A Times Investigation

LOOSE REINS ON NURSES IN DRUG ABUSE PROGRAM

Some Covertly Get Jobs and Steal Drugs for Their Own Use. Regulators
Are Slow to Act, Leaving Patients Vulnerable.

The morning of her second day at Starpoint Surgery Center in Studio
City, nurse Melony Currier was found in the parking lot, passed out in her car.

Once roused, she was escorted to a drug-testing facility to provide a
urine sample. In the restroom, she injected an anesthetic she had
stolen from the surgery center, according to state records and a
Starpoint official.

Currier, a participant in the state's confidential recovery program
for impaired nurses, had failed repeatedly -- and spectacularly -- at
rehabilitation, the records show.

Over 4 1/2 years, she'd been discovered high in her car at a
Hollywood hospital, stolen anesthetics at a San Gabriel Valley
hospital, been convicted of burglary after taking more drugs from the
same hospital and flunked a drug test.

Yet it wasn't until Currier shot up at the drug-testing facility in
September 2006 that she was kicked out of the recovery program.
Though her evaluators labeled her a "public risk," the California
Board of Registered Nursing didn't impose discipline until 1 1/2
years later, leaving her free her to work without restriction in the
interim, the documents show.

As the state begins overhauling regulation of California's 350,000
registered nurses, one of the board's most touted programs stands out
as seriously troubled: drug diversion.

For years, nursing board officials have described diversion as a
haven where good nurses can kick bad habits -- without losing their
licenses or their reputations.

But an investigation by The Times and the nonprofit news organization
ProPublica found participants who practiced while intoxicated, stole
drugs from the bedridden and falsified records to cover their tracks.

Since its inception in 1985, more than half the nurses who have
entered the program haven't completed it. Some who fail at diversion
are deemed so incorrigible that the board labels them "public safety
threats" (sometimes referred to as "public risks").

Based on a review of all nurses who faced disciplinary action since
2002, The Times and ProPublica identified more than 80 such nurses.

Dire as they sound, the labels do not trigger immediate action or
public disclosure. Some nurses that the board considers dangerous
continue to treat patients.

"These healthcare professionals may be in the operating room. They
may be serving you when you're sick," said George A. Kenna, an
addiction researcher at Brown University. "You just don't want that
sort of person who's impaired" at the bedside.

Earlier this month, Gov. Arnold Schwarzenegger replaced most of the
nursing board and demanded wholesale reform after The Times and
ProPublica reported that it took more than three years on average to
investigate and discipline nurses. The newly appointed board meets
for the first time Sunday and Monday.

Confronted with reporters' findings on the diversion program this
week, State and Consumer Services Secretary Fred Aguiar answered
nearly every question by saying the program was part of a "broken
system." Aguiar, whose agency oversees professional licensing,
promised it would be on the new board's agenda.

In a separate interview, Carol Stanford, who has directed the
diversion program since 2006, vigorously defended it. She said
reporters were focusing too heavily on nurses who failed and not
enough on those "saved" by diversion.

"You can pick apart any program," she said. "But what about the good?
What about the other side of that story?"

Stanford said the program, which nearly 1,400 nurses have completed
since 1985, had a graduation rate of 59% last year.

"Of course, nothing's perfect," she said. "We're working on whatever
issues might be going on."

Diversion, embraced in various forms by many regulators, is intended
to protect both professionals and the public.

Nurses enroll voluntarily, sometimes after a complaint, sometimes
before they land in trouble. They agree to a host of conditions, such
as submitting to random drug tests, seeking treatment and pledging
not to work without permission.

In return, the board suspends the disciplinary process, keeping
secret the nurses' participation in the program. With an annual
diversion budget of nearly $3 million, it relies on an outside
contractor to run the program day to day.

Because the program is confidential, it is impossible to know how
many enrollees relapse or harm patients. But a review of court and
regulatory records filed since 2002, as well as interviews with
diversion participants, regulators and experts, suggests that dozens
of nurses haven't upheld their end of the bargain. And oversight is
broadly lacking.

Nurses must promise they won't work until they're sober, yet the
board doesn't confiscate their licenses, nor does it ensure that
addicts have kept their word.

Some covertly get jobs and steal drugs. The board typically doesn't
find out until the nurse gets in trouble again.

Even after the program expels nurses and labels them public safety
threats, the board takes a median 15 months to file a public
accusation -- the first warning to potential employers and patients
of a nurse's troubles. It takes 10 more months to impose discipline,
based on the Times/ProPublica review of disciplinary records filed since 2002.

Labor and delivery nurse Tiffany Fahrni, who originally enrolled in
the program after stealing and using painkillers, said she was kicked
out and labeled a "public risk" in December 2005 because she had
worked without permission. But the board didn't file an accusation
against her until January 2009.

During that time Fahrni logged at least two arrests on drug-related
charges, though she says she did not work as a nurse.

"They terminate you. They say you're a danger to public society . . .
then it takes three more years for them to do anything," she said.

The nursing board "should have been all over me like a hawk," Fahrni
said. "An addict -- you got to watch them like a baby."

Julianne D'Angelo Fellmeth, administrative director of the Center for
Public Interest Law at the University of San Diego, said every
"public risk" case should be pursued within five days.

Nurses "treat how many dozens of patients?" she said. With such
delays, "the chance for harm to a patient is exponentially multiplied."

Drug Convictions

In retrospect, Melony Currier may not have been a good candidate for diversion.

She first landed in trouble on Nov. 8, 2001, when she was arrested
for stealing Demerol from Providence St. Joseph Medical Center in
Burbank. (She later told board investigators that she'd stolen drugs
every day for months.)

Nearly two weeks after her arrest, while working at Planned
Parenthood in Van Nuys, she was found collapsed in the bathroom,
injecting herself with the general anesthetic propofol. Two days
after that, she returned to Providence St. Joseph and stole more of
the drug, board documents say.

She was later convicted of misdemeanor theft in the Van Nuys case and
petty theft and drug possession in the Burbank case.

Currier, then known by the last name Dietrich, was allowed into
diversion in February 2002. The program bars nurses who have been
convicted of selling drugs or who have caused patient harm or death.
Also rejected are those previously disciplined by the board for drug
use or mental illness, and those previously kicked out of any
diversion program.

None of this applied to Currier. When the program finally expelled
her in 2006 -- after the five relapses -- her case entered the
clogged pipeline of ordinary complaints. There it was investigated
outside public view.

A month after Currier was ejected, according to board documents, she
went to Providence St. Joseph, where she'd been arrested five years
earlier. Posing as an employee, she said she'd come to collect drugs
for outpatient surgery.

When questioned, she "fled," board records say, driving 10 miles to
Verdugo Hills Hospital in Glendale. Again posing as an employee, she
stole two cases of propofol, according to court and board records.

Two days later, on Oct. 18, 2006, Currier was arrested when she
returned to Verdugo Hills for more.

The board filed a public accusation against Currier in March 2007--
nearly 5 1/2 years after the agency first learned of her drug problems.

When the board settled the case in 2008, Currier's license was
suspended for a year and she was put on probation. As part of the
settlement, she admitted the allegations.

Currier is now free to practice with restrictions. She has declined
to comment on her case.

Asked about delays in cases like this, in which a nurse has been
deemed a public risk, diversion manager Stanford said: "That nurse
still has due process. . . . You cannot go after a registered nurse
in this state for falling out of treatment."

In some other states -- Arizona, Texas, North Carolina and Ohio, for
instance -- nurses are booted from diversion much more quickly and
disciplined sooner, according to interviews with regulators there.

"You can't stay in the program after one relapse, even one," said
Julia George, executive director of the North Carolina Board of Nursing.

Leonard LaBella, Verdugo Hills Hospital's chief executive, said he
was dumbfounded that the California board had not moved against Currier sooner.

"They might be overwhelmed," he said. "But this one, I think, might
have floated to the top."

Risky Honor System

At the moment, the main person responsible for protecting the public
from a drug-addicted nurse in California is the drug-addicted nurse.
It's a risky honor system.

Anette Ekelius, who landed in diversion for allegedly stealing drugs
in April 2001, said she knew the rules -- she couldn't work without
the board's permission. She also knew there was nothing to stop her.
"I thought, 'This is good,' " she recalled. " 'I need to work. I need
to pay my bills.' "

Ekelius got an unauthorized job as a temporary nurse at Torrance
Memorial Medical Center that September, according to court records.
She later pleaded guilty to stealing Demerol on her first -- also her
last -- day. The hospital reported her to the board, but she remained
in diversion.

Months later she took another job without permission, she said in an
interview. At Corona Regional Medical Center, she appeared high and
was accused of leaving a critically ill patient unattended, board records say.

Two days later, in February 2002, she was kicked out of diversion.
She got another job and stole drugs before the board filed an
accusation against her. Her license was revoked in August 2004.

"I was a good nurse, but not when I was using, obviously," said
Ekelius, who said she is now sober.

Diversion manager Stanford said she doubted there were more than a
handful of such cases but conceded she has no way of knowing for sure.

Doctors Program

California regulators well know that diversion programs can fall
dangerously short.

In recent years, audits of the state medical board's program found
that relapsing doctors weren't always removed from practice, surprise
drug tests often weren't surprises and designated monitors sometimes
left doctors unwatched.

The medical board closed the 27-year-old program last year.

At legislative hearings on the matter, nursing board officials
insisted that their program did not have the same problems and was
"very successful."

But the board often defines success as completing the program. By
that measure, it has lagged behind the medical board. Historically,
about three-fourths of doctors who entered diversion finished it.

And the nursing board does not track nurses once they complete the
program. Scott Bertrand, a Claremont nurse anesthetist, relapsed
three months after graduating. In August 2005, he was caught
injecting himself during a surgery with the painkiller fentanyl,
which was intended for the patient. Afterward he admitted using
opiates every workday for 10 to 12 weeks, according to his board
disciplinary record.

Given a second chance at diversion, he was kicked out, according to
his board record. Last year the board suspended his ability to work
as a nurse anesthetist for one year and put him on probation.

Reached twice by telephone, Bertrand said he was busy and never called back.

The board almost certainly misses other cases like Bertrand's,
addiction experts said.

"I'd want to know what their relapse rate is," said Dean Dabney, a
criminal justice expert at Georgia State University, who has written
about impaired practitioners. "That's your true indicator."

In this week's interview, Stanford initially stuck to her overall
assessment of her diversion program as "a success."

Pressed on the flaws identified by reporters, however, she said
officials were taking steps to "tighten it up."

One change in process, she said, is a requirement similar to that in
New York -- in which new enrollees in diversion inactivate their
licenses. Another would allow the state to investigate complaints
even while nurses are in diversion, as the state of Washington does.
A third would expedite legal action on cases in which nurses are
considered "public safety threats."

"You're raking me over the coals," Stanford said to reporters. "I'm
trying to work with the program to enhance it."

A Fatal Overdose

Chad Matheny's newspaper obituary said he died unexpectedly at his
Cathedral City home May 19, 2008.

Just 32, Matheny was described as a loving husband and father, a
musician and singer, a dedicated nurse and caregiver. Left unsaid:
Matheny's death came after a years-long battle with drugs.

It was a fight the nursing board knew he was losing.

An autopsy found that he had died of an accidental overdose: of
powerful painkillers, antidepressants and anti-anxiety drugs. Some of
the drugs appeared to have been obtained by phoning prescriptions in
under the name of the physician he worked for, the autopsy report said.

Matheny had been booted from the diversion program two years earlier,
and the board had labeled him a public threat, saying he had a
"complete lack of insight into addiction." But, with disciplinary
proceedings pending, he could still work -- and score drugs. He died
in bed, beside his wife.

Matheny's mother, Gaytha Minor, said the nursing board failed her
son. But she is a veteran nurse herself -- and what most angers her
is that the board didn't step in to protect the public.

"How many patients suffered because of my son?"