BEVERLY — The theft of nearly 18,000 pills, most of them opioids, from Beverly Hospital is the largest incidence of its kind from a Massachusetts hospital reported in the past decade, state officials have confirmed.
But that confirmation came only after The Salem News, a sister paper of The Eagle-Tribune, requested information on the number of drug thefts from hospitals in the state and the amounts taken over the past decade — and discovered that no state agency is keeping track of that information.
And, it turns out that the Beverly case could be among the largest pill thefts in the United States, according to one expert, who adds a caveat: There is also no national system to track drug diversions, even as the country is coping with a drug overdose crisis.
“I think the problem is bigger than most people realize,” said Charlie Cichon, executive director of the National Association of Drug Diversion Investigators.
Lisa Tillman, 50, of Salem, Massachusetts, a former Beverly Hospital pharmacy technician, was charged last fall with larceny of drugs. The arrest came months after hospital officials say they discovered in an audit that Tillman was exploiting a feature of their new, automated medication dispensing machines to mark pills as expired, then remove them from the machines.
Questioned by a state trooper, Tillman acknowledged taking the pills, including OxyContin and Percocets, during what she termed a “rough time” in her life, according to the trooper’s report. But she denied that she was selling any of them, according to a police report, instead insisting that she took some of the pills herself and flushed the rest down the toilet.
Tillman, who has pleaded not guilty, is due in court again on Feb. 27. She could face up to 10 years in prison if convicted.
After The Salem News reported on the case in October, the newspaper filed a public records request in an effort to determine the scope of drug thefts from Massachusetts health care facilities.
Last month, the Department of Public Health provided records that show just two hospital drug diversion cases of more than 10,000 doses during the past decade: the Beverly Hospital incident, and a case involving two nurses at Massachusetts General Hospital found in 2013 to have taken nearly 16,000 pills. (The agency initially forgot to include the MGH incident in its response.) There were a significant number of incidents that fell below the 10,000-dose threshold, officials also confirmed — so many that the newspaper agreed to modify its original request for diversions of more than 100 pills, after officials said they had turned up enough reports to fill two banker’s boxes.
Cichon, a former Baltimore police detective and investigator for the Maryland Medical Board, said that there’s virtually no way to know the full extent of the problem.
One report by a health care compliance analytics firm, Protenus, estimated the total number of pills diverted from all sources at roughly 20 million a year — but acknowledges that the figure is based on news accounts or other publications reporting on incidents, and not on any official database. That’s because no such database exists.
And laws on reporting requirements vary from state to state. In Massachusetts, hospitals, nursing homes and pharmacies are required to report diversions to the Department of Public Health Drug Control Program, as well as to any licensing authorities overseeing a doctor, nurse or other licensed employee, such as a pharmacist or pharmacy technician, said Ann Scales, a spokeswoman for the state DPH.
Federal regulations require pharmacies to report lost medications that are on the list of controlled substances to the Drug Enforcement Administration. The varying reporting requirements mean that in many states, cases often go unreported, potentially masking the size of the problem.
“That’s been an issue in this field with everyone trying to put their arms around how big the diversion issue is,” said Cichon. And even when some states require health care facilities to report diversions by doctors, nurses or pharmacists, they may not have similar requirements for lower-level employees, such as pharmacy techs, said Cichon.
Melvin Patterson, a spokesman for the DEA, said the agency’s Diversion Control Division doesn’t have a tally of the number of missing drugs.
The agency does keep track of the amounts of controlled prescription drugs ordered from distributors by state, and also collects data from states with prescription drug monitoring programs that track the numbers of pills prescribed in the state. Massachusetts has such a prescription management program.
But the DEA does not calculate the difference between the two figures, which would give an idea of how many pills end up diverted, Patterson said. Not all states submit that data, he added. Patterson said the DEA Diversion Control Program has just 450 employees to oversee some 1.8 million entities registered to prescribe or dispense drugs.
‘A huge gap in knowledge’
Cichon said that without media coverage of drug diversion incidents, there’s often no way to know the extent of the issue.
The Tillman case came to the attention of the public only as a result of a reporter being at the courthouse and hearing about it after Tillman’s arraignment.
The DEA also has jurisdiction to investigate diversion cases and was apparently notified of the Beverly Hospital incident. No one from the Boston field office responded to requests for comment on whether there is an ongoing investigation.
Scales provided figures for 2018 that showed a total of 12 criminal investigations involving the DPH last year in Massachusetts. State Rep. Paul Tucker, the Salem Democrat, said he did a double-take when he first read the number of pills allegedly diverted from Beverly Hospital.
“How much is going on that we don’t know about?” asked Tucker, a former Salem police chief and before that, detective. “This really points out a huge gap in knowledge.”
He continued, “This is one issue at one facility.”
Tucker has pushed legislation aimed at combating the opioid crisis.
“I have to wonder how deep and what the magnitude of this problem really is,” he said. “It bothers me that with so much attention on the opiate crisis, we’re being undermined by drugs being diverted into the hands of vulnerable people.”
He said he thinks the issue warrants at least some discussion with the DPH to see if there are ways to tighten accountability, such as requiring periodic audits, in order to determine the full scope of the issue.
“Hopefully the majority of facilities are doing things properly,” said Tucker. But unless the scope of the problem is brought to light, he said, there’s no way to know for sure.
Cichon said it’s virtually impossible to gather data from the DEA, in his experience. And by the time any sanctions — such as the $2.3 million penalty paid by Massachusetts General Hospital in 2015 — are reported, it’s several years later.
“I don’t want to say these cases are rare, because how do we know about them, unless you put a story in the paper and I Google it?” said Cichon. “What isn’t being made public?”