When employees at Rapid City Regional Hospital need to administer narcotic medications to patients, they obtain the drugs from a high-tech mobile pharmacy that requires a scan of their fingerprint.

It's just one part of a system designed to prevent the kind of drug theft that recently occurred in Colorado.

"We look at anyone who touches our narcotics," said Dana Darger, director of the pharmacy at Rapid City Regional Hospital.

Earlier this month, two hospitals in Colorado acknowledged that a surgical technician exposed as many at 5,700 patients to hepatitis C after she stole syringes containing the painkiller fentanyl and replaced them with her used syringes. She is infected with hepatitis C.

The Denver Post reported the employee may have also exposed patients in facilities in both New York and Texas.

Although there are federal guidelines for preventing theft of controlled substances in health care facilities, the rules are just a foundation, said Ron Huether, executive secretary of the South Dakota Board of Pharmacy.

Hospitals, nursing homes and pharmacies are allowed to develop their own protocol, based on those guidelines, to prevent the theft of narcotics by employees.

"There's not an automatic procedure or formula … there are many kinds of facilities," Huether said.

In the Colorado case, it's believed the surgery tech stole pain medications that were left unattended in operating rooms.

Unattended medications are something patients shouldn't ever find at Regional Hospital, because protocol restricts it, Darger said. "We work really hard … to make sure that they don't do that kind of stuff."

Darger said Regional's medical personnel are taught to keep narcotics with them or locked in a secure drawer until they are administered. If a portion of the drug remains after treatment of the patient, medication must be disposed of in front of a witness.

As director of the hospital's pharmacy, Darger said he takes responsibility for all narcotics in the facility.

"If it's a drug, it's my responsibility no matter where it is in the hospital," he said. "My opinion is it's my responsibility all the way until the patient gets it."

Regional also requires employees to fill out detailed logs, which include the time a drug is removed from storage to the time the drug is administered to a patient. Fingerprint identification is used to ensure that only qualified employees access the medications.

Each month, Darger also runs a "proactive diversion report," examining all narcotic logs. He looks for trends: Maybe one employee seems to be administering an unusual amount of narcotics.

"It creates a red flag," he said.

In those cases, Darger investigates whether the employee had a larger number of patients with pain needs or whether something is amiss. Darger said he investigates in a very low-key manner and usually has the investigation completed within a couple of days.

Darger said about 90 percent of the time at Regional, he finds that there is no misconduct. But sometimes, even the best prevention systems fail.

Drug thefts by health care workers are not uncommon, mainly because the health care profession is where the drugs are located, he said.

John Wenande investigates prescription drug theft for the South Dakota Division of Criminal Investigation. He said nationwide, prescription drug abuse has grown to the second-leading cause of death for people ages 12 to 21.

Wenande said he doesn't see an unusual amount of drug thefts within the health care profession in the Black Hills area. He attributes that to Regional Health's prevention protocols. Yet, any system can be beat from time to time, he said.

"It's not real common, but it does happen," Wenande said.

On June 12, a nurse named Betty Carol Arthur was sentenced in Lawrence County for possession of a controlled drug or substance, according to 4th Judicial Circuit Court records. According to the South Dakota Board of Nursing Web site, Arthur's nursing license was revoked after she admitted taking Demerol from Lead-Deadwood Regional Hospital in 2006. After complying with probationary requirements, she entered into a probationary contract with Queen City Regional Medical Center in Spearfish in July 2007. According to records, she was fired from there after failing urine drug tests and her license revoked last year.

The South Dakota Nursing Board received complaints that Arthur used other nurses' names to fill prescriptions for narcotics such as oxycodone, called in prescriptions for Darvocet for herself and tampered with prescriptions from physicians.

The Nursing Board Web site lists three other South Dakota nurses who lost their licenses after stealing controlled substances during the first seven months of 2009.

The South Dakota Board of Medical & Osteopathic Examiners licenses doctors of medicine, doctors of osteopathy, physical therapists, advanced life support personnel, physician assistants, athletic trainers, occupational therapists, respiratory therapists, nurse practitioners, nurse midwives and dietitians.

For the first seven months of 2009, its Web site lists three providers disciplined for substance abuse, but does not indicate whether theft was involved.

Lesley Wilkinson, chief nursing officer at Black Hills Surgery Center in Rapid City, said all narcotics are tightly controlled at the Surgery Center. Narcotics are kept behind a locked door, medications are counted each shift and a surveillance system is used. Employees also undergo random drug testing.

Although Wilkinson hasn't had a theft case in her three years as nursing director at the center, she knows it can happen.

While working in an Oregon nursing home years ago, Wilkinson said she noticed a nurse logging large amounts of narcotics for patients. "I saw the pattern and I reported it."

The nurse was stealing the drugs to feed her own addiction and was fired.

That experience taught Wilkinson that one of the most important tools in drug theft prevention is other health care workers. She is preparing to train employees about the signs of drug abuse and theft.

Darger said training also is a part of Regional's prevention plan.

"We get a fair number of co-worker reports," he said.

Regional trains supervisors and directors to watch for the signs of drug use, including mood swings and unusual absences.

After a health care worker has been caught stealing controlled substances, they face criminal charges and the forfeiture of their license. Although some do return to health care after treatment, it's not easy to go back, Darger said. He knows a pharmacist who kicked the drug habit, but chose to work in a consulting capacity rather than be exposed to the temptations of the drug.

"There is a huge recidivism rate in health care," Darger said. "It's there. It's kind of like working in a bar if you're an alcoholic."

Contact Lynn Taylor Rick at lynn.taylorrick@rapidcityjournal.com or 394-8414.