Cheshire Medical Center reached a settlement with the NH Board of Pharmacy late last week, allowing Keene Hospital to retain its pharmacy license with various restrictions, including regular audits of its controlled substances, and pay up to $235,000 in fines and fees.
The Dartmouth Health branch’s pharmacy license was at stake after the state pharmacy board learned earlier this year that gallons of fentanyl solutions had been lost or missing from the hospital since last fall.
According to documents from the NH Office of Professional Licensure and Certification, the board of directors voted on May 25 “to initiate disciplinary action” against Cheshire Medical for the drug losses.
A pharmacy license is required to operate a pharmacy in New Hampshire, including those that hospitals operate internally for dispensing medications to inpatients.
Cheshire Medical reached a settlement agreement with the board of directors on July 28, which, if obeyed, will resolve all disciplinary action against the hospital related to the drug loss.
In the 12-page settlement, the hospital acknowledged that the months-long incident “could constitute grounds for the Council to impose disciplinary sanctions”.
The drug loss at Cheshire Medical dates back to last September, with approximately 8.8 gallons of fentanyl solution reportedly in the hospital on June 5. An ICU nurse herself reported in February that she had stolen hundreds of bags of the drug.
However, following the nurse’s death in March and after corrective action was taken, OPLC documents state that drugs are still missing.
Cheshire Medical admitted in the settlement that the additional drug loss “was due to nurses not adequately documenting the administration or wastage of fentanyl”. The settlement also notes that a surge in COVID-19 patients last winter presented unprecedented challenges to the pharmacy’s operation.
Under the terms of the settlement, Cheshire Medical’s pharmacy license is limited to three years.
Those restrictions require the hospital to employ a council-approved external monitor by October to conduct audits on controlled substances. These assessments will be made weekly for the first four months and monthly for the following eight months, the settlement said. For the remaining two years, the audits will be conducted on a quarterly basis.
In addition, Cheshire Medical must appoint two different employees for the positions of Chief Pharmacist and Pharmacy Director. During the time of the drug loss, both roles were filled by Melissa Siciliano, who also recently reached a settlement with the board after previously undergoing disciplinary sanctions.
The hospital can petition the state board after two years of compliance with the restrictions to have them lifted, the settlement notes said.
Cheshire Medical’s agreement also requires it to pay a $225,000 administrative fine, though all but $45,000 will be suspended if the hospital adheres to the settlement. That $45,000 must be paid within 30 days. The hospital must also pay the costs of investigation and prosecution, totaling $10,000, within 30 days.
The settlement also requires Cheshire Medical to continue its investigation into the drug loss.
That criminal investigation, by the Drug Enforcement Administration, is ongoing, a federal agency spokeswoman said Monday.
“Our top priority is to provide high-quality care and provide a safe patient and employee environment…” the hospital said in a written statement on the settlement Monday. “Since the controlled substance theft we discovered and reported earlier this year, we have been intensely focused on taking action to prevent future events.”
These steps, the statement says, include extensive training and education of clinical staff, hiring specialized drug abuse prevention specialists and implementing new surveillance practices.
In connection with the drug loss, the OPLC has disciplined several other Cheshire Medical employees in their oversight role. Other than the ICU nurse, no hospital workers have been accused of stealing the drugs themselves.
Van Siciliano, the former pharmacy director and pharmacy manager, had her license suspended in March and reinstated in mid-April. She reached a settlement agreement with the state on July 20, requiring her to pay a fine and a three-year ban as a chief pharmacist.
Prior to that settlement, Siciliano resigned from her role at Cheshire Medical. She still works at the pharmacy, according to her attorney, Rick Fradette, who declined to say where she works.
The pharmacy board also suspended pharmacist Richard Crowe’s license in March. On the same day as Siciliano, he reached a similar settlement with the state council, banning him from practicing his profession as a hospital pharmacist and paying a fine.
Amy Matthews, Chief Nursing Officer of Cheshire Medical, was granted an emergency license suspension in late May, but after a hearing with the state board of nursing in June, she got her license back.
Matthews is no longer the hospital’s head nurse.
Anne Tyrol, associate chief nurse officer at Alice Peck Day Memorial Hospital in Lebanon — also a subsidiary of Dartmouth Health — is Cheshire Medical’s acting chief nurse, spokesman Matthew Barone told The Sentinel on Thursday.
He has continually declined to say whether Matthews is an employee at Cheshire Medical, citing a “longstanding practice… [to] not comment on specific questions regarding staffing.”
This article has been updated with comments from the Cheshire Medical Center.
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