Veterinary practices are often targets for theft, loss, or diversion of controlled substances. A 2015 article on drugabuse.com titled, “Ill Inventory: Drug Theft and Loss in the United States,” showed “22.1 percent of drug theft is due to employee pilferage, 6.2 percent armed robbery, 2.2 percent customer theft.” (If you’re wondering, 8.5 percent comprises night break-ins, while 60.9 percent of drugs are lost in transit due to subscriber or patient errors.) These statistics make it clear that complying with controlled substance regulations is essential to reducing your risk.
As a former practice owner and hospital administrator, I realize it’s often difficult to find the time or resources to meet all the required regulations. You’ve got to manage your practice, see patients, perform surgery, and deal with HR issues all day long. That doesn’t leave much time for reading up on state and federal regulations, let alone making sure they’re followed. However, the penalties for controlled substance noncompliance in today’s environment leave us little choice.
The problem is real
The Centers for Disease Control and Prevention (CDC) states, “Drug overdose deaths continue to increase in the U.S. From 1999 to 2017, more than 700,000 people have died from a drug overdose. Around 68 percent of the more than 70,200 drug overdose deaths in 2017 were opioid-related. In 2017, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was six times higher than in 1999. On average, 130 Americans die every day from an opioid overdose.” An article published in the September 2015 issue of the Journal of the American Veterinary Medical Association (JAVMA) found that “72 percent of respondents said they had worked with someone in the veterinary workplace they suspected of having a drug problem. More than 40 percent said they knew two or more people who fit that description. A full 68 percent said drug abuse and addiction are at least as big a problem in the veterinary profession as in the general population, if not bigger.”
Unfortunately, just being aware of the problem won’t help you when you’ve suffered an actual theft or substantial loss. You must be prepared to take action, as there are various timelines you need to meet to remain compliant with state and federal regulations. The following is an actionable checklist to help you minimize your risk and protect your practice now and in the future.
How do I know if it’s a theft or a significant loss?
A break-in or robbery is easier to recognize, but determining if you have experienced a significant loss can be more difficult to identify. The Drug Enforcement Administration (DEA) provides some critical variables to consider when determining if you have experienced a significant loss. The regulations can be found here and in 21 C.F.R. § 1301.74(c).
(1) The actual quantity of controlled substances lost in relation to the type of business;
(2) The specific controlled substances lost;
(3) Whether the loss of the controlled substances can be associated with access to those controlled substances by specific individuals, or whether the loss can be attributed to unique activities that may take place involving the controlled substances;
(4) A pattern of losses over a specific time period, whether the losses appear to be random, and the results of efforts taken to resolve the losses; and, if known,
(5) Whether the specific controlled substances are likely candidates for diversion;
(6) Local trends and other indicators of the diversion potential of the missing controlled substance.
The “DEA recognizes there is no single objective standard that can be applied to all registrants—what constitutes a significant loss for one registrant may be construed as comparatively insignificant for another.” Further, it strongly encourages registrants to use factors beyond what it suggests to determine if your loss is significant.
The agency goes on to say, “The registrant shall design and operate a system to disclose to the registrant suspicious orders of controlled substances. The registrant shall inform the field division office of the administration in his area of suspicious orders when discovered by the registrant. Suspicious orders include orders of unusual size, orders deviating substantially from a normal pattern, and orders of unusual frequency.”
What does that all mean? To stay compliant, best practice would strongly suggest keeping a very tight ordering and receiving system; current, complete, and accurate closed and open logs; daily reconciliation counts; a discrepancy log; and an administration waste log. In order to save valuable time, increase security to reduce risk and consider using an electronic recordkeeping system to help prevent theft and determine if the drug loss was significant.
Don’t keep it to yourself
If you’ve suffered a theft or significant loss of controlled substances, there are very clear and precise actions you must take to remain compliant. The following steps should help you do so:
1) Call the police immediately to report the theft or loss. Be sure to have as much detailed information as you can for the police officer and the DEA. This includes date, time, location, suspect ID, substances and amounts lost, witnesses, etc.
2) You have one business day to contact your local DEA local field division office to report your theft or loss.
3) The registrant also must complete and submit DEA Form 106 to the local field division office regarding the theft or loss. Thefts and significant losses must be reported whether or not the controlled substances are subsequently recovered or the responsible parties are identified and action is taken against them. The form can be found online at bit.ly/2LQ2PUC.
4) Some states require you notify your veterinary board of the theft or significant loss. Check to see if your state is one of them.
5) Call your business insurance and/or your professional liability insurance agents to report your loss.
6) Keep a copy of the police report, your DEA Form 106, and any other supporting documents filed. You may need them later.
7) Educate your staff about the theft or loss, as failure to do so may cause unnecessary fear and gossip throughout your hospital. Ask all staff members if they have any details about the incident, but do not mention specifics you may know, as you do not want to compromise the integrity of the ongoing investigation.
8) Be sure to let your staff know you will be pressing charges to the furthest extent of the law when the culprit has been identified. It is critical to make this clear, as it lets your staff know you will not tolerate an internal or external theft or significant loss of any kind.
9) If you suspect your employee has stolen or caused a significant loss of your controlled substances, immediately contact your lawyer, HR consultant, and/or your employee assistance program (EAP) professional.
10) If you catch an employee in the act of stealing, causing a significant loss, or diverting your controlled substances, call the police immediately and fire that employee as the police officer escorts him or her out the door. Don’t forget to document the entire event in complete detail and place that information in the employee’s file for future use. Additionally, if an employee is fired for egregious and provable reasons, most unemployment offices will not allow them to receive any benefits.
Quick prevention tips
As the saying goes, “An ounce of prevention is worth a pound of cure.” Get your staff involved by forming a safety committee. Have them help you develop and execute a quick and easy safety plan to ensure everyone is secure, especially during a violent or armed robbery. They need to know how to act, and what to do in case an intruder/active shooter enters the building while they are working. An active and well-rehearsed plan with identified safe rooms and a fast escape route will make everybody feel much more at ease.
Most local police departments have education officers that will gladly walk through your building with you to help you understand where your potential areas of risk may be. This is usually done at no charge. Have that same police officer speak with your team at your next staff meeting. He/she can describe in detail what they can do to protect themselves if an intruder/active shooter enters your building in the future. From previous experience, I can tell you this service was one of the most well-received staff meetings I’ve ever held.
And don’t forget to perform background checks on all current and future employees. This may be a preemptive strike against a possible future theft or loss event.
These prevention tips can give you and your staff a feeling of well-deserved security in the event of an unfortunate incident in the future.
Jan Woods is the professional services and regulatory affairs manager for Cubex, LLC. For further help, information, or to see her speak in person at a veterinary conference near you, contact her at firstname.lastname@example.org or visit the Cubex website at www.cubex/askjan.com.