This case of opioid diversion from May 2017, took place in the State of Mississippi, Jackson to be specific, but it could have occurred in any state in the nation. In fact, in 2016, in Indiana alone, there were 37 healthcare providers charged with opioid embezzlement. What does Medical Ethics Failure look like? Here it is!
It is important to add that nationwide, opioid deaths are up to 90 people a day. It is especially troubling when these drugs go through back-channels courtesy of physicians and registered nurses looking to make easy money. The age range most commonly affected by opioid addiction is 25-40; younger people who have a drug dependency problem, not a condition or post-surgical pain. The money gained by unethical behavior – Medical Ethics Failure – can be made by stealing, but more often through over-prescription. The over-prescription, whether intentional or unintentional, still leads to addiction and death.
The amount of abuse is raging out of control and it must be stopped. As further illustration, just one week before this case broke, two Mississippi physicians and two nurse practitioners were arrested for over-prescription and pharmaceutical diversion fraud. Again another example of a Medical Ethics Failure.
According to The Clarion-Ledger, May 24, 2017, Jeremy David Duke who is a registered nurse was caught in a crackdown of opioid abuse. He was arrested for embezzlement or “diversion” of drugs. He was able to divert Dilaudid and morphine, powerful drugs which are controlled substances. Here’s a link to the full story.
Consequences
After being charged by the Mississippi Bureau of Narcotics (MBN) and the DEA, Duke’s first consequence was that he was taken off to jail and booked. Almost immediately following his arrest he lost his nursing license. Not a great surprise as an initial consequence for a Medical Ethics Failure.
I should pause for a minute and point out something that should be obvious: it’s not easy to get a nursing degree, especially an RN. In the State of Mississippi (certainly not a rich state), the annual, average RN salary is about $57,000. Obviously, extra training or specialties pay more. In other words, Jeremy David Duke was making a “decent” salary plus benefits. He didn’t have to steal or divert drugs to make ends meet. He threw it all away to make a few more bucks. He thought he could get away with something and it was his choice, but the consequences are in the disconnect. With a Medical Ethics Failure there is typically a disconnect with consequences.
How does it happen that a nurse, nurse-practitioner or even physician become so far removed from his or her oath so as to embezzle addictive drugs and profit by their sale? Maybe the more important question: how does it happen that someone “sworn” to protect life and to do no harm, intentionally “releases” a drug on the open market that has the potential to harm or even kill?
The answer to both question lies in a lack of meaningful and on-going ethics training. Though every healthcare professional is exposed to ethics training, it is all too frequently an after-thought, crammed between courses and examinations.
How Does Fraud Occur?
In this particular case, an opportunity was created and Jeremy David Duke rationalized that somehow and in some way, his behavior was acceptable. There are several ways in which the medical ethics failure might have occurred.
Somewhere down the line there was a lack of oversight. Dilaudid and morphine are controlled substances in every hospital in the nation, and in some way Duke was given access to a controlled substance “cabinet,” or was able to make pharmaceutical department requests without proper checks and balances. However he gained access to the drugs, he was home free in terms of distributing those medications after that point.
Rationalization is the far more interesting aspect to this fraud. We can easily make up almost an unlimited number of rationalizations that this RN might have used. He might have been angry at what he perceived as the disparity between what he made for a living, and those he cared for, or even those he worked with. He wanted more. The stolen drugs gave him more.
He might have believed that if “everyone did it,” than he could do it too. Where or how he arrived at this conclusion is hard to say. Even if he knew no one who was diverting drugs, he may have extended this rationalization to politicians he didn’t like or income tax cheaters, or most anyone.
In his mind, perhaps he saw himself as a “player.” He might have wanted to emulate what he had seen in the movies or on television.
Whatever the rationalization, he could not see the consequences of his choices. He could not imagine the effects these drugs might have on other human beings. He would never think of himself as a pusher, though now he must live with the knowledge that he was.
YOUR COMMENTS ARE WELCOME!
Mr. Gallagher, I realize that this article is several years old, but it is full of inaccuracies. So much so that it is libelous. As someone who writes blogs and articles, you would think that you would have the professionalism to make accurate statements. You see, Mr. Jeremy Duke was not selling any drugs that he acquired. Those drugs were for personal use because of circumstances in his life at the time. Does that justify his actions? No of course not. Mr. Duke was prescribed opiates because of an injury he received while on the job working as a nurse and he got addicted to them. Are nurses exempt from the same disease of addiction that so many others face? No! Tell me, how many time have you held a dying cancer patient in your arms? How many times have you held a dying newborn infant in your arms? Tell me, how many times were you pulled in 50 directions, stressed with the responsibilities of taking care of people, working 12-14 hour shifts? That is just the surface level stuff that Mr. Duke had on his plate. That doesn’t include any personal stuff going on in his life at the time. Mr. Gallagher, I sure hope that you are a perfect person who has NEVER made a mistake, otherwise, that makes you a hypocrite. It makes you human. To catch you up, Mr. Duke has been clean and sober for over 5 years now. He also has gone to talk to multiple nursing classes to give talks on drug diversion. You pass judgement on a man that has turned a negative in to a massive problem. Mr. Duke is working on being a solution to the problem society faces and not just someone who reports ,especially lies, about the problem and the drug addicts.
Greg thank you for your comments and I’m thrilled that Mr. Duke is both clean and sober and, more importantly, paying it forward by “being a solution to the problem society faces.” It sounds a bit like my story. While my issues was not drugs…regardless of how obtained…I know that choices have consequences and mine was Federal Prison. The fact that I wrote about Mr. Duke in the past does not mean that he couldn’t change or that he isn’t doing good things now. In fact, I’d welcome the opportunity to interview Mr. Duke today so talk about how life has given him, like me many years ago, Second Chances. If you have a way to connect us both…feel free. I think him sharing his story would be incredible.
Chuck