How theft ring stole millions of drugs from Emory

• 110 gallons of promethazine with codeine, a cough syrup. Codeine is an opioid. Promethazine fights allergy symptoms. The drug is combined with soda and a Jolly Rancher to make “purple drank,” a sweet concoction that gained popularity in southern hip hop clubs.

• More than 420,000 doses of alprazolam. Sold under the brand name Xanax, this sedative is prescribed to fight anxiety.

Source: Rick Allen, executive director, Georgia Drugs and Narcotics Agency; National Institute on Drug Abuse

The criminal drug scheme that ran from Emory University Hospital Midtown's pharmacy was the biggest that state investigators had ever seen at a hospital. Technicians ordered narcotics by the pint for the recreational drug concoction known as "purple drank." Security video shows them rolling cardboard cases of drugs on carts down Peachtree Street.

The five-year operation put an estimated $20 million to $40 million of the most addictive prescription drugs on the streets, at a time when the state's prescription drug epidemic was growing to deadly new heights, said Georgia Drugs and Narcotics Agency Executive Director Rick Allen. And it was entirely bankrolled, unwittingly, by Emory Midtown

“They should have known,” said Allen, a 40-year agency veteran. “You’re talking a massive amount of drugs out there. It boggles the mind.”

By the time Emory Midtown reported its suspicions to law enforcement in 2013, some 2 million doses of opiates and other addictive drugs had gone missing. The suspects — all hourly employees — were driving Mercedes Benz and BMW cars, Allen said.

The Georgia State Board of Pharmacy recently fined Emory Midtown $200,000 and put it on two-year probation, which could end much earlier according to terms the hospital reached in negotiations with the board.

But two years after the case was turned over to the Fulton County District Attorney’s Office, not a single person is behind bars, Allen said. The registrations for three technicians were revoked by the state pharmacy board, and at least one longtime pharmacist left her post, he said, although the public agreement mentions only two technicians.

Allen said he could not release the names of the employees involved at this time to protect the investigation.

Fulton County District Attorney Paul Howard did not respond to requests for comment.

Emory Midtown’s case is yet another example of how prescription drugs can be put to illegal uses at top brand-name hospitals, even when administrators think they’re following the rules. There are no statistics on how often these kinds of cases happen, in part because the hospitals hush them up, said Kimberly New, founder of Diversion Specialists, which advises hospitals on how to prevent prescription drug theft, which is often called drug diversion. They let problem employees go quietly and fail to report the thefts to law enforcement and regulators, she said.

But in recent years, the Mayo Clinic, University of Michigan Health System, and Massachusetts General Hospital have all had major problems. The U.S. Drug Enforcement Agency fined Massachusetts General — Harvard Medical School's largest training hospital — $2.3 million on accusations that its failure to follow basic rules allowed employees to steal drugs for personal use.

State and federal rules regulate the sale and distribution of controlled substances, but certain common-sense controls are not required, said New, who has written for the Centers for Disease Control and Prevention on drug diversion. Some states have published best practices, she said, but there is no national set of guidelines.

“The onus is on the hospital to say, ‘OK, we’re meeting the federal requirements, but we also want to do what we can to prevent diversion,’ ” New said.

After a high-profile diversion problem at the Minnesota-based Mayo Clinic health system, it instituted a set of stringent procedures that include surveillance cameras at loading docks, restricted access to pharmacy storage and the testing of drugs thrown away by staffers, said Dr. Keith Berge, chair of the hospital’s committee that assesses suspicious activity. He said drug theft declined because of the new rules.

“Any place these drugs exist, they’re under attack by somebody,” Berge said. “People are addicted and desperate and they’re smart.”

When diversion takes place, the results can be deadly. There was no evidence that patients were harmed in the Emory case, but nationally between 2004 and 2014, six disease outbreaks took place because hospital staffs injected patients with needles workers used to get high on drugs meant for patients, according to a CDC report, and more have been reported since. Dozens contracted the potentially deadly Hepatitis C virus.

“There is a terrible patient safety danger,” Berge said.

Emory Midtown stands apart from these other high-profile hospitals because workers typically steal drugs to feed their own addictions, not to sell them, experts said.

“This is different than a lot of the stories coming out of the hospital systems,” said Charlie Cichon, executive director of the National Association of Drug Diversion Investigators.

Scheme detailed

In a written statement Thursday, Emory said it had safeguards with “multiple levels of redundancies” in place during the thefts, and ordering, dispensing, auditing and payment oversight has since been strengthened. The hospital did not give specifics.

Here’s how Allen said the scheme worked. After the hospital placed a legitimate order with its wholesaler, Emory Midtown technicians would use a pharmacist’s password to make an illegal purchase. Once the wholesaler approved it, they would erase the second order from the computer systems.

Both orders would arrive at the same time, but with separate receipts, Allen said. The technicians would hide the paperwork from their portion and cart it away.

“If they’ve been doing this for a five years period — wow, they probably made quite a bit of money,” Cichon said.

The scheme may have gone unnoticed for longer had Emory Midtown not changed its financial accounting system, which helped administrators catch the suspicious spending within a month, Allen said. The hospital did not release how much money it lost, but Cichon said it could have easily cost it millions of dollars.

Now Allen wonders whether Emory Midtown was a top supplier in the region’s illegal prescription drug trade. After the bust, drug activity died down, he said.

“We can’t say for sure, but once this got caught, it dried up overnight,” Allen said. “There was no more supply.”