My wife, Mary, suffered an accident almost 30 years ago. Since then, she lived with a disability that caused her a lot of pain, and she used a wheelchair to get around. Mary was also living with diabetes, lung deterioration, heart disease, high blood pressure, and arthritis. She took many medications, including painkillers, to manage her illnesses.
Mary was always very conscientious about her prescription pain pills, so when I noticed that the pills were disappearing faster than they should have been, I worried that maybe she was taking more than she should. We both suspected that a woman we had hired to clean our house was stealing the pills, but I still worried that the medications she took made it hard for her to remember whether she had already taken the dosage.
About three years before she passed away, Mary required oxygen equipment to assist her respiration. Mary lived at home right up until four months before she died, and she was able to use the oxygen equipment at home. She got around the house very easily because we could hook up long tubes to the oxygen equipment, and this allowed her a lot of independence.
We leased the oxygen equipment from Fresh Air, Inc. As part of our lease agreement, a technician would visit the house monthly to check the equipment. The technician, Brad, was friendly and mild-mannered, and Mary really liked him. They would chat quite a bit when he came by to evaluate the equipment. Soon after Brad started, I noticed that he was visiting every week. He came by the house much more frequently than business needs justified... mostly mid-day, sometimes early evening. During every visit, Brad would spend time with my wife talking to her about his grandparents and other personal details. He developed such a close a relationship to her that he even called her "grandmother."
One evening, he came by the house pretty late, and Mary was sleeping so he just talked to me. He was acting a little strangely, but when he asked me if he could use the restroom, of course, I said it was fine. In order to get to the bathroom, Brad had to pass by the shelf in my office where Mary kept her pills. Brad was acting so strangely that I listened for him to shut the bathroom door. When I did not hear that sound, I walked into my office and found him holding my wife's pain medication pills in his hand. When he saw me, he dropped the bottle of medication. I did not say anything and he quickly walked into the bathroom, shut the door and spent a long time in there.
When he came out again, I still did not say anything to him about what I saw, because I was not sure how dangerous he might be or what he might try to do.
Brad did not return to our home after this incident. When I told Mary about what happened, she was devastated. She really liked him and felt betrayed by what he had done and scared that he might try to do something. I was completely disgusted by his actions.
I didn't make a report right away because I wasn't sure that anything would happen. I also wasn't sure if there was enough evidence. Later, I saw on the news that Brad had been arrested because he had been videotaped stealing pain medications from another elder. I called the State Police after I saw the report. Once I called, the response turn-around time was quite fast. The State Police immediately referred the case to the Attorney General's Medicaid Fraud Unit. Linda Purdy from the Medicaid Fraud Unit came to our house twice to conduct an investigation.
Many months later, I testified about what I saw Brad do and its impact on my wife. Mary died before the case was resolved. I believe that what happened had a significant impact on her health. She was so upset over what happened that her health went downhill very quickly.
Theft of a patient's drugs ("drug diversion") impacts not only the victims, but the healthcare system in general. Linda Purdy, Director of the Medicaid Fraud Unit, Vermont Attorney General's Office, sees the unit's role as addressing the following issues in the investigation and prosecution of cases:
Once Mary's husband reported the crime to the State Police, swift action was taken. Brad is now serving 16 months in jail as part of a three to ten-year sentence that includes conditions that he not work with vulnerable people or have access to narcotics. He has paid more than $8,000 in restitution to victims, Medicaid, and two hospice programs. In addition, he will make an educational video about his drug abuse.
What happened to Mary is becoming a more and more common occurrence. In Mary's case, the impact of Brad's actions had a devastating impact on her emotional well-being, which may have contributed to a rapid advance of her illness. In another egregious case in Vermont, a nurse stole morphine from a dying man and replaced it with a diuretic. Nursing home staff providing the man's care could not understand why the pain medication was not keeping him comfortable in his last days. According to Linda Purdy, Director of the Medicaid Fraud Unit of the Attorney General's office, "This was not a victimless crime. There were many victims. All of these folks were helpless, very ill people who relied on [this nurse] for their care. She took pain medications from people who needed it the most."
According to Purdy, these cases are complex and require great patience. There are usually no eyewitnesses, although many offenders have been caught on camera. Furthermore, there is not a universal practice among hospital and nursing home facilities for the handling of narcotics. The Licensing and Protection Agencies/Adult Protective Services, Licensing Boards, and local law enforcement are ill-prepared for handling drug diversion cases because there are no referral systems or protocols in place for reporting, investigating, and prosecuting.
Karen is the Training Specialist for the Training Grant described below. As part of the needs assessment process for the Training Grant, she and others interviewed seniors and people with disabilities about their experiences. The names and identifying information of these people have been changed.