New Hampshire Legislature Efforts to Provide Patient Safety by Tom Sherman, MD

February 10, 2014

Evelyn McKnight and Lauren Lollini

Over the past two and half weeks, the New Hampshire legislature has passed two new bills to address drug diversion.

The history of these bills began in the spring of 2012 when my partner and I noted that we had two patients with acute hepatitis C under our care. Neither of us had seen acute hepatitis C in our practices since it usually presents as a chronic disease. The common thread was our cardiac catheterization lab. We reported these immediately which began the cascade of events eventually resulting in identification of 10,000 patients at risk nationwide from 17 hospitals. At our hospital, there were 32 cases that resulted from drug diversion by a medical technician named David Kwiatkowski.

I have had the dual advantage of being a member of the state wide Drug Diversion Task Force, a working group that arose following this episode, as well as being elected to the New Hampshire State Legislature House of Representatives in the same year. Two pieces of legislation had been introduced to address the problem of drug diversion as a response to this incident. I took these pieces of legislation, with full support from their sponsor, to the Task Force. With all of the major stakeholders participating and with the hard work of legislative subcommittees, we were able to revise these two pieces of legislation to address the problems identified by our Department of Health and Human Services as a result of its investigation of the outbreak.

The first bill will require all licensed health care facilities in the state to have a policy creating a drug-free workplace utilizing the template provided on the US Department of Labor website. This template is comprehensive but allows flexibility for the policy to be tailored to the specific needs of each facility. This passed the house two weeks ago by a wide margin. It will now head to the Senate as the next step toward becoming law.

The second bill creates a registry for medical technicians who have a combination of patient and controlled substance contact. This was the hole in the repertoire that Kwiatkowski took advantage of, moving from state to state and hospital to hospital with impunity even though he had a record of suspected diversion at several of these facilities. While this law will only address New Hampshire health facilities, it is hoped that it will serve as model legislation for other states. This bill was passed by the House last week and will now go to another House committee for final review. It will then come back to the house for final passage.

I applaud and am grateful for the effort, cooperation and collaboration of all those who have taken part in this process. It is our hope that, as a result of this legislation, NH will be the last place in the country where someone trying to feed their addiction with diverted drugs will ever consider. For the sake of our patients and our healthcare workers, there needs to be zero tolerance for drug diversion. This goal can be achieved with a coordinated, uniform effort by all health care facilities supported by statute.

Thomas M. Sherman, MD
Core Gastroenterology
Exeter, NH
NH State Representative
Rockingham District 24 – Rye and New Castle

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