Forensic Nursing Science Section News

The COVID-19 Traveling Nurse

A traveling nurse arrives in New York City to answer the call for medical professionals during a pandemic. Did she arrive to heal the sick or did she have something else on her mind?

Not since the attack on the World Trade Center have New Yorker's been caught so totally unprepared for a crisis. Suddenly, the New York City hospital system found itself without enough personal protective equipment, medicines, ventilators, and qualified staff to address the sudden onset of COVID-19.

Hospital executives now found themselves competing with each other to obtain the equipment and staff necessary to treat the sudden onset of patients flooding into their emergency rooms. Personnel agencies who place medical professionals found their phones ringing off the hooks with pleas from overworked medical centers for additional nurses and physicians. The need was immediate. With no time for lengthy interviews or background investigations, there were patients dying, and the need for front-line troops was at the crisis level.

Answering the call, medical professionals did step forward, most of them motivated by a sincere desire to help save lives. They flew in from all over the country, lived in hotels, and worked long hours in unfamiliar settings and, sometimes, unfamiliar cultures. Some nurses and physicians were also unfamiliar with the policies and procedures of their new employers but adapted quickly. Others begrudgingly went along in an effort to get the job done.

They were all dedicated to saving lives, all except the COVID-19 Traveler.

Brandi (not her real name) was a nurse who arrived in New York City during the height of the pandemic. She was selected by a vendor who supplied temporary professional staff to hospitals. Her background investigation revealed only a minor criminal misdemeanor charge for drunk driving and no other negative information. She had previously been employed as a nurse in Missouri and had resigned from the position for personal reasons. Her license was current, and she possessed all the necessary training and skills.

After a brief eight-hour orientation, she was assigned to the emergency room of a major New York City hospital. She was very personable and invited some of her new coworkers over to her hotel room for breakfast. At first things seemed fine, but then some staff commented that Brandi seemed to be spending an inordinate amount of time in the medication room. Staff assumed this was because she was new and still learning the intricacies of a system she was unfamiliar with.

One day a staff member reached for a vial of narcotics and the cap appeared tampered with. She went to her supervisor and an inventory was conducted. A second tampered vial was uncovered, and an investigation began.

For narcotics to be withdrawn from the safe, a medication order from a physician must be issued. In cases of an emergency, an override can occur, and narcotics can be removed, but a physician's order must eventually be documented. If an override was not necessary, the transaction could be canceled. If the drugs had been removed, it would need to be wasted and witnessed. It is rare for a nurse to access medication via override and then cancel the transaction. Brandi was involved in a high percentage of override/cancel transactions relative to her peers. She had entered overrides for hydromorphone, morphine, fentanyl, diazepam, and midazolam as well as propofol and diphenhydramine. A total of 11 vials/syringes from the Emergency Department (ED) were identified as being potentially manipulated due to vial tops missing and/or visible puncture holes. When tested at the hospital pharmacy, these vials/syringes contained less than their labeled amount of volume. Testing determined that the drugs had been replaced with sodium chloride.

It was clearly time to have a chat with Nurse Brandi. I was working from home, but as soon as I got word as to what had transpired, I got in my car and drove to the hospital. After a period of denying any wrongdoing, she finally confessed to having diverted controlled substances using two 3ml syringes, withdrawing the drug with one, and the other, which contained Normal Saline (NS), she would use to infuse the NS into the controlled substance vial. This was done on at least 12 occasions during a two-week period.

Brandi told me that she had been under investigation at her previous place of employment for doing the same thing, but they couldn't prove the charges. She claimed that she did not use the drugs herself but had diverted for a coworker who had caught her stealing benadryl and propofol.

When interviewed, the coworker was shocked at these allegations and completely denied any wrongdoing. He offered to take a polygraph test and was very convincing in his denial. Later, when I spoke with an investigator from Missouri, he told me that Brandi had made the same false charges against one of her coworkers at her previous employment in that state. It was determined that a number of patients had been administered the altered drugs by unsuspecting staff. It was impossible to accurately determine exactly which patients had been the recipients of the altered vials or if it harmed or even hastened any of their deaths during the pandemic.

I immediately contacted the local narcotics prosecutor's office and relayed what we had found and what Brandi had admitted to in a signed statement. I was told by the prosecutor that a number of her investigators were out sick with COVID-19 and unavailable to help at this time. In fact, even if Brandi had been arrested, she would be immediately released under the new bail reform provisions. Additionally, the courts were closed, and their office was currently backlogged by 18 cases in the Grand Jury.

Brandi left the hospital and was not seen or heard for some time. It was almost a year later that I learned the system finally caught up with her and she pled guilty to a felony. She avoided jail by pleading guilty.