Cheshire Medical offers no more information on stolen, lost fentanyl

The drug loss has prompted emergency license suspensions for key hospital personnel, and a hearing is scheduled before a state medical licensing board later this month to determine whether Cheshire Medical can keep its pharmacy permit.

A criminal investigation into the missing drugs is ongoing, a spokeswoman for the Drug Enforcement Administration said Tuesday.

The 11 questions from The Sentinel — based on the N.H. Office of Professional Licensure and Certification’s (OPLC) documentation of the drug loss — include what drug-diversion prevention protocols Cheshire Medical has and how hospital officials can be sure patients still got their prescriptions.

The OPLC documents also state that other controlled substances aside from fentanyl were stolen or lost, but do not specify the type or quantity. A reporter asked Cheshire Medical Center this as well.

Through the hospital’s marketing and communications department, The Sentinel on Monday requested a phone interview with President and CEO Dr. Don Caruso. A reporter emailed the list of questions Tuesday morning.

Hospital spokeswoman Heather Atwell said in an email Tuesday afternoon that Caruso “has a very busy schedule today and will not be available by your deadline” of 5 p.m., but noted the hospital “will make sure he is available” to a reporter “when his schedule permits and when we have further information to share.”

She did not respond further to the list or provide answers to the questions, from Caruso or anyone else at the hospital.

Cheshire Medical also did not answer questions from Sentinel reporters Thursday or Monday, including what fentanyl solution is, how it’s used in a medical setting and the most recent total of unaccounted for fentanyl at the hospital.

“Cheshire Medical Center continues to work closely with government agencies on the ongoing investigation of this matter, even as we revise and refine our policies and protocols regarding the secure handling of pharmaceuticals,” the hospital said in a statement emailed to The Sentinel on Friday. “Patient and employee safety are always our first priority, and we have a zero-tolerance policy regarding the diversion of any controlled substance.”

Dartmouth Health, of which Cheshire Medical is an affiliate, did not answer a similar list of questions Tuesday afternoon, pointing a reporter to Cheshire Medical’s spokespeople.

According to OPLC documents ordering the emergency license suspensions of three hospital practitioners, Cheshire Medical has reported that more than 7½ gallons of fentanyl solution went unaccounted for — much of it stolen — from the Intensive Care Unit between September and May.

Fentanyl is a synthetic opioid used in the medical field for sedation and pain relief. It is 50 to 100 times more potent than morphine and highly addictive and dangerous when used illicitly, according to the National Institute on Drug Abuse.

Around Feb. 4, the OPLC documents say Alexandra Towle, a nurse in the hospital’s ICU, self-reported that she had stolen fentanyl from Cheshire Medical.

Before her death the following month, she signed a preliminary agreement, on Feb. 9, not to practice that states she stole 12 bags of fentanyl solution in October, 50 to 100 bags in November, about 100 bags in December and 200 bags in January.

However, not all of the lost fentanyl can be attributed to that theft, according to the documents, which state that hospital staff said a winter surge of COVID-19 and a software transition also impacted record-keeping related to fentanyl and other drugs.

Fentanyl solution also went unaccounted for between April and May, the documents say, even after the hospital implemented remedial measures meant to prevent further losses. The hospital does not have reason to believe this was due to theft, the documents state.

Hospital reports from the period when fentanyl was being stolen indicate that patients being treated with the drug still received their prescriptions, according to the documents.

The missing drugs have led to several disciplinary actions.

The OPLC issued the emergency suspension of Chief Nursing Officer Amy Matthews on May 26 and the emergency suspensions of Pharmacist-in-Charge and Director of Pharmacy Melissa Siciliano and Pharmacist Richard Crowe on March 30.

According to the OPLC, neither Matthews nor Siciliano, whose license has been reinstated, have been implicated in the theft.

The OPLC investigation into the lost drugs implicated Crowe “as having played an integral role in the diversion and/or failure to report the diversion” of fentanyl solution, according to the document ordering his license suspension. He signed a preliminary agreement not to practice April 19.

An email The Sentinel sent to Matthews’ Cheshire Medical Center address for comment Friday returned an out-of-office reply, and attempts to reach her by phone were unsuccessful.

Siciliano resigned from her roles at Cheshire Medical Center and will remain an employee at Dartmouth-Hitchcock as the system clinical manager of pharmacy services, a letter she sent the state pharmacy board last month indicates.

Rick Fradette, a lawyer representing her, said Friday that she is cooperating with the ongoing investigation into the lost drugs.

Crowe could not be reached for comment by phone or email late last week.

A nursing board emergency license-suspension hearing scheduled for Matthews on Tuesday was continued after a request for additional time, according to OPLC documents. The hearing is now scheduled for June 23 with a prehearing conference scheduled for Thursday, the documents state.

The state pharmacy board is set to hold an adjudicative hearing for Siciliano on June 29 that will consider whether she committed misconduct and whether disciplinary action is warranted, a notice filed with the OPLC indicates.

The N.H. Board of Pharmacy is scheduled to consider whether to suspend or revoke Cheshire Medical’s pharmacy permit — required to run a pharmacy in the state — at the end of the month.