Transcript:
Terri
Welcome back, everybody. Today’s guest for drug diversion insights is Antoinette Brown. Antoinette is the coordinator for experiential education at the University of Wyoming School of Pharmacy, and I want to hear all about that and what the program entails, so we’re going to talk about that. But Antoinette is also a patient. She was a patient at the time of Kristen Parker when Kristen was diverting and Antoinette was on the list of patients the hospital had to follow up with, and she’s going to share that experience with us today. Welcome, Antoinette.
Antoinette
Hi. It’s nice to be here. Thank you for having me.
Terri
Absolutely. So let’s start with a bit of your history. You are a fellow pharmacist, so tell us where you’ve practiced in your career. How did you end up at the university, and what is experiential education?
Antoinette
All right, well, it’s kind of been a full-circle lifetime cycle in my career. I actually graduated from the University of Wyoming School of Pharmacy with a bachelor of science degree in pharmacy back in 1992. And right after graduation, I worked for about ten years as a retail pharmacist, and during that time, I also owned my own pharmacy. And then from there, I moved on to the Wyoming Department of Health, where I became the Medicaid pharmacy program manager. And then I had the wonderful opportunity to get to come back to the University of Wyoming School of Pharmacy and take my current position, which is a Coordinator of experiential education and I have been in that role for the past ten years. And with that, I get to do what I love probably the most, is working with students and future pharmacists. I help them prepare for the fourth and final year of their financial education practice, prepare them for that, and then I kind of shepherd them through that final year of pharmacy school. They come back to campus three times a year, and so we have capstone participations. The students do. We have great guest speakers such as yourself that come in and educate them about things that they may not have learned in their didact class education. So it’s really just kind of fun to see them grow and develop these competent, smart professionals. And so I love my job, and it brought me to you, so that’s even better.
Terri
That’s great. Well, one, it’s great to hear that you love your job. Some people aren’t happy right, with what they do, but I’m really glad to hear that you love your job. And, yes, you bring in speakers. And so I did go and speak with them on diversion. That’s a topic that I don’t think is really covered much in most universities. And so given that opportunity to kind of share and to educate them a little bit about diversion being a thing and what it looks like and that the pharmacy really has a role in watching for that. So every pharmacist needs to be aware of it. So that’s all part of it. So thank you for having given me that opportunity. Okay, so let’s jump into your experience as a possible diversion victim. Now, for those of you that are not familiar with Kristen Parker, let me give you a little bit of background.
Kristen was a surgical tech who worked in Colorado back in 2008. She was first when she was hired, her pre-employment screening indicated that she might have hepatitis C and she was made aware of that, but she didn’t do any follow-up. So I think those of you that haven’t heard of her can kind of guess where this is going. She had a substance use disorder and she went on to infect at least 18 patients with hepatitis C because her method of diversion was substitution and leaving dirty needles on syringes. According to the facts of the case, several patients also woke up in pain because they had not received their fentanyl. She would swap out the fentanyl syringes for water or saline syringes that she found lying around in the procedural rooms. And hospitals don’t typically give their surgical text access to the automated dispensing machine.
So she didn’t have the access, but she still found a way to get her hands on multiple syringes that were left unattended. This is why it is so important in the procedural rooms that everyone takes real ownership for the meds that they have dispensed and are administering so that others do not gain access. I have been in a room observing actually from outside the room, when a medical device representative was in the back of the room, right by the meds that were on the table. And nobody had eyes on him or the meds. Well, in that case, I did for that particular case, but normally nobody would have had eyes on him because everybody was facing the bedside. So you really need to be mindful of what is going on in your procedural rooms. Kristen ended up being sentenced to 30 years. That is typically a longer sentence than what you would expect.
The judge that sentenced her said that her actions were incomprehensible and unconscionable. Ms. Parker didn’t just quit, she got caught. Addiction explains, but never excuses. Yes, Kristen Parker owns much of the blame, but several victims also blame the hospital. They stated that the hospital was negligent and that those meds should never have been accessible to her. I don’t believe the hospital suffered any legal consequences for the case. And I also believe that had this case happened today, they probably would have because we have seen more and more hospitals being held responsible for diversion and harm to patients or employees. So this is a really good reminder that all facilities need to take ownership for their controlled substance security throughout the whole continuum of care. Now, Antoinette, you were a surgical patient at that hospital at the time, and you got the call. So share with us what that was like.
Terri
How did the hospital reach out to you? How did they rule out an infection? And what were all of the emotions that you went through that journey?
Antoinette
Sure, yes. I was at the hospital in December of 2008 for some breast cancer surgery and the beginning of reconstruction. And so I was already kind of at a heightened level of just nervousness anxiety, as anyone would be if they’re suffering an illness. But everything went great. My surgery went great, and I actually had a very good experience. And then it was, you know, that was in December and the beginning of the summer. So in 2009, I received a letter from Rose medical center saying that there had been a potential exposure to the hepatitis c virus and that I would need to be tested and that they would pay for the testing, and that I had to find one of the approved labs in the area. I had to make an appointment, go down and get testing. They would cover the cost, and then they would let me know the results.
And so being in Cheyenne, Wyoming, I had to travel down into Colorado again to do the testing. And just during that whole time, I guess, being a healthcare professional, I knew what hepatitis C was. I knew the consequences of having that infection. And at the time, we didn’t have the medications we do now to treat the disease. So, of course, a lot of nervousness and anxiety around that and kind of like, oh, I gotten through one hurdle, and this is a completely unexpected hurdle in my breast cancer journey. But I did go down. I received the testing, and fortunately, I was not one of those who was expected. But the one thing that Rose did do was provide links and resources so that patients could follow the case. And I will have to say, I watched it quite closely from two perspectives. One is just feeling very compassionate towards those patients who were infected, and then also just because of my pharmaceutical background and I have a very strong interest in substance use and opioid use disorder, just kind of watching the case from the patient’s perspective of what happened and how did it get to this level. It was an emotional roller coaster during that time.
Terri
Yeah. And you said something I didn’t really think about is that we didn’t have the medications then that we have now, so that could have made a world of difference to some of the victims that did come out positive. But I hadn’t really thought about that from a time perspective as to when things came out. So that makes it even scarier. And the hospital sent out a letter, which I guess you can’t necessarily expect a phone call, which I think would have been a better process, but depending on how many people they need to notify that’s not really the letter that you want to get in the mail, right? So that’s a shout out to every hospital. They need to know how to get a hold of patients and what their process is going to be should they have an incident. You also said that you took a particular interest in substance use disorder.
And you had shared with me previously that in your career you had seen, I think, one or maybe two people that did have an Sud that either you realized at the time or maybe didn’t realize at the time. But looking back, you did. Is there anything that you can share on that with us?
Antoinette
I did work with a couple of pharmacists who really probably at the time I suspected but didn’t know for sure that they did have a substance use disorder. And I guess in hindsight, probably a little bit of denial, just thinking that surely somebody with the understanding of medications that a pharmacist would not use substances inappropriately. But I’ve long since learned that substance use disorder, it’s a disease much like diabetes or any other diseases that we treat. And then also just working in community pharmacy, which I did for many years, you do see a lot of patients come through with a substance use disorder and kind of, I guess maybe the initial response those patients is frustration, exacerbation. But over the years, I also came to know a lot of those patients just as people and realized that this is a disorder and we need to try to be as compassionate and caring and helpful to these patients as possible.
And so really, it was kind of multiple paths that led me to the desire to learn more about substance use disorder. And then, of course, with the opioid use disorder, that whole crisis with opioids part of that time when that was happening, I was a community pharmacist. And the other part of the time I was more on the payer end of prescriptions. And so it really opened my eyes to how complicated these disorders are and how costly they are and impactful they are to not only the person who suffers from this disorder, but from the people around them. And having this particular situation with being a patient at Rose and essentially having this exposure to hepatitis C because of.
Terri
A person who had a substance use disorder.
Antoinette
It just came for me from so many different angles that I just kind of just couldn’t avoid not being interested in it and wanting to help educate.
Terri
People about substance use disorder and opioid use disorder and kind of help be. Part of the cure and the solution to the problem.
Terri
Yeah, you settle that very well. I cannot imagine I’ve spent a little bit of time in community pharmacy, but most of my career has been in hospital. And I will say early on when I was in community, I did not encounter anybody that had a substance use disorder coming into my pharmacy. I guess I can be thankful for that. Didn’t experience it at all. A little bit of experience later on. In fact, I even went so far as to call the physician’s office. Is this patient yours? Is this what you I was working for DM for that retail pharmacy and I didn’t do very many shifts after that. But I guess I took it too seriously for them, maybe, but I can imagine that is very draining working in a community hospital, especially if you’re trying to stay compassionate, but yet you know exactly what’s going on and you feel for them.
But then there’s the payer issue and there’s just so many things involved. So I think you summarized it all very well and also the fact that as you’re looking at these pharmacists that there’s something going on. You know, it and as you said, hindsight, you were probably ignoring some things. But I do think the first thing that comes into mind is surely not as a healthcare professional, you know what these medications do and don’t you know to get help, right? You should recognize it and then go get help quickly. And that’s where the disease comes in. They just are not thinking straight anymore, like you or I would be thinking as pharmacists and healthcare professionals. And that is what we need to remember as we see people through our journey, that they are not thinking straight. So to think, surely not, that doesn’t make sense for them and we need to assist that and get them help.
During Kristen’s trial, I don’t know how much they had. Was it live? Was the whole thing live that day? Or was it more news clippings that you were looking at?
Antoinette
So I mostly got updates. I did never watch the trial, but I would receive regular updates on how. It progressed through the legal system, the progress.
Terri
Well, during the trial, Kristen had said, I know everyone is waiting for me to answer the million dollar question why? I won’t sugarcoat it, I was a drug addict. So she recognized that and that’s what the whole problem was. Kristen’s parents asked that the victims not hate their daughter and stated that had they known about her addiction, they would have spent the money to get her help. They would have spent the money getting her help rather than for the lawyers fees. Well, this is a lesson learned. Everybody out there, review your processes. Make sure all your areas are at all times secure and staff understand what controlled substance security looks like. And if someone is suspected of having a substance use disorder, don’t enable them. It does not serve anyone well to ignore a possible problem. Our expert, Diversion Solutions offers many services that can assist.
Terri
And if you’d like a consultation, just reach out and we’re happy to talk to you and see how we can partner with you. Thank you, Antoinette, for your time today. Is there anything else that you would like to share before we end our time?
Antoinette
No, just thank you for giving me this opportunity to talk a little bit more about substance use, opioid use disorders, and bring more awareness to people about the impact it can have.
Terri
Absolutely. Well, thank you for taking an interest, and thank you for what you do with your future pharmacists your students that you are exposing to all of these different things. That’s a great thing that you’re doing and mentoring them.
Antoinette
Thank you.