing staff and anesthesiologist staff.”

Last year, the Pyxis system was upgraded, producing “much more sophisticated” analysis of the dispensing of drugs.

“It looks at all activity, comparing users to their peers in a certain areas, as well as looking at their activity compared to everyone in the hospital.

“It certainly has a much more broad capability, to dig in deeper, and identify activity that might not have been flagged prior.”

Love said the upgraded system has been “very helpful,” but also “overwhelming,” producing a monthly report that can exceed 1,000 pages.

“It’s not all about drug diversion,” she said. “It’s also about inventory control, and how often we’re refilling.”

Along with the data analytics, hospital officials do random monthly auditing of the Pyxis machines.

Launching the team

If the Pyxis data, “or behaviors or things that we observe,” prompt officials to suspect medications might have been mishandled, “we will launch a diversion team,” Love said.

Members of that team including leaders from seven departments and offices within the hospital – including the specific area where potentially suspicious activity has been noted.

If the team reviews the situation and believes “there’s an issue,” Love said, she is required by law to notify the Drug Enforcement Administration within 24 hours.

And at that point, an official investigation is launched.

There are many instances when a nurse is determined to have had completely legitimate reasons for accessing what seems to be an unusually high amount of a medication.

“Often it’s related to the person picking up shifts, working extra,” Love said. “There might be a situation where a particular patient’s clinical status necessitates the need for that higher amount of medication.

“There may be a legitimate reason for that. And often there is. I’d say most of the time there is.”

Less frequently, situations are uncovered where the quantity of a controlled substance being dispensed can’t easily be explained.

That is when the DEA – and, at his request, Chief Deputy Prosecutor Craig – become involved.

‘We are the community’

While the recent arrests of three BMH nurses might be disheartening, that some personnel at one of East Central Indiana's largest employers might become substance abusers is not a surprise. 

"We have over 850 nurses," said Carla Cox, the hospital's chief nursing officer.

Cox noted studies reflecting about 10 percent of Americans are dealing with addiction issues.

"Really, for nursing, it's no higher," she said. "But it's the same. 

"We are the community. We are the people who live in our community. When you think about it, the risk is always there if we're part of that population."

Some studies have also suggested substance abuse might be "an occupational hazard" for nurses "because we are exposed to these narcotics all of the time," Cox said.

The nursing officer said she appreciated the hospital's "robust system" for tracking potential problems "because our goal, if somebody does have an addiction problem, is to find it as quickly as we can."

Cox said efforts were being made to “educate all of our staff out there” about possible signs a colleague might be a substance abuser.

“Our goal in our education is to immediately report it,” she said. “Obviously our number-one thing is to keep our patients safe.”

‘We know it’s a disease’

BMH officials are not without empathy for those medical professionals who have fallen into addiction, derailing their careers in the process

"You want to help that person," Cox said. "Because if you find it early, you can get them into programs, and they can get help. The longer somebody is using, the harder it is."

"We know it's a disease," Love said. "We do know that people are more likely to report, and self-report, if they know they're going to get help, but not necessarily be arrested, and even be on the front of the paper. It's devastating."

Cox said allegations of substance abuse would result in an immediate suspension of a nurse, who would then be referred to a state assistance program.

Successful completion of a treatment program in some cases can lead to that person's return to nursing, provided state authorities are willing to restore their license, often with "parameters" about their handling of drugs, the chief nursing officer said.

"If you need the help, and you get the help, then you can still have your nursing license," Cox said. "If you don't admit to it, and we have proof this is going on, that's a different issue. ... Every circumstance is different because it depends what all was involved and what was done."

The hospital officials did not discuss the specific cases that led to recent arrests.

'We can't get past that patient safety issue'

Chief Deputy Prosecutor Craig, who since Jan. 1 has overseen drug-related cases in the Delaware County court system, said his prosecution of Jose A. Ramos, who had worked as an anesthesiologist at BMH, "just kind of illuminated the issue to us."

Ramos, arrested last July, admitted to ingesting narcotics stolen from the hospital before participating in medical procedures.

In March, Ramos was placed on probation for two years and ordered to perform 200 hours of community service after pleading guilty to possession of a narcotic drug and criminal recklessness.

Delaware Circuit Court 5 Judge Thomas Cannon Jr. told the anesthesiologist he had "played Russian roulette" with the lives of his patients.

Craig said he was not opposed to leniency in cases of medical professionals who are confronting their substance abuse issues, but also suggested there was a line that could not be crossed.

"These are individuals that were taking medication and then using it while at work, and then proceeding to perform their duties out there," he said. "At that point, they obviously have addiction issues, and it's gotten so bad they're willing to put somebody else's safety in jeopardy.

"It's awful that it potentially harms and jeopardizes their livelihood and their chances to provide for themselves, but we can't get past that patient safety issue... That's our position."

The three BMH nurses arrested over a seven-week period between mid-March and early May are accused, like Ramos, of ingesting narcotics during their work shifts.

Craig said the hospital cases are "just another part of the opiate epidemic, really touching every aspect of society."

Contact news reporter Douglas Walker at (765) 213-5851. Follow him on Twitter: @DouglasWalkerSP.

Hospital drug arrests

Jose A. Ramos, anesthesiologist at IU Health BMH, was arrested in July 2016, accused of stealing narcotics from the hospital and ingesting the drugs before participating in medical procedures.

In March, Ramos was placed on probation for two years and ordered to perform 200 hours of community service after pleading guilty to possession of a narcotic drug and criminal recklessness.

Between March 16 and May 3, three nurses at the Muncie hospital – Alisha K. Sue, Kadee D. Klafka and Ruth E. Williams – were each charged with possession of a narcotic drug, theft and criminal recklessness.

Each nurse is accused of stealing narcotics from the hospital and ingesting them during work shifts.

Sue has negotiated a plea deal with the prosecutor's office and is set to be sentenced July 13 in Delaware Circuit Court 5

Klakfa has received a Jan. 8 trial date in Circuit Court 2.

Williams' case, the most recent filed, has not yet been set for trial.