Drug Tampering Cases Show Gaps in Nurse Regulation in Kansas

A nurse with a prior felony conviction for forging prescriptions dilutes morphine solutions for five Halstead, Kan., nursing home patients. Another nurse convicted of stealing drugs from patients at an Emporia home gets another job in Topeka, where she adds tap water to a painkiller prescribed for a 105-year-old patient.

Still another nurse fired from her last job at a Wichita hospital over drug discrepancies gets a new job in Salina, where she’s later accused of taking home syringes full of morphine and replacing the medicine with a dangerous sodium chloride solution.

All three women were prosecuted this past year in unrelated federal cases that patient advocates and nursing home administrators say highlight regulatory gaps in the oversight of nurses, particularly for those working in the long-term care facilities that serve some 90,000 Kansans.

Kansas law does not require nursing homes to do their own criminal background checks for licensed medical personnel such as nurses, even though it requires them on other workers like janitors. But the state board which licenses some 56,000 nurses in Kansas was given legislative authority to do the background checks and fingerprinting just three years ago and then only on new licenses — leaving health care facilities and patients alike in the dark about the possible criminal backgrounds and drug addiction problems of nurses.

Most states now do criminal background checks at least before issuing new licenses to registered nurses. But just three states — Arizona, Florida and Rhode Island — have an “absolute bar” on licensure for registered nurses who have felony convictions, according to data compiled by the National Council of State Boards of Nursing. Ten states, including Kansas, have an absolute prohibition on issuing nursing licenses for applicants with a conviction for personal felonies such as murder, manslaughter or aggravated kidnapping, but allow licensing otherwise on a case-by-case basis.

Nationwide, 37 states make it mandatory to report to their nursing regulatory board any violations of the Kansas Nurse Practice Act. Kansas is among those states requiring hospitals to report nursing violations, but the state doesn’t require long-term care facilities to report violations _ potentially making it easier for nurses fired for stealing drugs from patients at one nursing home to get a job at another.

The Kansas Board of Nursing says it receives between 1,500 and 1,700 complaints annually on Kansas nurses, with roughly 80 percent of them related to drug or alcohol abuse, said KBN administrator Mary Blubaugh. Fewer than 120 of those are referred for further administrative discipline amid a regulatory climate across the nation that prefers education and addiction treatment to suspension or revocation of nursing licenses.

“Our board will place them first in our impaired provider program to try to give them the opportunity to get sober, go through rehab to stay a productive member of the work force,” said the board’s practice specialist Diane Glynn. Those nurses must go to counseling and are monitored for drug use for three years.

But critics say the federal drug tampering cases document serious gaps in state regulatory enforcement that puts nursing home patients at risk. Those three nurses came to the attention of law enforcement after Midwest Health Management Inc., which manages 10 Kansas nursing homes, reported them to authorities.

“We have taken a pretty hardcore stance when it comes to nurses abusing medication and we have been very proactive in trying to actually get folks in trouble, if you will,” said Brett Klausman, vice president of operations at Midwest Health. “We have been reporting to authorities at every step in the way because we don’t think these people should be allowed to continue providing care.”

Wendy Parmenter, 37, was caught stealing Hydrocodone in April 2010 from her patients at Flint Hills Care Center, a nursing home in Emporia. Two months later she got a job at a Topeka nursing home, the Rolling Hills Health Center.

Her new employer didn’t know about the case in Emporia, “a prime example of a situation where we had zero knowledge, nobody shared that information with us,” Klausman said.

Court documents showed that during Parmenter’s employment at the Topeka home, the charge nurse found two empty bottles of morphine. Employees with access to the narcotics had an oral drug test, which Parmenter failed. She passed two subsequent urine tests after convincing another employee to provide urine which she submitted as her own, according to her federal plea agreement. She also admitted that in November 2010 she added tap water to a bottle of morphine on the rolling cart used to dispense medication to a 105-year-old patient.

But just this past March, the Rolling Hills Health Center was informed by the nursing board that Parmenter had enrolled in the Kansas Nurses Assistance Program, an addiction rehab program for nurses, and the board would take no action on her license.

In November, Parmenter pled guilty to federal charges of consumer product tampering and adulteration of a drug and will be sentenced in February. Her plea agreement recommends three years in prison and would keep her from working again in health care. But the nursing board still shows she has an active nursing license with no mention of her criminal history.

“She can go out and get a job at any nursing home in the state right now,” Klausman said.

Her attorney declined comment.

Glynn, the board’s practice specialist, said health care facilities are not notified when a complaint is first filed against one of their employees because of the nurse’s presumption of innocence. Nurses who enter rehab rather than face disciplinary action must notify their employers and sign waivers allowing the program administrator to share information with employers. Participation for nurses who enter drug treatment on their own is confidential, and not even the Board of Nursing is told about them.

Deborah Riggs is no longer nursing because she’s serving a four-year prison term. She was sentenced in August for tampering with a consumer product and adulteration of drugs after removing morphine sulfate solutions prescribed for five patients and replacing it with an unspecified substance at a Halstead nursing home.

The 56-year-old nurse, with a long history of opiate addiction, was first convicted in 1997 on federal felony charges for forging prescriptions and was sentenced to probation and home detention. The Kansas Board of Nursing suspended her license in 2000 for forging prescriptions, but immediately stayed its own order and let her continue practicing nursing. Eight years later, the board again suspended her license for stealing narcotics while working in a Wichita hospital, but the board again immediately stayed its own order.

The risks to patients are laid out in the federal indictment against Melanie Morrison, a 25-year-old nurse who while working at the Holiday Resort Nursing Facility in Salina allegedly used syringes to remove morphine from vials, hiding the thefts by replacing the morphine with sodium chloride, which can harm some patients, particularly those with congestive heart failure.

Morrison recently pleaded guilty to tampering and drug adulteration charges in a plea deal that could send her to prison for three years. The deal also requires that she give up her nursing license. Her attorney did not return a message left for comment.

Mitzi McFatrick, executive director of Kansas Advocates for Better Care, said some nurses are afraid of voluntarily participating in the addiction rehab program for fear of losing their licenses.

“But it ought not trump the people who are on the receiving end of their health care,” she said.