Are drugs leaving your veterinary practice the wrong way?

A client of mine—let's call her Dr. Jones—recently learned of her need for tight drug controls in a painful way. One of her employees failed to show up over a holiday weekend to clean cages and walk and feed boarded animals. On my recommendation, Dr. Jones fired the employee for cause and was preparing to escort her from the building, when the employee dropped a bombshell.

"You shouldn't fire me," she exclaimed. "You should fire Julie! She's the one who's stealing drugs from you."

Whoa. That just added a new element to the story. Now not only was Dr. Jones firing one employee, but she had to figure out what to do about Julie, a technician who had been with the practice for three years and had nothing but rave reviews.

Losing control

Here's the backstory. Six months prior, my firm had conducted an on-site consultation at Dr. Jones' hospital. As part of the operational audit, we discovered the practice didn't keep track of controlled drugs. Practice logs failed to match up with inventory and medical records. Dr. Jones didn't keep controlled drugs in a proper locked cabinet or safe.

We discussed these problems with Dr. Jones, and she was receptive to our recommendations. But when we presented those recommendations to her technician Julie, who was in charge of the controlled drugs, she balked.

Julie said the drug handling protocols we recommended were "stupid" and unnecessary for such a small practice. We assured Julie that these procedures were, in fact, necessary and gave her the information and tools the practice needed to comply with the law and effectively manage controlled drugs. We even recommended they treat Tramadol as a controlled drug, even though it technically isn't one.

One of the biggest objections Julie had was to the controlled drug cabinet we suggested they buy and install in the treatment area. She said a cabinet was a waste of money. The practice was in the habit of keeping all their controlled drugs out on the counter all day, then placing them in an unlocked drawer at the end of the day.

Prevent and protect

In retrospect, it all made sense. I advised Dr. Jones to review the controlled drug logs and match them to the actual inventory on hand. Each bottle had been numbered and the controlled drug log sheets matched up to each bottle. Dr. Jones found that the quantities listed on the controlled drug logs matched the quantity on hand. She then compared the controlled drug logs to what the computer showed as used and dispensed. No big surprise; they didn't match.

Where the controlled drug log showed 40 Tramadol dispensed to a client, the computer showed that only 20 were invoiced to the client, and the same held true for Valium. In total, it appeared that about 140 pills were taken from the current bottle of Tramadol, and we had only started the investigation. All the incorrect entries were in Julie's writing, with her initials on the form.

Long story short, Dr. Jones contacted the local police and filed the appropriate paperwork with the Drug Enforcement Agency. She also confronted Julie about what she found, with the practice manager in attendance to witness the discussion.

When Dr. Jones told Julie that the police had been contacted and were on their way, Julie broke down in tears and confessed to a drug problem that prompted her theft over the past two years.

In this sad but true cautionary tale, it's easy to see why establishing drug controls are so very important. The moral of this story is that this can indeed happen to you if you don't take the steps necessary to prevent it. A bit of time up front can save you tons of time, money and heartache later—and protect your staff, clients and patients from costly or even deadly mistakes.

Mark Opperman, CVPM, owns veterinary consulting firm VMC Inc. in Evergreen, Colo. Please send questions or comments to ve@advanstar.com.