WA report looks at how to keep hospital staff out of the medicine cupboard

The Western Australian Corruption and Crime Commission has published a treatise on the subject of how to make it harder to steal drugs from hospitals.

After investigating the theft of “an extraordinary amount” of strong opioids from two big public hospitals, the CCC found “disturbing gaps” in the management and control of Schedule 8 narcotics — the strong and addictive stuff — at Sir Charles Gairdner Hospital and Fiona Stanley Hospital.

The pilfering, which occurred over two years, was made possible by “inadequacies in checks, balances, reconciliation processes, and basic audit procedures” that allowed drug supply systems to be circumvented.

After-hours access to secure drug storage safes, failures to reconcile drugs supplied by the pharmacy with those received by clinicians, forms not being filled out properly and inadequate registry management are some of the issues highlighted in the report.

The thefts are part of the sad tale of a promising young pharmacist — top of his university course in 2008 — who became addicted to the powerful opoid hydromorphone following a family tragedy. “There was limited intervention by WA Health to see how the tragedy affected him,” according to the report, and then the unfortunate pharmacist moved from Sir Charles Gairdner Hospital into a new position as a senior pharmacist at Fiona Stanley Hospital:

“But he had a dark secret. Mr Foster came to FSH highly addicted to a potent opioid drug that pharmacists liken to heroin — hydromorphone. He stole and used hydromorphone while at FSH.”

The addiction got so bad he was taking doses that would probably kill most people without a tolerance for the drug, the commission heard. In total he was convicted for the theft of 17.78 grams of hydromorphone and 11.96 grams of oxycodone, another powerful opioid, and incredibly this only accounts for 46 of 130 separate thefts.

But, the CCC said in a statement, the main concern is not so much what the pharmacist did wrong, but the systems that made it possible:

“Importantly, the Commission revealed that the systems and controls in place to manage Schedule 8 drugs at Sir Charles Gairdner Hospital were “inadequate and easy to circumvent without detection”.

“The Commission also discovered that Fiona Stanley Hospital had not identified “obvious warning signs”, meaning serious misconduct was only exposed when a colleague raised suspicions with hospital authorities.”

The commission accepts that “work is underway” on new arrangements for Schedule 8 drugs and guidance for staff at both hospitals. But it notes “a key policy reform approved by hospital management in September 2016 has still not been implemented and mandated quarterly audits are yet to be conducted” and believes serious risks of corruption and misconduct will still exist in WA hospitals until this work is done.

The CCC has made 10 new recommendations to WA Health, but also points out it is taking an inordinately long among of time for hospitals to implement a long list of other recommendations from several other inquiries.

These include two linked coronial inquests into the deaths of two nurses who self-injected similar drugs in 2013, a 2012 auditor-general’s report on purchase and management of pharmaceuticals in public hospitals, and the CCC’s own 2010 report into misconduct handling procedures in WA Health.