Surgical Tech Swiped Fentanyl at Colorado Hospital

Thousands of patients who underwent surgery at Swedish Medical Center in Englewood, Colo., might be at risk of HIV and hepatitis B and C infections, the hospital has warned, after it caught a surgical tech diverting fentanyl from an OR.

On Jan. 22, 2016, Rocky Allen, 29, removed a fentanyl syringe from the top of an anesthesia workstation and replaced it with another labeled syringe, according to the state division of professions and occupations. A subsequent urine test revealed that Mr. Allen tested positive for fentanyl and marijuana. The state suspended his surgical technologist license when it learned of the incident on Jan. 29.

Swedish Medical says it is working closely with the state department of health to investigate the incident, which may have exposed nearly 3,000 patients to the infections. The hospital is calling and sending letters to the patients who underwent surgery at the facility beginning on Aug. 17, when Mr. Miller started working in the hospital's main and orthopedic ORs. At this point, there is no evidence of patient exposure. The hospital has fired Mr. Allen.

"We deeply regret that one of our former employees may have put patients at risk, and are sorry for any uncertainty or anxiety this may cause," says Richard Hammett, president and CEO of Swedish Medical Center. "Please know our first concern is the health, care, safety and privacy of our patients and we are working diligently to look after the wellbeing of the patients who may have been affected by the wrongful actions of this individual."

Swedish Medical notified police the day after the incident reportedly took place, says Sgt. Brian Cousineau, a spokesman for the Englewood Police Department. He says Mr. Allen has not been arrested, but remains under investigation.

Holly Falcon, CST, FAST, the vice president of the Association of Surgical Technologists, says her organization is working with sponsors on legislation that will increase the monitoring of surgical techs to ensure the health and safety of patients. She says, "The AST supports oversight of surgical technologists, and this incident further demonstrates this is not the time to decrease surgical technologist regulation.

Mr. Allen's alleged actions are reminiscent of similar drug diversions that occurred at nearby Rose Medical Center and Audubon Surgery Center in Denver. Over the course of several months in 2008 and 2009, surgical tech Kristen Parker replaced fentanyl syringes with saline-filled needles. Her thefts ended up infecting upwards of 25 patients with hepatitis C and ultimately landed her in jail, where she's currently serving a 30-year sentence.

Daniel Cook

Physicians More Likely to Battle, Beat Substance Abuse

Physicians are more likely to suffer from substance abuse issues than the general population, but they're also more successful at beating addictions, according to a report from the American College of Surgeons.

In fact, the report notes, addiction treatment programs designed specifically for physicians see 5-year success rates of 80%, while those attended by non-physicians tend to see success rates closer to 20%.

While the report attributes physicians' increased chances of success in treatment to their driven personalities and attitudes toward high-risk stakes — physicians "tend to be particularly conscientious, hard-working individuals with good support systems" — experts also note that their treatment programs are more likely to match them with peers, and put long-term monitoring systems in place.

As a result, the report notes, addiction recovery experts have recommended that treatment programs for the general public borrow these methods to increase their own patients' chances for success.

To learn more about the prevalence of dependence disorders among healthcare professionals, make plans to attend this year's OR Excellence conference in Bonita Springs, Fla., Oct. 12 to 14, 2016, where anesthesiologist Ashish Sinha, MD, PhD, will speak on "Addiction and Abuse: Medicine's Dirty Little Secret."

"Addiction is an occupational hazard for people who routinely handle drugs with high addiction potential; doctors and nurses. Unfortunately in the end, whatever title we carry and uniform we wear, we are all human, same as non-clinicians, and we similarly succumb to the curiosity and temptation of narcotics," says Ashish Sinha, MD, PhD, DABA, MBA, vice chair of anesthesiology and preoperative medicine at Drexel University College of Medicine in Philadelphia, Pa. "Fortunately de-addiction treatments work. There is a high possibility of success in a good treatment program, which includes monitoring, an oral opiate blocker, support from family, friends and colleagues, and self-help groups like Narcotics Anonymous."

Kendal Gapinski

Are Pre-Colonoscopy Consultations a Waste of Money?

Colonoscopy patients are collectively wasting millions of dollars through needless consultations with gastroenterologists before their procedures, researchers report in the February 2 issue of JAMA, since primary care physicians are well equipped to alert patients to the need for screening, to discuss the risks and benefits, and to order the procedures.

Their study, based on a review of more than 800,000 patients' cases, found that 29% consulted gastroenterologists in the 6 weeks leading up to their procedures, at an average cost of $124 each.

Although some of the visits may have been clinically necessary, says Kevin Riggs, MD, MPH, an internist at Johns Hopkins University School of Medicine and a co-author of the study, open access programs, which let providers and sometimes patients schedule screenings, are becoming routine. In many cases, he says, patients might be able to simply show up for the colonoscopy, without taking more time off from work or spending more money on an office visit.

Those visits added an average of $36 to the total costs of colonoscopies, the study finds. "It's nickels and dimes," says Dr. Riggs, "but when you add it up over 7 million colonoscopies annually, it's a pretty significant cost."

Jim Burger

InstaPoll: Should You Remove LMAs Before or After the Patient Wakes?

Anesthesia providers love laryngeal mask airways, but they disagree about the best time to remove the supraglottic airway devices from patients. Should you remove LMAs before or after the patient wakes up? Cast your vote in this week's InstaPoll, and check back here next week for the results.

Time for new fasting guidelines? Thirty-seven percent of the 419 readers we polled last month say it's time to question NPO-after-midnight rules for all patients. The results:

Is it still necessary for surgical patients to not eat or drink after midnight?

  • Yes: 63%
  • No: 37%

Dan O'Connor

News & Notes

  • Can your AER do duodenoscopes? In the wake of the duodenoscope cross-contamination controversy, the FDA has posted, and will continue to update, a list of automated endoscope reprocessors which have completed validation testing for high-level disinfection and/or liquid chemical sterilization of the flexible scopes. The agency requested the data from AER manufacturers as part of its recent investigation into the outbreak.
  • Preferred paths to pain control Post-op pain management begins in pre-op education, and it depends on an individualized care plan that should take opioid-sparing multimodal approaches and non-pharmaceutical options into account, says an evidence-based clinical practice guideline recently published by the American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine and American Pain Society in the journal Pain.
  • When anesthesia was untrusted Some 19th century surgeons eschewed anesthesia because it added more risks to surgery and negated the patient's role in medical decision-making. The fear of being unconscious around men led many female patients to forgo analgesia, as did biblical passages reminding women that pain during childbirth was their lot in life. And Philadelphia surgeons initially saw sedation as profit-seeking and quackery, report researchers from Harvard Medical School and Brigham and Women's Hospital in Boston. They recount the early resistance to ether anesthesia in the decades following its 1846 introduction in a recent issue of the Journal of Anesthesia History.