February is coming to a close.  We just celebrated my son’s 4th birthday this past weekend.  On the day of his birthday I flew out of LAX to SEA-TAC for an EMS Conference in Ocean Shores, WA.  The West Region EMS & Trauma Care Council has been putting this EMS conference on for well over 20 years now.  The coordinators were very professional and down to earth, good people all of them.  No matter where you go, I think most everyone in EMS is cut from similar cloth, at least the good ones are.  Part of me wishes I could have stayed in Washington longer, but, I had a little boy and family I needed to get back to, I had a birthday celebration to attend to.  Priorities.

It hit me hard last night, my son’s birthday is also a not so subtile reminder of the events that are the genesis for StopNarcoticTampering.org and my mission to Stop Narcotic Tampering Through Awareness & Prevention.  3 years ago in January, I found an obviously tampered-with vial of morphine on my squad, less than 3 weeks later in February I found another vial of morphine that had been tampered-with, this time not from my squad, but from the stock on the transport ambulance.  We thought, or it was suggested that the chances of finding 1 vial of tampered-with morphine was like 1 in a million and the chances of finding 2 vials, from two different agencies, in less than a month was inconceivable.  So much so, that when law enforcement finally began to investigate the matter (4 months later), they accused me of being the one that tampered-with the narcotics.  In no uncertain terms, I was told that the investigation ended with me.  But, I’m getting ahead of myself here. 

After the second tampered-with vial was discovered, we didn’t know what to think.  By we, I mean the people I worked with.  I learned quickly how cold it can be in the fire house, even one that has 4 people on the truck, 3 on an engine, 2 on the squad and 1 BC.  During the morning shift change, the engine room would normally have firefighters milling around, when I walked in everyone would scatter, like roaches when the lights were turned on.  Not that they were roaches, my people for the most part are good people.  It’s just that during times of uncertainty, when an unusual light is shined on someone, especially when that light is also looking at something sinister, something whose implications were beyond our imagination, well... I can understand why persona-no-grata comes to my mind.  Especially when my partner, the one supervising my upgrade from level 1 medic to level 2 medic says I’m wrong, says I should throw that vial out the window, tries to talk me out of reporting my discovery.   Says you don’t know what you’re talking about, you’ve not had training in this, you don’t know how these things are made.  How do you know what you saw isn’t normal?  These things were said to my face and to my captain in my presence, and if you know how information travels in the firehouse, also to most anyone that listens. 

So, back to my child’s birthday.  That year was his first birthday, we arranged for a party at a very nice indoor kids playground in South Pasadena called Amy’s Playground.  Invitations were extended to my co-workers, at least the ones with young children.  I understand that South Pasadena is far away from Ventura County, none-the-less, some planned to go.  No one called ahead of time to say they wouldn’t be able to make it (except one, his conscience is clear) The rest, no call, no notice, no show.  Thankfully, we have family, neighbors and friends who made it.  My wife even had a few coworkers come too.  My fire family, eh. 

I think back these 3 years, thankful that time has healed my wounds.  The scars remain, I wear them, if not proudly.  I know the harm that deep seated resentment can lead to, drinking, depression, and fits of anger.  I’ve felt these, I’ve done these.  I also know that it can be channeled.  I’ve tried to channel my feelings creatively.  Express myself through words, connect with others that have seen the damage that narcotic diversion can cause in the health care setting.  Teaching what I’ve learned, so others may not make these same mistakes.

I was asked by an IAFC writer, why do you do what you do?  Why do you teach others about Narcotic Tampering in EMS?  I do this because I discovered Narcotic Tampering in my own county, 2 times in less than a month.  I felt the spotlight on me, I lived firsthand the police investigation and interrogation and in my opinion, it was wanting.  I saw how the cloud was lifted once a certain EMS Clinical Education Specialist “admitted (to) forging documents and stealing drugs from his ambulance company for a year in what may be the largest case of its kind in California history.”  (that last part was penned by Andrew McIntosh, formally of the Sacramento Bee.)

That revelation, and the phone calls of support that started to pour in, both were a relief and the ignition source for a slow fuse that continues to burn today. 

How did he get away with this for so long? 

Why were the signs missed?  There were many signs.

Why did law enforcement drop the ball and not catch him?

Why wasn’t there an internal investigation in my own agency?

This questions lead to:

If this was so pervasive, why didn’t anyone else find evidence of tampering and report it?

Based on what I saw those 2 times I found the tampered-with narcotics, I was able to reverse engineer how they were done using expired non-narcotic medication vials and tools found in most any home, at least the home of someone that works in EMS.  I shared these discoveries with my supervisors and others in my agency and I found their reaction curious, their surprise was universal.

Before coming to Ventura County, I worked for a large national private ambulance company in Los Angeles, before that I interned in Pebble Beach, Monterey County for that same large private ambulance company, did my clinical’s in Santa Clara County and was a volunteer firefighter in Santa Cruz County.  That makes 5 counties I’ve had personal exposure to over 14 years.   Reflecting back on my time in these different areas, I realized that while in LA County, the narcotics at my company could have easily been tampered-with.  While in Monterey County, the likely hood was very high that narcotic tampering did occur, I gave narcotics to patients who did not react to them and now we suspect there was an addict working among us.  Buddies from Santa Cruz County told me stories of good people becoming train wrecks, losing their careers and families due to drug abuse.  And Santa Clara, well they have their stories as well.  Actually the oldest story of a Medic diverting narcotics, that I’m aware of, comes from Santa Clara in 1979. 

Again, why am I doing this?

I’m doing this because people get hurt from tampered-with narcotics; medics across the county have unknowingly given and probably continue to give tampered-with medications today; many medics are unaware this is going on and addicts will continue to do this as long as they can get away with it. 

I do this because I know.

I know what it feels like to be a suspect, to be falsely accused.

I know what it feels like to have a friend and coworker not get relief from morphine. 

I know what it feels like to give morphine and wonder why isn’t this working?

I know how addicts do it and get away with it.

I know I can have a positive impact upon an industry I care deeply about. 

I do this because I know how to prevent it.

I do this because I know someone should.

I do this because I know I can.

I’ll end with this, a recent quote.

-Alton 02/28/11

Narcotic Diversion and substance abuse among EMS providers is probably an issue that most states and jurisdictions have difficulty quantifying, much less identifying a solution. There appears to be a lack of sufficient data to validate the scope of the problem--much less point to any potential solutions. The EMS community needs to understand that the issue is pervasive among health care professionals and most likely a problem nearby or within their own service.

    -Lawrence Tan

    President, International Association of EMS Chiefs

    02/26/11