Well being officers in not less than three states are investigating a journey nurse suspected of tampering with and probably contaminating vials and syringes of opioid painkillers in two hospitals, then returning the vials to remedy cupboards the place they may very well be unknowingly given to sufferers.

100 sufferers who might have been uncovered to contaminated syringes final yr at Johnson Metropolis Medical Heart in Tennessee have been urged to get examined for hepatitis and HIV, in line with state documents obtained by KHN by means of a public information request.

The paperwork additionally reveal that Raleigh Common Hospital in West Virginia this yr gave vials to regulation enforcement to check for proof of tampering. These outcomes haven’t been made public.

The journey nurse, Jacqueline Brewster, 52, of Belfry, Kentucky, was arrested by her native sheriff’s workplace on undisclosed fees Tuesday in response to a fugitive warrant from Washington County, Tennessee, the place the allegations of tampering started, in line with jail and court docket information. Brewster was launched Wednesday with orders to report back to Tennessee inside 10 days.

“I didn’t run away from something,” Brewster stated in court docket. “I don’t know the way I’m a fugitive.”

In response to paperwork filed by Tennessee and West Virginia well being authorities with their respective nursing boards, Brewster is suspected of repeatedly opening hospital remedy cupboards to withdraw vials or syringes of an opioid painkiller, Dilaudid, allegedly eradicating some of the drug to both use or steal, after which returning the vials or syringes, probably after gluing a cap again on. The CEO of one of the affected hospital techniques alleged in an interview with KHN that the journey nurse added one other liquid to syringes ⁠— probably in an try to cowl her tracks.

The allegations towards Brewster, which haven’t been beforehand reported, come at a time when the coronavirus pandemic compelled many U.S. hospitals to rely greater than ever on journey nurses, who usually cross state strains to work months-long stints in short-staffed hospitals. Because the virus flooded hospitals with sufferers and worsened nursing shortages, many hospitals turned to journey nurses to fill the gaps, usually at a dramatically elevated price.

However “desperation” to recruit nurses additionally exacerbated current flaws within the authorities infrastructure meant to carry nurses accountable, stated John Benson, co-founder of Verisys, a knowledge administration firm that researches potential staff for well being care techniques.

Nurses and different medical professionals are licensed, investigated, and disciplined on the state stage. However investigators don’t talk effectively throughout state strains, Benson stated, in order extra nurses started to journey through the pandemic, it turned simpler to “outrun” investigations by getting a brand new job in one other state lengthy earlier than allegations of wrongdoing turned public.

“The system was damaged earlier than covid,” Benson stated. “It simply acquired extra damaged throughout covid.”

Brewster, a registered nurse, has been licensed in Kentucky since 2004 and holds a license allowing her to work in additional than 30 states that participate in the Nurse Licensure Compact. After she was accused of tampering at Raleigh Common final month, the West Virginia nursing board suspended Brewster’s capability to apply within the state. Days later, Tennessee well being officers acted on a grievance they obtained from Johnson Metropolis Medical Heart final July, launching knowledgeable disciplinary continuing that would revoke Brewster’s capability to work in that state later this yr.

As of Wednesday, Brewster’s multistate license was “beneath investigation” in Kentucky however in any other case unrestricted, that means she might nonetheless work as a nurse in most of the nation. It’s unknown the place else Brewster might need labored as a journey nurse, together with within the seven months after she was first accused of tampering in Tennessee.

Brewster couldn’t be reached for remark and it’s unclear whether or not she has an legal professional. A Knoxville lawyer listed as Brewster’s legal professional in information filed with the Tennessee Board of Nursing denied representing the nurse.

One hospital that turned closely depending on journey nurses through the pandemic was Johnson Metropolis Medical Heart. Ballad Well being, which owns the hospital, stated final summer time the pandemic elevated the quantity of journey nurses the corporate employed from about 150 to 400.

Brewster was amongst these employed. She was employed by Jackson Nurse Professionals, a journey nurse firm in Orlando, Florida, and labored on the Johnson Metropolis Medical Heart for 3 months earlier than the alleged tampering was found, in line with the information.

Ballad Well being CEO Alan Levine instructed KHN one other nurse flagged a suspicious vial within the hospital’s medical cupboard, and an inside investigation linked the vial to Brewster.

“She was eradicating the Dilaudid and changing it with one other substance that seemed clear like Dilaudid, and changing the vials within the Omnicell system,” Levine stated. “One of our different nurses observed that one thing seemed completely different in a single of the vials and notified the pharmacy instantly.”

Ballad Well being fired Brewster and alerted regulation enforcement and the Tennessee Division of Well being, in line with an announcement from the corporate. It despatched 5 Dilaudid syringes to the Tennessee Bureau of Investigation’s crime lab, which confirmed the quantity of remedy inside was “inconsistent with the producer’s label,” in line with the nursing board paperwork.

The hospital reported that it additionally tried to provide Brewster a drug check. She initially supplied an inadequate urine pattern, the paperwork allege, after which after offering a second pattern Brewster “accused the lab technician of being corrupt,” grabbed the pattern out of his hand, and dumped it down the sink.

“That is my *** [sic],” Brewster stated as she took again the pattern, in line with the paperwork.

The Tennessee Division of Well being filed the skilled disciplinary case towards Brewster with the Board of Nursing on March 31. She is scheduled to look Aug. 24 at a board listening to and dangers dropping her nursing license.

Sooner or later, after she was fired from Johnson Metropolis Medical Heart, Brewster started to work at Raleigh Common, an unrelated hospital about 120 miles to the north in Beckley, West Virginia.

Final month, the hospital reported to the West Virginia nursing board that Dilaudid vials in its drugs cupboards appeared to have been tampered with, in line with a board order suspending Brewster’s license. Some vials have been lacking tops and others had tops marked with a residue that “seemed like glue,” the board alleges.

As soon as once more, an inside investigation “led immediately” to Brewster, in line with the board order.

Raleigh Common “disposed of many vials of Dilaudid to be able to shield sufferers from contamination” and supplied some vials to regulation enforcement for testing. Outcomes haven’t been disclosed.

Jackson Nurse Professionals didn’t reply to requests for remark. It’s unclear whether or not Brewster nonetheless works for the corporate.

Raleigh Common Hospital in West Virginia launched an announcement that it was nonetheless investigating Brewster and cooperating with authorities however declined to reply questions in regards to the case.

Brett Kelman: [email protected], @BrettKelman