Diversion of drugs within health care facilities, a multiple-victim crime: patterns of diversion, scope, consequences, detection, and prevention

Mayo Clinic has been involved in an ongoing effort to prevent the diversion of controlled substances from the workplace and to rapidly identify and respond when such diversion is detected. These efforts have found that diversion of controlled substances is not uncommon and can result in substantial risk not only to the individual who is diverting the drugs but also to patients, co-workers, and employers. We believe that all health care facilities should have systems in place to deter controlled substance diversion and to promptly identify diversion and intervene when it is occurring. Such systems are multifaceted and require close cooperation between multiple stakeholders including, but not limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel, and human resources. Ideally, there should be a broad-based appreciation of the dangers that diversion creates not only for patients but also for all employees of health care facilities, because diversion can occur at any point along a long supply chain. All health care workers must be vigilant for signs of possible diversion and must be aware of how to engage a preexisting group with expertise in investigating possible diversions. In addition, clear policies and procedures should be in place for dealing with such investigations and for managing the many possible outcomes of a confirmed diversion. This article provides an overview of the multiple types of risk that result from drug diversion from health care facilities. Further, we describe a system developed at Mayo Clinic for evaluating episodes of potential drug diversion and for taking action once diversion is confirmed.

Fighting the scourge of metal theft

Last December one acute hospital in south Wales, the University Hospital Llandough near Cardiff, was forced to cancel eight operations, with 81 patients affected in total, after thieves stole copper cabling from a back-up generator. HEJ editor, Jonathan Baillie, reports on the growing theft of cabling, pipework, and other vital supply infrastructure, from the healthcare estate, and asks senior estates personnel what lessons have been learned that might be useful in combating this lucrative, opportunistic, and also potentially highly dangerous, practice, in the future.

Public health and the law

Promoting and protecting the public's health in the United States and abroad are intricately tied to laws and policies. Laws provide support for public health measures, authorize specific actions among public and private actors, and empower public health officials. Laws can also inhibit or restrict efforts designed to improve communal health through protections for individual rights or structural principles of government. Advancing the health of populations through law is complex and subject to constant tradeoffs. This column seeks to explore the role of law in the interests of public health through scholarly and applied assessments across a spectrum of key issues. The first of these assessments focuses on a critical topic in emergency legal preparedness.

Combating employee theft in the healthcare industry

The healthcare industry is especially susceptible to internal fraud and employee theft, the author's research has found. He presents details of 14 costly healthcare embezzlements that took place in three months and gives insight into schemes employed on the most common types of embezzlement. He also describes proactive steps which can be taken to prevent, detect and respond to this phenomenon as well as providing a primer on conducting an internal theft investigation.

Identity theft and your practice

Medical identity theft is a growing problem in America. The federal government has passed laws to help "prevent" identity theft. However, several powerful medical associations are fighting the legislation. Americans need to know what is happening with these laws and why these laws are important to protect providers from lawsuits and consumers of healthcare from medical identity theft.

Growing trend of identity theft poses safety and billing loss threats

Identity theft is more than just a legal issue. Patients with improper identification are at risk for receiving potentially harmful treatment. Have registration department require photo identification from all patients. Ask additional questions, such as the patient's date of birth. Ask staff members to be the "eyes and ears" of registration and security, and ask them to report anything suspicious.