Nurse Dead, Medical Center Fined $2 million, Gallons of Fentanyl Stolen

Around Feb. 4, 2022, Alexandra Towle, a nurse in the Cheshire Medical Center’s ICU, self-reported that she had stolen fentanyl from Cheshire Medical Center, according to the New Hampshire N.H. Office of Professional Licensure and Certification (OPLC) documents. At that time, she signed a Preliminary Agreement Not to Practice medicine.

Towle died on March 3, 2022.

State licensure boards subsequently suspended the licenses of Cheshire Medical Center’s chief nursing officer and two other personnel after gallons of fentanyl solution went missing from the Keene hospital, according to OPLC.

The state’s medical licensing authority, which oversees the New Hampshire boards of pharmacy and nursing, issued the emergency suspension of Chief Nursing Officer Amy Matthews on May 26. It issued the emergency suspensions of Pharmacist-in-Charge and Director of Pharmacy Melissa Siciliano and Pharmacist Richard Crowe on March 30.

Documents ordering the suspensions state that hundreds of bags of fentanyl solution were stolen by a nurse. But according to the OPLC, neither Matthews nor Siciliano, whose license has since been reinstated, have been implicated in the theft.

Rather, the documents note the supervisory nature of their roles at the hospital and their responsibilities for safeguarding controlled substances used there.

The document ordering Matthews’ license suspension states: “To have such a significant amount of fentanyl lost under her management, even after remedial measures were implemented, indicates the Licensee is negligent and/or careless in her work such that she poses an imminent threat to the public health, safety, or welfare.”

The document ordering Crowe’s license suspension says that the OPLC investigation implicated him “as having played an integral role in the diversion and/or failure to report the diversion” of fentanyl solution. It notes he was responsible for reconciling the controlled-substance reports at Cheshire Medical between September and February.

A spokeswoman for the federal Drug Enforcement Agency confirmed an ongoing criminal investigation Thursday into the lost fentanyl. She declined to comment further on the investigation.

A spokesman for Cheshire Medical Center declined to answer emailed questions about the situation and responded with only a brief statement.

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

Since September, more than 7½ gallons of fentanyl solution from Cheshire Medical’s Intensive Care Unit have gone unaccounted for, much of which was stolen by the nurse, the suspension documents state. But not all 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 also impacted recordkeeping related to fentanyl and other drugs.

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

A preliminary agreement not to practice that she signed Feb. 9 states she stole 12 bags of fentanyl in October, 50 to 100 bags in November, about 100 bags in December and 200 bags in January.

She said in an email to an OPLC investigator that the drugs were for her own use as a way of coping with the stress of working during the pandemic, but that representation differs from what she provided to the hospital in a separate email, according to an OPLC document. In that email, she said she had given 12 bags of fentanyl to a friend, the document states.

Sometime between Jan. 31 and Feb. 4, the OPLC received complaints about the theft of fentanyl from the ICU, according to documents from that office.

On Feb. 2, the OPLC received a loss-of-controlled-substance form and letter from the hospital, indicating there were 23 bags, or 1,150 milliliters, of fentanyl solution that had been stolen, but that it expected those numbers to increase due to an ongoing internal investigation, the documents state.

In response to questions emailed to Siciliano, her lawyer, Rick Fradette, said she became aware of the theft of fentanyl on Feb. 1 and reported it to the board of pharmacy the following day.

Over the next few months, the hospital submitted at least three updated loss-of-controlled substance forms that by April 14 indicated a cumulative amount of lost/unaccounted-for fentanyl solution totaling 583 bags, or 7.7 gallons, all attributable to the period between September and January, according to OPLC documents.

Investigators with the OPLC held a meeting with hospital staff on March 8, during which staff explained that the spike in critically ill COVID-19 patients during the winter surge resulted in controlled-substance procedures not being enforced, according to the OPLC document reinstating Siciliano’s license.

Siciliano said she worked between 50 to 60 hours a week before the surge but more than 80 hours during it, the document states. She oversaw multiple machines that dispensed fentanyl solution to which hundreds of professionals had access, and some of the record-keeping discrepancies also arose due to software changes made by the hospital, according to the document.

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

In February and March, the hospital responded to the loss and theft of fentanyl by implementing remedial measures, including permanently locking the medication room, training nursing and pharmacy staff to prevent and detect theft and implementing a daily accounting of controlled substances, the OPLC documents state.

After these measures had been implemented, the hospital submitted another controlled-drug-loss form showing an additional 553 milliliters — or about 11 bags — of fentanyl solution had gone unaccounted for between April 10 and May 7, according to the documents, which state the hospital did not believe this fentanyl was stolen.

“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. “Patient and employee safety are always our first priority, and we have a zero-tolerance policy regarding the diversion of any controlled substance.”

Citing an inability to comment on personnel issues, Matthew Barone, spokesman for Cheshire Medical Center, declined to answer emailed questions that included whether Matthews, Siciliano or Crowe remain employed at the hospital. He also did not address questions about the medical uses of fentanyl solution at the hospital, the most recent total of lost fentanyl or the quantity of the drug the hospital kept in stock at any given time.

The board of pharmacy reinstated Siciliano’s license on April 20, according to the OPLC. But she has resigned from her roles at Cheshire Medical Center, as indicated in a letter she sent the pharmacy board dated May 25. She will remain an employee at Dartmouth-Hitchcock, which is affiliated with Cheshire Medical Center, as the system clinical manager of pharmacy services, that letter states.

Matthews could not be reached for comment. An email sent to her Cheshire Medical Center address returned an out-of-office reply, and attempts to reach her by phone were unsuccessful. Crowe also could not be reached for comment by phone or email.

The OPLC did not return multiple requests for comment about whether Matthews or Crowe have appealed the suspensions of their licenses.

On August 7, 2022, Cheshire Medical Center agreed to a settlement with the state Board of Pharmacy that will allow the Keene hospital to retain its pharmacy permit with some restrictions — in addition to paying over $235,000 in fines and fees.

In a statement, Cheshire Medical Center officials said the facility’s top priority is to deliver “high quality care and to provide a safe patient and employee environment.” “Cheshire Medical Center continues to make significant progress in the essential work of strengthening our controlled substance policies and practices,” Cheshire Medical Center said in a statement. “Since the theft of the controlled substance that we discovered and reported earlier this year, we have been intensely focused on taking steps to prevent future occurrences. These steps include extensive training and education of clinical staff, hiring specialized drug diversion specialists, and implementing new practices for oversight among other beneficial changes.”

We thank Ryan Spencer of the Sentinel Source for his reporting on this incident.