Looking for the Smoking Gun?

Every now and then when performing a diversion investigation, you will find the smoking gun. One that is so hot you don’t need the healthcare worker to admit to diversion in order to be 100% convinced they are diverting. However, 99.9% of the time, you will not find that smoking gun early on. And by the time you do, it’s too late. It is in the form of harm to someone else, the healthcare worker themselves, or a patient.

The person who has a substance abuse problem lives and breathes their addiction every day. They are constantly 10 steps ahead of you, the investigator, who has other responsibilities at work. Although you may feel you dedicate hours to a single case, and you have, it is nothing compared to the hours the diverter spends thinking about how to divert and how to keep you guessing. So how should you proceed if there is no smoking gun? First, if the data tells you something is not right, then something probably isn’t. Second, if there are any, absolutely any, questionable performance or behavioral issues, then take that into consideration. This assessment requires one to be unbiased, ask the right questions and often it is the investigator who recognizes the issue rather than the employee’s manager. Third, if it is not sitting right with your gut, listen to it.  Most especially if you have some years of experience under your belt. This feeling at the gut level will take the data, the behavioral/performance aspect and their response during the interview into consideration. If all this comes together giving you concern but there is no admission, the right answer may be to report them to their licensing agency and let the licensing body address the matter. They may already have a complaint on file from a previous employer or be aware of a matter involving law enforcement and your complaint is just what was needed to prove a case. It may be their smoking gun.

Terri Vidals
Terri Vidals

Terri has been a pharmacist for over 30 years and is a drug diversion mitigation and monitoring subject matter expert. Her years of experience in various roles within hospital pharmacy have given her real-world insight into risk, compliance, and regulatory requirements, as well as best practices for medication and patient safety.

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