CRNA Captivates OR Excellence Attendees With His Story of Drug Diversion and Addiction

HELPING HAND Rodrigo Garcia, APN, MSN, CRNA, MBA, now runs a center for professionals struggling with substance abuse.

Rodrigo Garcia, APN, MSN, CRNA, MBA, knew he was addicted to the drugs he had such easy access to in the OR. But no one who worked with him suspected he was under the influence, at least not initially. Mr. Garcia was an all-star anesthesia provider, a leader within his hospital and a respected colleague. He was also a master manipulator who worked the system, doctored urine tests and managed to hide his addiction for more than a year.

Today, Mr. Garcia has beaten his demons. He's a chief anesthetist at Great Lakes Anesthesia and the director and co-founder of Parkdale Center for Professionals, a specialized treatment program that focuses on helping those who are struggling with substance use disorder. Last week at OR Excellence, he spoke about the problem of addiction among healthcare workers and what surgical leaders can do to recognize signs of abuse and drug diversion within their facilities.

Mr. Garcia grew up in a loving and supportive household. He excelled academically and played baseball in college. The darkest period of his life began innocently enough. He broke his ankle during an adult league baseball game and was given a prescription for Vicodin to help control the pain of the injury. His addiction was spurred when he started popping a pill whenever he felt a body ache. Then he started branching off into other drugs, like fentanyl. Eventually, he needed a fix just to get through the day. But he refused to seek help and admit his problem, which he realized would ruin his career. "We all know what the societal implications of addiction are," says Mr. Garcia. "The last thing I wanted to say was, 'I'm addicted.'"

Addicts don't always appear disheveled and sloppy, according to Mr. Garcia. Instead, they're often well-liked and respected workers, the top performers and the most intelligent. In fact, on the day Mr. Garcia finally got caught, he was honored as the hospital's employee of the month. Hours later, he was being escorted out of the facility in handcuffs and would soon be charged with 1,500 felony counts of drug diversion.

"I can't tell you how many people went to my defense because I was well liked," says Mr. Garcia. "This is what happens in a work environment. I had a group of people going to bat for me." That, he explains, is what enabled him to continue his addiction: The more he could get people to like him, the less they would suspect he had a problem. And that's where the real danger starts.

Mr. Garcia says a key to detecting diversion is knowing that addiction can impact anyone — your best nurse, your best anesthesiologist or your top surgeon could become hooked on drugs. Also realize that addicted healthcare professionals are often easily able to hide their problems. "Addicts know drug testing policies better than facility leaders do," he says. "They know how to stay one step ahead."

Brielle Gregory

Anesthesia Shortage Forcing Hospital to Cancel Surgeries

STAGGERING DELAYS Facing an average of 380 operations/month, Denver's VA hospital has made up to 90 recent surgical delays and is spending funds on borrowed physicians to address the issue.

Due to a shortage of anesthesia providers on staff, Denver's veterans hospital has had to postpone or cancel between 65 and 90 recent non-urgent surgeries. Though unable to quote exact figures, VA spokeswoman Kristen Schabert reasons that staff members, including both docs and nurse anesthetists, have left for better offers in an already competitive area, and now the hospital is looking to hire 3 additional MDs and 3 CRNAs to fill the void.

Currently, Denver VA hospital employs 8 of each role to manage a caseload of roughly 380 operations per month. With the green light to make the additional necessary hires, Ms. Schabert reports offers of "up to $400,000 for new anesthesiologists" and "$173,000 for CRNAs." She adds that the VA is also prepared to offer "student-loan repayment programs" and "signing bonuses" to new hires, though she was not able to report income averages for current members of staff. Still, though, Denver's private facilities are making themselves more appealing to local anesthetists, and the VA is finding it difficult to keep up and also meet its own demands, especially with a growing veteran population in the area.

A temporary fix has taken shape in a locum in which the VA Eastern Colorado Health Care System is able to contract outside physicians on a temporary, as-needed basis. Until new hires are made, says Ms. Schabert, this solution is how they're plugging gaps in patient care, and they have been steadily addressing the issues of delayed appointments and staggering waiting times that have plagued them in the past. Yet the fix is undoubtedly costing them much-needed funding as time presses on without permanent staff, and after the debacle over the delayed construction of a $1.7 billion new facility in recent years, the VA can't afford more fiscal blows.

Joe Madsen

Ibuprofen Controls Pain as Well as Morphine for Pediatric Post-op Recovery

HAPPIER CAMPERS Children given ibuprofen experienced less nausea, dizziness, vomiting and constipation.

Ibuprofen controlled pain as well as morphine and was associated with significantly fewer adverse effects in a recent study of children who'd had minor outpatient orthopedic surgery.

The study, which was published in the Canadian Medical Association Journal, tracked pain scores among 154 children between ages 5 and 17. Half were given ibuprofen, and half morphine. All were permitted to take one dose every 6 hours, up to 8 doses over 48 hours.

The groups had no significant differences in pain scores, but the morphine group reported significantly more incidents of drowsiness, nausea, dizziness, vomiting and constipation.

Though prescribing morphine after minor pediatric surgery has become increasingly popular, say the authors, the results suggest that ibuprofen is a better first-line option after minor surgery. Ibuprofen is less expensive, they point out, requires no prescription and has less severe consequences if accidentally ingested or overdosed.

Jim Burger

InstaPoll: How Concerned Are You About a Cyberattack at Your Facility?

Ransomware. One word that can make a surgical facility leader shudder. It's never been more important to protect your sensitive electronic records from online criminals. Tell us how concerned you are about a cyberattack at your facility in this week's InstaPoll.

More than half (58%) of the 479 respondents to last week's InstaPoll automatically deduct 30 minutes from employees' daily time records for meal breaks. The results:

Do you automatically deduct 30 minutes for employees' meal breaks?

  • yes 58%
  • no 42%

Dan O'Connor

News & Notes

  • Bariatric surgery reduces cancer risk Among severely obese patients, those who had bariatric surgery were 33% less likely to develop cancer in the 3.5 years following the surgery, a new study finds. The difference was even greater with obesity-associated cancers, such as postmenopausal breast cancer, endometrial cancer, and colon cancer, each of which indicated a reduced risk of 40% or more.
  • Nighttime neurosurgery means more complications The risk of complications during neurosurgical procedures rises 50 percent when those procedures are scheduled to begin between 9 p.m. and 7 a.m., a study from Neurosurgery found. The study analyzed more than 15,000 neurosurgery patients over seven years to come up with the result. It was noted that the complications were not more severe after hours — they were merely more common.
  • Diversity of nursing workforce The nursing workforce is more diverse and educated than ever before. A new study out of New York University has found that more people of color and more males are entering nursing than they did a decade ago. For perspective: White nurses now only make up 73.8 percent of all nurses (as opposed to 78.9 percent in 2008), and males now make up 13.8 percent of the workforce (as opposed to 8.8 percent in 2005). Nurses today are also 12 percent more likely to have a bachelor's degree than they were 10 years ago.