I am grateful HONOReform had the opportunity to respond in the June 12 Concord Monitor to the horrible but all too common report of provider drug diversion by a healthcare worker.
As Steve Langan, HONOReform executive director, said, “Drug diversion may likely be the most enormous elephant in the room, in healthcare.” Anyone who has tried to pay attention to the many conversations on healthcare in the United States knows that there are many gaps and there have been many breakdowns.
If we continue to look the other way and deny and ignore the fact of widespread drug abuse and drug diversion among healthcare workers, more and more systematic challenges will develop.
According to recent statistics, there are as many as 379,000 addicted healthcare workers right now in the United States.
What does this mean for patients? They may not be receiving the medication they have been prescribed, in the recovery room or in other hospital settings. And, worse yet, they may receive an infection of bloodborne pathogens, such as hepatitis C or HIV.
At HONOReform, we believe a first priority in American healthcare is protocol and regulations that prevent drug diversion. This is a problem that can and must be fixed.
Robust materials developed by partners at the Safe Injection Practices Coalition the One and Only Campaign will soon be in place. We welcome the opportunity to help distribute these materials to leadership at healthcare facilities throughout the country.
Messaging and education are essential, important; but, in this case, we need government leaders at all levels to take a stand. Patients have been placed over and over in a vulnerable position, and addicted healthcare workers continue to practice with very little oversight and not nearly enough intervention.
In the near future, we will make an announcement of an upcoming meeting on drug diversion prevention.
Welcome back to the HONOReform blog, aka “Survivor Stories,” for our second full year of publication. We thank everyone who has had a role in making our blog a growing success—contributors and readers and everyone who has suggested to friends that they should check out our blog and pass it on to others.
And we encourage you to please continue to support our efforts.
Here at HONOReform, community-building is a key to emphasizing safe injection practices and doing all we can to educate the public and reeducate providers on the absolute necessity of injection safety.
Thanks to you and our many supporters, our work at HONOReform continues to evolve
Curtis McKnight talks about HONOReform
Once a year, HONOReform reaches out to our loyal supporters to ask for their continued support of our mission. We include below the text of a letter we are sending this week to many of our previous donors. In advance, we are grateful for the generous support, and we ask you to please consider forwarding this request to people in your network.
Thanks to you and our other helpful supporters and donors, our work at HONOReform continues to evolve. We never waver from our core mission and message, the absolute importance of protecting the medical injection process for Americans. Our goal is to do all we can to prevent outbreaks caused by lack of adherence to medical injection fundamentals.
In the last couple years, however, we have explored additional injection safety issues that can cause harm to patients—misuse of insulin pens, reuse of single-dose medical vials, and drug diversion, among others. There have been many very good advances, and there is a lot of work ahead of us.
I value our work at HONOReform…and my roles as board president, presenter and spokesperson. I believe we make a difference, and that we contribute to public health and wellness. But, I have to say, I really felt the impact of our work when my son Curtis, as part of his medical training, reported that our work was highlighted during his training. When he called to tell me about it, I asked “Did you whisper to your neighbor, ‘That’s my mom?’” “No,” he replied. “I just yelled it out for everyone to hear!”
I am, clearly, a proud mother. This pride extends to the services that we provide here at HONOReform. I thank you for your recognition of our work—and your support and your generosity. Together, we reeducate healthcare providers and educate the public on the importance of proper medical injection technique.
I encourage you to please continue to help support our work. Go to www.HONOReform.org to donate to our vital mission. If you have any questions, please contact our executive director, Steve Langan (; 402.659.6343).
Tom McKnight reflects on 33 years of family practice
It is a pleasure to announce that Dr. Thomas A. McKnight—Tom—a founding member of HONOReform and our medical director, was honored by Governor Dave Heineman on October 8, 2014. In a special proclamation, Tom was named “2014 Family Physician of the Year” in Nebraska. We are grateful for Tom’s ongoing leadership and guidance.
He is pictured with Representative Jeff Fortenberry and Governor Dave Heineman. The text of his talk is included here.
Thank you Gov Heineman, Representative Heineman, and the NE Academy of Family Physicians. I am humbled and honored by this award. I know that there are many deserving family physicians in our state that provide outstanding, compassionate care on a daily basis to Nebraska families.
I chose to go into family medicine because it provides the opportunity to be involved in peoples’ lives from birth to death. I’ve enjoyed family medicine because of the broad range of challenges emotionally and intellectually that each patient encounter brings. In my daily routine I often celebrate with new parents when they bring their baby to the doctor for the first time and then go to the next exam room to break the news to a married couple that the husband has terminal lung cancer and has only a few months to live. I have to say family medicine is as challenging and exciting now as it was 33 years ago when I started my practice.
After finishing medical school at UNMC i did my residency in Cedar Rapids, IA. I took a temporary position in the ER while we were waiting the birth of Luke. This gave me a chance to see a different side of medicine. It taught me that i wanted to develop long term relationships with patients and that i would only be fulfilled in having my own practice.
We volunteered for 6 months in various Native American Health Centers in NM, MT and AK before we settled in our new home in Fremont. This time period also allowed me to get licensure and staffing in place to open my solo practice in July, 1981. I still remember how happy but anxious i was to see my very first patient with brand new staff. Evelyn and I wonder if it was bravery or foolishness to have a new baby, buy a house, start a brand new practice with no patient base, all with no other income. It worked out. Fremont has been very supportive of us and it has been a marvelous place to practice medicine and raise a family.
The loyalty of my staff is unmatched. In the 33 years of practice 2 employees have been with me from the beginning, 6 have been with me 25 years or more and 9 have been with me for more than 10 years. We have 5 families who have two generations that serve patients with me. With all the stresses and changes in medicine, I think this is remarkable. It shows their dedication to caring for their friends and neighbors in Fremont. Their dedication goes beyond the time they spend at the office. They attend patients’ weddings and funerals, give baby showers for needy patients and organize fundraisers to help with patient’s medical bills. Most importantly they hold patients’ hands when they need a compassionate listener, share in the joy of a new baby and shed tears in the loss of a loved one. Patients know their dedication and i think that often they would rather see their favorite staff member than me. The same devotion the staff shows to our patients they extend to me and my family. They do their best to make my day run as smoothly as possible and that is not easy, given how many emergencies come up in one day. In the years of illness within my own family, they sent supper home with me every day for a year. They took our kids to their activities and hugged me through the time of my mother’s death. We will never forget your kindness and compassion.
The most important part of this journey is my family. They were patient and understanding when i was called from family life to attend to others’ needs. I was privileged to mentor all three sons during their medical education. It was marvelous to see their compassion and care of patients during their family medicine rotations. It gave them an understanding of my career. I’m honored that they have chosen medicine for their own career paths. Its rewarding and sometimes humorous to talk to them about their own patients. I got a phone call from Curtis the psychiatrist recently, asking me how to treat constipation!
The most important person here is Evelyn. She has stood by my side, been the most trusted confidante and understanding partner that i could have. She was the mother, often the father when i wasn’t able to be part of family life. She waited patiently for me many late nights to share the joys and sorrows of my day. I know how difficult it is and she continues to offer her support and love. I am eternally grateful.
Being involved with medical students throughout my career has been extremely rewarding. It is a source of continued stimulation and keeping up with the advancements of medicine. Sharing the joy of their first delivery or the satisfaction of suturing their first laceration gives me a warm feeling. Its interesting to show them private practice medicine and what it is like to be involved in a community. I love following their educational and career advancement and then have them as specialty consultants.
The patient doctor relationship is special. I am privileged to care for 4 generations of families. I am so humbled that they have placed their trust in me, many for 3 decades. We’ve gotten to know each other well and i feel like a part of their lives. They are a part of mine as well; they ask about my family and send me gifts and articles that they know i would like. This is really what family practice is about – caring for families through generations. It is a blessed coincidence that the first baby I delivered in Fremont in 1981 was JoAnne’s baby girl named Christine. I delivered Christine’s baby girl Caitlyn in 2011, the last baby I delivered.
Many things have changed in medicine in the years of my career. Immunizations now prevent many diseases that were devastating to families when i first started practice. I remember many nights interrupted by trips to the ER where i did spinal taps on children, looking for meningitis, which is now very uncommon with meningococus vaccine. We now have genomics to assist with cancer care and cardiovascular disease. We used to have to get hard copy medical journals to research new developments but now i can consult Medscape on my smartphone. Computerized medical records are replacing cumbersome paper charts and will allow patients to have their medical records anywhere in the world. Patients have changed also, for the better. They are more involved and knowledgeable about treatment options. They are full partners in their healthcare, which is better for them and healthcare providers. Patients know their bodies better than anyone and bringing this knowledge to the partnership makes for better health. We need to embrace these changes in technology and patient partnership.
I’ve enjoyed opportunities to serve in ways other than office medicine. Service trips to third world countries, membership on nonprofit boards, medical staff offices and our own patient safety foundation HONOReform has promoted my own personal growth. We have met so many wonderful, committed people in these endeavors. Their dedication inspires me.
Our own experience with medical error and the work of HONOReform has made me a better doctor because i understand both the doctor and the patient side of the relationship. I’m less defensive, more compassionate, and more grateful than i used to be. I’ve learned how to accept responsibility and do the right thing, even when that is a very difficult thing to do. To say “I’m sorry, this is not what i wanted for you” when my care of a patient did not turn out as planned is the right thing to do.
HONOReform is a national organization, and we stay very active here in Nebraska. If I could wish one thing for our state, it would be the adoption of a bill that emphasizes safe injection practices. We have seen many lives here in Nebraska (and throughout the country) altered or ended because of lack of adherence to injection safety. HONOReform is willing to roll up our sleeves and work with Nebraska lawmakers to put an injection safety bill in place. We believe this legislation is overdue.
For all of this, I thank you from the bottom of my heart. Our work is not done, we are eager to see what the next 33 years will bring.
We were honored to have a comment published to HAI Focus last week. It is a website designed to help you find the information or news you need about healthcare-associated infections (HAIs) and infection control. The site is updated on a daily basis to reflect current news and events related to HAIs. Our comment was in response to a recent patient notification that is taking place on Long Island. Click on the link http://www.haifocus.com/lets-talk-lives-depend-on-you/ or read the comment below.
I remain troubled by the news that 4,277 patients on Long Island, because of improper use of an insulin pen, have been placed in harm’s way (“Nassau hospital’s call to test injected patients seen as opportunity,” March 15). These men and women are in my thoughts and prayers.
I joined the CDC and its partners in 2008 to launch the One and Only Campaign. Because of troubling patient notifications and devastating outbreaks that have occurred in the last six years, our work on the campaign has expanded. We developed extraordinary resources on proper use of the insulin pen, for instance. I encourage healthcare workers throughout New York and the area to take time to reeducate themselves on all injection safety fundamentals.
In addition to my encouragement to healthcare workers to always give a safe injection, I encourage them to be unafraid in addressing each other directly, anytime injection safety standards are violated—or seem to be.
I was one of 99 people in Fremont, Nebraska, who was infected with hepatitis C while receiving treatment for cancer at an outpatient clinic in 2002. Syringes were reused, and the saline flush was used improperly. Not only does an outbreak of hepatitis C affect patients, it affects an entire community. Notifications like the current one on Long Island chip away at a community’s confidence in its medical care.
Did anyone speak up, when my fellow patients and I, people who were fighting one fatal disease only to have to take on another, were being violated over a long time through unsafe injection practices? Sadly, the answer is no.
In the recent reports, it appears an unnamed healthcare worker did make a stand. He or she heard a colleague say it’s okay to reuse an insulin pen on more than one patient. As we know, blood can become trapped in the reservoir and, if it is reused, cause an infection. As it states in the One and Only Campaign materials, “Insulin pens that contain more than one dose of insulin are only meant for one person.”
To the healthcare worker who said to his or her colleague, No, that is not how it is done, we issue our thanks. I expect this person will not perceive him or herself as strong or brave. I expect he or she would say, if I had a chance to provide a commendation, I was just doing my job.
However, speaking up to a colleague, and especially to a person of higher rank, clearly does not occur as often as it should in healthcare. I am one of many people throughout the United States who have been deeply affected by ongoing, unchecked unsafe injection practices.
On behalf of my fellow patients, and with the patients from Long Island in our minds and hearts, I urge healthcare workers to be unafraid to say, “Stop.” To say, “No.” Lives depend on you.
New Hampshire Legislature Efforts to Provide Patient Safety by Tom Sherman, MD
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.