Drug theft affects care

Central Oregon long-termcare facilities can struggle with medication theft

By Mac McLean / The Bulletin / @agingbeat

When he was confronted by police and his supervisors with some questionable medication records about nine months ago, Cole Elf, 28, of Bend, admitted he stole 40 prescription painkillers from a handful of residents at the Touchmark at Mt. Bachelor Village retirement community, according to a police report.

“Since November (2012), Elf estimated he has accessed the narcotics cabinet in the locked medication room approximately 15 times to retrieve hydrocodone and a couple Oxycontin pills,” Officer Whitney Wiles with the Bend Police Department wrote in a report chronicling an interview she had with Elf and Touchmark's administrators on Dec. 11, 2012.

Elf was arrested and charged with unlawful possession of oxycodone and a schedule II controlled substance, both of which are felonies, as well as unlawful possession of hydrocodone and third-degree theft, which are misdemeanors.

Elf declined to comment for this story when contacted by The Bulletin. According to Wiles' report, he had been working at Touchmark since 2010 and was known “as a good employee.”

“He told me he never took any of the pills when he was working,” she continued as she described her interview with Elf. “But when he got home he took (the pills) so he could sleep.”

According to records obtained by The Bulletin, the Oregon Aging and People with Disabilities Division has investigated 29 cases of medication theft that have taken place at 17 long-term care facilities in Crook, Deschutes and Jefferson counties since 2009.

With 15.8 cases of medication theft per 1,000 beds/units in a long-term care facility, these three counties — which make up the division's District 10 region — have the second-highest medication theft rate in the state, according to the division's data. District 14, which includes Grant, Harney and Malheur counties, has the state's highest medication theft rate with 16.2 theft cases per 1,000 beds/units in a long-term care facility.

In each of Central Oregon's medication theft cases, investigators suspect the thefts were committed by a facility employee who, as part of his or her job duties, was given access to a locked cabinet, cart or room where the medicines needed by dozens of elderly residents were kept.

These staff members, some of whom had been working at their facilities for years, most often stole strong narcotic painkillers like hydrocodone and oxycodone.

Local law enforcement officers, working with the state's investigators, identified and arrested five medication theft suspects and charged them with a variety of felonies and misdemeanors, depending on the number and type of pills stolen.

The state agency also cited the suspected thieves with abuse — an administrative red flag that according to one expert can wreck a person's career — even if there wasn't enough evidence to bring them to trial. In cases where a suspect couldn't be identified, it administered this sanction against the facility itself for allowing such a theft to happen.

“In our legal definition, it is elder abuse to steal anything from a person living in a nursing home,” said Paul Greenman, legal counsel for the Oregon Health Care Association, a trade organization with almost 600 long-term care facilities as members. “This is a prohibited activity and there is a clear penalty for it.”

Local law enforcement officers say these thefts aren't as common as other examples of drug diversion — the act of taking a legitimate drug such as a painkiller and putting it to an illegitimate use — that they've seen in our community.

According to a report by the Mayo Clinic, this problem has been seen with increasing frequency in health care facilities across the country, yet its full scope is still relatively unknown.

But while medication theft from long-term care facilities may not be as common as obtaining drugs through stolen prescription pads or doctor shopping, its consequences can be severe for the people whose drugs were stolen. Residents can experience increased pain or be put at risk of taking an improper medication or going through opioid withdrawal, according to reports.

“Certainly it has a detrimental impact on the resident,” Greenman said. “If a caregiver steals a resident's medication, then he or she may not be able to get it when they need it.”

Touchmark

Located on the banks of the Deschutes River in southwest Bend, Touchmark is a sprawling 25-acre community where more than 260 people ages 55 and older live in an array of well-appointed apartments and cottages.

It also features a 75-unit residential care facility known as Terrace Lodge, where a team of nurses and other health care workers provide 24-hour care to people who cannot live alone.

Since 2009, the Oregon Adult Protective Services program — a state agency that investigates any allegation of theft or abuse in Oregon's long-term care facilities — responded to five alleged medication thefts at this facility, more than any other place in the region.

Scott Neil, the facility's resident care manager, declined to comment for this story about the thefts that have happened at his facility or the steps it took to correct them. Investigators also recorded a series of steps Touchmark's managers took during the past three years that made it easier for them to not only discover medication theft but to identify and prosecute the alleged thief as well.

The facility's problems started in September 2010 when staff discovered a bubble pack of prescription painkillers — each of which contains about 30 pills — was missing from a medication cart. This prompted a full audit of Touchmark's medication room that found 12 other bubble packs, or a total of 360 pills, had been stolen between June and September of that year.

When Touchmark's administrators called APS investigator Michelle Smith to report the crime, she noted they had already taken considerable steps to beef up their policies regarding how often the medication is counted and how each dose of medicine is handed out.

Smith noted these steps made it possible for Touchmark's administrators to immediately detect the theft of two more bubble packs on Oct. 22, 2010. These enhanced counting and logbook procedures also helped catch Elf when he stole medication from the facility two years later.

During the winter of 2010, Touchmark's administrators also implemented a policy that required a weekly audit of the medications kept in its medication room.

A Touchmark employee performing one of these audits in January 2011 noticed some pills contained in a bottle of narcotic painkillers one of its residents hardly used had been replaced with an over-the-counter drug and that another patient's bottle of cough syrup with codeine had been diluted with an unknown substance.

Because of this discovery, the facility's staff members were able to prevent these tainted medications — the byproduct of medication theft — from going to residents and potentially causing an allergic reaction or another negative side effect.

But while these new procedures helped Touchmark discover the theft of its medications almost immediately after they had been taken, they didn't make it any easier for Smith or local law enforcement investigators to identify a suspect.

The facility's final step — installing a security camera in its medication room and hallways — did.

When a staff member discovered someone replaced hydrocodone pills that belonged to two residents with an over-the-counter drug during an April 2011 audit, Touchmark's administrators watched the camera's footage and saw Touchmark worker Shirley Postma, 63, of Bend, make the switch, according to Smith's report.

They gave a copy of this video to Officer Troy Wiles with the Bend Police Department, who then had all he needed to bring a case against the suspected employee.

“I informed Postma there was solid evidence she had, in fact, taken medication that did not belong to her,” Troy Wiles wrote in his report. “I told her I knew what had happened, but was curious as to why it happened.”

The report said Postma took a total of 101 pills from Touchmark's residents, including the two bubble packs that went missing on Oct. 22, 2010, and admitted she had about 10 pills in her purse at the time of her interview.

She was arrested and later charged with three counts each of second-degree theft and unlawful possession of a schedule III controlled substance, and two counts of recklessly endangering another human being, all misdemeanors.

Postma could not be reached to comment for this story. According to Wiles' report, she had been working at the facility since 2009 and took the medications for her personal use.

“Postma said she suffers from back pain ... she has taken about two tablets a day of the stolen medication,” Wiles wrote. “She said she could not afford medication of her own.”

According to the U.S. Bureau of Labor Statistics, the average personal care aide working with the elderly or disabled at home or in a specialized care facility in Central Oregon earns $10.20 an hour. A 30-day supply of 120 hydrocodone 5/325 (5mg hydrocodone, 325 mg acetaminophen) pills costs about $67.

“Medication aides receive very little training and they are paid poorly,” said Andrew Mendenhall, the outpatient director of the Hazelden Addiction Treatment Center in Beaverton, which has a program specializing in treating health care professionals. “They may steal medication because they have addiction issues or because they can make some extra money selling it on the street.”

Mendenhall said these jobs may also not include health insurance, and that causes even more problems — it could keep people who have a legitimate reason to take pain medication from getting help.

“The absence of health care may prevent people from getting what they need,” Mendenhall said, including both medication for pain and treatment services if they develop an addiction to the medication.

A new camera wasn't needed to solve Touchmark's fifth medication theft case. According to one of Smith's reports, the facility's enhanced record-keeping procedures were enough to suggest after a December 2012 audit that Elf was giving a considerable amount of painkillers to patients who normally didn't ask for them at night.

None of these residents remembered asking for the extra drugs, and the facility's key card records — which list any time one of Touchmark's 100-plus employees enter a resident's room — show that Elf never entered their rooms when he said he did.

Neil, the resident care manager, called police and arranged for them to talk with Elf when he was supposed to report to work.

“It should be noted that the facility's uses of resident door and (other) monitoring systems enabled administration to quickly identify a suspect in this matter and stop the diversion,” Smith wrote in a report describing her investigation into Elf's case.

Big and small

Almost two-thirds of the medication theft cases discovered in The Bulletin's investigation took place at large long-term care facilities like Touchmark.

Between 2010 and 2011, Smith and other APS staff members investigated three theft cases at the East Cascade Retirement Community — a six-building campus in Madras that features a traditional retirement community, 12 independent living apartments, a 36-unit assisted living facility, a 16-unit memory care facility and a 20-unit nursing facility. It has about 60 employees, facility manager John Wakeman said.

The adult protective services program's investigators also checked out two theft cases each at the Ashley Manor-Rimrock in Redmond, Emeritus at Cougar Springs in Redmond, the Ochoco Care Center in Prineville and the Summit Assisted Living Facility in southeast Bend.

The Ochoco Village Assisted Living Facility in Prineville and the High Lookee Lodge in Warm Springs were each home to one case of medication theft between 2009 and 2012.

Each of these facilities has been cited for financial abuse or exploitation at least once in the past three years because they failed to prevent thefts. Seven of their employees, including Postma and Elf, were cited for abuse as well.

Amber Darden, 31 of Prineville, is accused of stealing approximately 890 pills from Ashley Manor between September 2011 and April 2012, according to court records and Smith's investigation report.

She was arrested and later charged with one count of first-degree aggravated theft, tampering with drug records and possession of oxycodone, all of which are felonies, and possession of hydrocodone, a misdemeanor.

Darden could not be reached for comment, but told Smith she “was not proud of her actions,” during a phone call the APS investigator logged in her report. It is not known how long she had been working at the facility at the time of the alleged thefts.

But the prevalence of medication theft cases at these larger facilities doesn't mean adult foster homes — where a handful of employees provide care to a small group of residents in a setting that resembles a large family home — are immune to the problem.

In some cases, the closeness and intimacy of this setting only makes the crime worse.

“One of our girls left her position (last spring),” said Connie Thornton, owner of the Haven House Adult Foster Home in Terrebonne. “... It was devastating.”

On April 20, 2012, one of Haven House's four employees counted the number of pills inside a resident's bottle of narcotic painkillers and noticed eight of them disappeared between the time she left her shift the day before and when she returned to the facility that morning.

According to Smith's investigation report, the employee confronted the person who worked the overnight shift — a woman the Deschutes County Sheriff's Office later identified as Mylea West, 31 of Redmond — and called the Sheriff's Office.

West denied the allegations, saying she may have given the resident one pill without writing it down in the medication log and did not know what happened to the other seven pills.

Deputies arrested West that day and charged her with one count of possession of a schedule II substance, a felony, and one count of third-degree theft, a misdemeanor.

West could not be reached to comment for this story and according to Smith's report had been working at Haven House for about a month when the alleged theft occurred. She has a trial scheduled for Sept. 26 in Deschutes County Circuit Court.

“Hopefully you can trust your caregivers to administer a resident's medication properly and not take it for themselves,” Thornton said, expressing her frustration at the alleged theft, which ruined a theft-free record she had running the facility for more than 12 years.

According to one of Smith's investigation reports, Thornton's record was besmirched again four months later when one of her staff members noticed someone had replaced a handful of one resident's anti-anxiety medication with another resident's high blood pressure pills, a potentially dangerous switch.

“This is a worst-case scenario because you could get multiple doses of a blood pressure medication (if it was not detected),” said Bruce McLellan, with the St. Charles Heart and Lung Center. “There's a good chance she would become lightheaded (if her blood pressure dropped too low) and could pass out as well.”

McLellan said if this condition lasted for a while, the resident could suffer other problems such as damage to the kidneys, brain, liver and heart. It could also induce a heart attack or a heart failure, he said.

This case yielded no arrests, but Smith noted a relatively new employee suspected of taking the medication was “no longer working at the facility” after the theft occurred.

“We are only going to hire people we know,” Thornton said, explaining she has since changed her policies so that only she and one other employee have a key to the home's narcotics cabinet.

“We run a pretty tight ship.”

But even people who are trusted can change.

In August 2011, Bend Police Officer Robert Dewitt arrested Ardis Cox, 53, of Bend, and charged her with one count each of possession of a schedule III controlled substance and third-degree theft — both misdemeanors — after she admitted to stealing 40 Vicodin pills from a resident at the Butler Market Adult Foster Home in Bend.

According to Smith's report, Cox worked at the facility for seven years and was responsible for ordering its medications. She could not be reached to comment for this story, but told police and Smith that she regretted what she had done.

“Cox told me she had just had surgery and was under a lot of stress at work,” Dewitt wrote in his police report. “She told me she took the pills 'to escape' and admitted that wasn't a very good excuse.”

The consequences

On Jan. 6, 2012, Cox pleaded guilty to one count of second-degree theft and in exchange for avoiding jail time, agreed to perform 40 hours of community service work, undergo a drug treatment program and complete 12 months of probation.

Postma got a similar sentence, except it came with 80 hours of community service, when she pleaded guilty to one count of second-degree theft on Sept. 6, 2011.

Elf also avoided jail time, pleading no contest to one count of unlawful possession of a schedule III narcotic on March 26. He was ordered to undergo a drug treatment program and complete 18 months of probation. But his story is not over.

The Deschutes County District Attorney's office says Elf violated the terms of his probation when he was arrested on suspicion of driving under the influence of intoxicants on June 27. He could get jail time as a result.

Both West and Darden face prison terms if they decide to go to trial.

But there are some cases where a person who is suspected of stealing medication from a long-term care facility does not go through the criminal justice system at all, said Rebecca Fetters, an operations and policy coordinator with the Oregon Department of Health.

“When it comes to our investigative process, our standard of proof is only a 'preponderance of the evidence,'” she said, explaining this means that only 51 percent of the evidence in a particular case needs to point toward a suspect for them to be considered guilty.

This standard is much lower than the “beyond a reasonable doubt” standard police officers and prosecutors like to reach before bringing someone to trial, she said.

Greenman, with the Oregon Health Care Association, said that in the past this has created a huge problem for facility managers because there was no way of telling whether a potential employee had been involved in a medication theft case unless they were convicted.

He said the state's background check system only flagged people with convictions — an applicant's conviction for theft or drug possession serves as a red flag but does not necessarily bar the applicant from getting a job at a long-term care facility — and it was possible that suspected medication thieves could get a job at another facility and steal again.

“Unless law enforcement populates their criminal record with a conviction,” Greenman explained, “there's no way to tell what happened. ... That person can just go down the street, get a job at another facility and you'll have a reoccurrence.”

Fetters said the 2009 Oregon Legislature worked to prevent this when it approved a piece of legislation that allowed her agency to cite individuals, as well as facilities, with abuse. The legislation passed and state officials said this database has been in effect for about two years.

The state has included these individual abuse citations in its background check system for the past two years, she said, so they now show up as a red flag when someone applies for a job at a long-term care facility.

The penalties are even stronger for certified nursing assistants who commit abuse at nursing homes, said Dave Allm, manager of the Aging and People with Disabilities Division's nursing facility licensing unit.

These people are immediately added to the state nursing board's abuse registry, a distinction that bars them from getting a job at a long-term care facility ever again and serves as a red flag whenever another health care facility or office looks up their license to see if it is still current.

For facilities, Allm said, an abuse citation can carry a fine, depending on a number of circumstances including how severely residents were hurt or put at risk because of the incident and whether the facility has a track record of abuse. Most of the time these fines range from $100 to $1,000 per offense, Allm said, but in especially bad cases the division may seek a fine of between $2,500 and $10,000.

Fetters said the division also keeps information about any abuse citation a facility receives on its website and keeps records of every investigation at the agency's local office for public view. She suggests people check both these sources of information whenever they're trying to find a facility for loved ones or themselves.

But these penalties pale in comparison to what can happen to victims whose drugs are stolen, said Mendenhall, of the Hazelden addiction clinic in Beaverton.

Mendenhall said on two separate occasions he experienced a case where patients suffered negative consequences because of theft.

In the first case, the patient was in a severe amount of pain before Mendenhall checked the patient's urine and discovered a lack of painkillers.

His second patient was rushed to the emergency room one night because of severe diarrhea, sweating and a host of other problems. Nobody knew the cause until they checked the patient's urine and realized the patient was going through opioid withdrawal.

Editor's note

• Investigators with the Oregon Adult Protective Services program are required by state law to keep the names of employees mentioned in their reports confidential so they can report suspected cases of abuse or theft without risking retaliation. The Bulletin identified employees named in this story by matching APS reports detailing thefts with corresponding police files and court records.

• State map: When matched against the number of beds or units, the rate of medications being stolen is higher in Central Oregon than almost anywhere else in the state.

• The Oregon Aging and People with Disabilities Division keeps records of long-term care facilities' abuse citations at apps.state.or.us/cf2/spd/facility_complaints