Nurses who steal opioids win their jobs back because addiction is a disease, the rules of the arbitrator


On the summer morning of 2016, a nurse at a long-term care facility in Waterloo, Ontario, saw the lights on in the bathroom she was going to use.

He waited, knocked several times, then opened the door, where he saw another nurse sitting on the toilet with an ampoule of painkillers Hydromorphone sideways in his mouth, as if he had just injected himself.

This is one of the earliest proofs that nurses, identified in legal records only as DS, have for two years stolen opioids for their own use and fabricated medical records to conceal theft.

Now, in a decision that has sparked a debate about whether addiction really is a medical illness, a labor arbitrator has ordered Waterloo City to give his job back, and to financially compensate for his unfair dismissal, including general damage to injury dignity, feelings and self-esteem. "

Nursing homes have a duty to accommodate undoubted nurse diagnoses about severe opioid use disorders and mild to moderate hypnotic use of sedative disorders, said arbitration arbitrator Larry Steinberg. This disease has left him with "total inability or reduced capacity" to resist the urge to feed his addiction.

He will, for example, file fake documents that show residents have asked for narcotics, then falsify the chart to show that they have received it, when in fact he uses it himself. He will also keep a part of the narcotics that is not used, rather than throw it away.

Faced with management, the nurse, a mother of three 50-year-old children, initially denied but later admitted her actions, which she said were related to the abuse of painkillers that began when she was treated for kidney conditions. He became very addicted, looked physically ill, and isolated himself from his family. About a month later, Sunnyside fired him for serious violations and theft.

At his trial, DS testified that he had not used narcotics since now in the late summer of 2016, when he entered housing rehabilitation.

His nursing permit was suspended for about nine months, and re-enacted with a series of conditions including that he did not have access to substances that were controlled and monitored at all times.

Lawyers for nursing homes argue that letting him go back to work with these conditions will force "undue hardship" in the nursing home. Every nurse has access to narcotics, for example, and some patients in advanced dementia, so they will not see if a nurse removes their fentanyl fillings. Furthermore, nurses need to work independently, not constantly monitored.

The nursing home also believes that he was not fired because of his addiction, and that did not play a role in that decision. He was fired for theft and falsification of records, citizen abuse and breach of trust, he said. But the arbitrator doesn't buy it. The nurse's action is a symptom of an addiction, and is discriminatory in firing someone because of his illness.

An expert hired by the region, Lawrie Reznek, a professor of psychiatry at the University of Toronto, testified that addiction is not a disease but rather a bad habit, although he "acknowledges that this is a minority view in the psychiatric profession and that it is contradictory, for example, with DSM-5, "psychiatric manual.

His view rejected by the arbitrator that supports the views of two other experts who testify to addiction is seen as a health condition, and that "looking (addicted) as a bad habit stigmatizes this condition and makes it difficult for people to get help," Steinberg wrote.

But Reznek is not alone in his view. For example, Marc Lewis, a Canadian neuroscientist and recovering addict who studies the development of addiction, argues that addiction is not a disease, but a "cascade of development," such as a form of learning. In his book The Biology of Desire, he opposes the fatalistic view that addiction is an intrinsic part of one's nature, or a biological or natural disability. Conversely, addiction is the result of "motivated repetition of the same thoughts and behaviors until they become habits."

In that case, he argues that addiction is more like racism than cancer, and is more like violence or domestic violence compared to cystic fibrosis or diabetes. No matter how comfortable it is to regard addiction as a disease, it is only "a very bad habit."

The disease model is grounded in both science and clinical practice. This is more than just a sympathetic metaphor that reflects the desire to help rather than judge.

Population level studies have shown a clear genetic basis. Addiction has clear environmental, epidemiological and social factors. It can change the structure and function of the body and brain. He can respond to systematic, biological, medical treatments, such as cancer or flu. This of course has terrible symptoms and can often be fatal.

The view that it is an established disease in Canadian society. When the Canadian government argued in court against a supervised injection site in Vancouver, for example, they recognized that addiction was a real disease. And when the Canadian Supreme Court ruled in this case, it was concluded that "the ability to make a number of choices (about drug use) does not negate the findings of court judges that addiction is a disease in which the main feature is impaired control over the use of addictive substances."

But the court does not always follow these instructions.

In his coverage of this and other similar cases, Waterloo Region reporter Gordon Paul identified a variety of results for nurses who stole opioids to feed their own addiction.

One person who stole a painkiller from an advanced cancer patient, was convicted of theft, was suspended as a nurse for five months, and finally resigned after College said he was embarrassing the profession. Another person who stole medicine from a dying teenager was revoked from his nursing license and spent 18 months in prison for theft, drug costs, violations of trust and disruption to driving. Others were sentenced to two years in prison.

In the current DS case, there is some uncertainty in the examination whether he "shortens" the patient, or gives them less than needed to save some for himself, but the adjudicator does not resolve this question, because it is irrelevant to the problem he must decide.

DS also testified that he was sorry and embarrassed by his actions.

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