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Patient safety has always been and continues to be our number one concern at Boulder Community Hospital. That’s why we were outraged to learn last fall that a surgical nurse had been stealing and tampering with a pain medication called fentanyl. This crime specifically occurred between September 24 and October 23, 2008, and was limited to the surgery department on our main campus at Broadway and Balsam in Boulder. The nurse, Ashton Paul Daigle, was terminated on October 24 and turned over to the authorities. The hospital sent affected patients a letter alerting them to the tampering. The letter stated that sterile saline had been substituted for the fentanyl, which was our understanding at that time based on interviews we had conducted with Daigle. Boulder Community Hospital is committed to helping victims and the rest of the community stay informed as this case continues to unfold. In addition to direct communication with patients potentially affected by this nurse’s actions, we have developed this Web page to provide answers to important questions. We will continue to share more information as it becomes available and encourage you to subscribe to our  RSS Feed to receive updates as soon as they are posted. Update March 5, 2010 – Daigle Sentenced to 4½ years in Prison Ashton Paul Daigle was sentenced today to four-and-a-half years in federal prison. He will also serve three years of supervised release following his prison term. He pleaded guilty in June 2009 to five counts of tampering with a consumer product and one count of creating a counterfeit controlled substance. We are relieved that Daigle has finally been brought to justice. This has been a long stressful period for our patients and our staff. Daigle’s actions were despicable and we would like to apologize again to the patients who were impacted. Since his arrest in October 2008, Daigle has been tested for HIV and hepatitis three times; the results of all tests were negative. These test results show there is no evidence that hospital patients were exposed to either hepatitis or HIV from Daigle’s crime. The last test was conducted in October 2009. According to both the Centers for Disease Control (CDC) and Boulder Community Hospital’s infectious disease specialist, nearly all indications of an HIV or hepatitis infection would have been identifiable within six months of exposure. This last test took place more than a year after Daigle was terminated by the hospital, which means it was conducted more than a year after the last time he could have possibly infected any BCH patients. Update February 23, 2010 – Sentencing Date Rescheduled The sentencing hearing for Ashton Daigle has been rescheduled by the U.S. Attorney’s Office. The new date is March 5, 1 p.m., at the Alfred A. Arraj Courthouse in downtown Denver. Update November 6, 2009 – Sentencing Date Rescheduled The sentencing hearing for Ashton Paul Daigle has been rescheduled by the U.S. Attorney’s Office. The new date is Feb. 24, 2010, at 9 a.m. at the Alfred A. Arraj Courthouse in downtown Denver. Daigle pleaded guilty last June to five counts of tampering with a consumer product and one count of creating a counterfeit controlled substance. Update November 5, 2009 – Final Test Results Negative Ashton Paul Daigle has tested negative again for HIV and hepatitis during a third and final round of medical testing. These test results show there is no evidence that hospital patients were exposed to either hepatitis or HIV from Daigle’s crime. The hospital does not plan to ask for any further testing of Daigle. According to our infectious disease specialist and the U.S. Centers for Disease Control, nearly all indications of an HIV or hepatitis infection would have been identifiable within six months of exposure. This last test took place more than a year after Daigle was terminated by the hospital, which means it was conducted more than a year after the last time he could have possibly infected any BCH patients. The hospital sent affected patients a letter informing them about these new test results. Update September 30, 2009 - Pandora Software Specialized Pandora software is now being utilized to expose potential diversion by detecting unusual activity patterns at Pyxis Med Stations. Reports produced by Pandora are reviewed daily and any questionable usage patterns are investigated by Pharmacy staff and the appropriate Nursing director. Pandora reports include the amount of medication removed, removal frequency, maximum dosages, waste, discrepancies, unused medication activity, returned medications and witnessing activity. Update August 4, 2009 - Surveillance Cameras Installed Video cameras have been installed to monitor activity at numerous Pyxis Med Stations throughout the hospital. The identity and actions of Med Station users are captured and stored on video files that can be reviewed when necessary. These cameras provide an additional layer of security for Med Stations in more isolated areas of the hospital. Update June 2, 2009 - Daigle Reaches Plea Agreement With U.S. Attorney Ashton Paul Daigle pleaded guilty to five counts of tampering with a consumer product and one count of creating a counterfeit controlled substance in U.S. District Court yesterday in Denver. The former surgical nurse is scheduled to be sentenced on October 26, 2009. He faces up to 70 years in prison. Patient safety has always been and continues to be our number one concern at Boulder Community Hospital. Despite all of our pre-employment screening and drug dispensing precautions, Daigle violated all measures of professional and personal accountability to circumvent the system and steal drugs. This incident has reinforced our commitment to patient safety. Boulder Community Hospital has always followed national guidelines for drug safety. We are constantly looking for new ways to improve patient safety. Boulder Community Hospital would like to thank our staff for bringing this crime to the attention of hospital leadership and the authorities. We will continue to use this Web page to keep our community apprised of new details in this case. Update May 5, 2009 The hospital was provided the results of the latest tests authorized by the U.S. Attorney’s Office to evaluate Ashton Daigle for signs of infectious disease. Mr. Daigle again tested negative for HIV and both Hepatitis A and C. It had been previously reported to patients that Mr. Daigle has immunity to Hepatitis B, and this test reaffirmed that he is not a carrier. Nearly all indications of an HIV or Hepatitis C infection would be identifiable within the first six months after exposure. According to the hospital’s infectious disease specialist, the probability that hospital patients were exposed to either Hepatitis or HIV from Mr. Daigle’s actions is highly unlikely after two negative tests over this time period. The hospital sent affected patients a letter alerting them to these new test results. In that letter, victims of this crime were offered free testing for HIV and Hepatitis at their request. Update March 26, 2009 Contrary to Daigle’s original story to hospital officials, federal prosecutors learned during their investigation that he allegedly used needles on himself that were also involved in replacing stolen medication with saline or water—an action that may increase the potential for transmitting an infectious disease. Fortunately, Daigle has tested negative on multiple occasions for infectious disease. Daigle was tested for HIV by Boulder Community Hospital on November 7, 2008. According to the U.S. Attorney’s office, he was retested for HIV on February 24, 2009. The results of both tests were negative. According to the hospital’s infectious disease specialist, the two negative test results indicate that there is a very low risk that any victim has been exposed to HIV from this crime. The hospital’s pre-employment testing of the nurse on June 4, 2008 confirmed that he had documented immunity against Hepatitis B. Daigle was also tested for Hepatitis C on November 7 and those results were negative. Based on those two results, it is very unlikely that victims of this crime have been exposed to hepatitis. The hospital has been told by the U.S. Attorney’s office that another test for hepatitis is scheduled for the near future. The U.S. Attorney’s office also has informed us that an additional set of tests for HIV and hepatitis will be performed before the former nurse is sentenced. We will communicate the results of those tests as soon as we learn about them. The hospital has offered the victims of this crime free testing for HIV and hepatitis at their request. Frequently Asked Questions Q: I had surgery during the time of this incident (Sept. 24-Oct. 23, 2008). What does that mean for me? A: The hospital has analyzed its surgical records and identified any patient who was prescribed fentanyl during surgery and may have been affected by this crime. These patients have been notified by mail. The drug tampering was confined to the surgery unit at the main hospital on Broadway and Balsam. No other facilities were involved. We will continue to share details of the hospital’s safety improvements via this Web site to ease fears that this could happen again. Q: What if I had surgery during another time and/or at another Boulder Community Hospital location? A: Our records indicate that the drug tampering only affected patients who had surgery from Sept. 24 to Oct. 23, 2008, at our main campus on Broadway and Balsam. No other surgeries were impacted by this crime. Q: Are patients who had surgery during the timeframe of this incident at risk for developing an infectious disease? A: According to the hospital’s infectious disease specialist, the fact that Daigle has tested negative on multiple occasions for HIV and hepatitis indicates that there is a very low risk that any victim has been exposed to either infectious disease from this crime. The hospital has offered victims of this crime free testing for HIV and hepatitis at their request. Q: What can happen if a patient does not receive the prescribed level of fentanyl? A: Anesthesiologists administer a mix of medicines before, during and after surgery. During surgery, they use multiple technologies to determine the safest and most appropriate amount of medicine for each patient. Pain medicines are only a part of any anesthetic. Fentanyl is one of many pain management drugs available and is commonly used because it typically provides quick pain relief. Its effect is realized within two-to-three minutes and lasts about 30 minutes.
During surgery, anesthesiologists use sophisticated monitors, direct observation and many years of training and experience to determine if administered drugs are having the desired effect. If any drug appears not to be working (which is not uncommon due to variability between patients), then additional doses of that drug or a different drug will be given until the desired effect is achieved. Before and after surgery, patients are able to directly communicate about their level of pain and the effect of the medicines given. If at any point a particular pain medicine does not seem to be effective for a specific patient, then a different one would be used. (This happens with all pain medicines.) It should also be noted that there was no evidence of tampering with any medicines in the Post-Anesthesia Care Unit (Recovery Room), so any post-operative pain problems would be due to variable patient response to medicine and not a failure to receive the prescribed medicine. Q: How did the hospital notify patients after you learned about Daigle’s actions? A: After terminating Ashton Daigle, Boulder Community Hospital reviewed our surgical records to identify patients who might have been affected by this crime. The hospital sent affected patients a letter alerting them to the tampering. During its investigation of the crime, the U.S. Attorney’s office created a videotape of Daigle talking about how he was able to steal drugs at Boulder Community Hospital. Victims of the crime were invited by the U.S. Attorney to view the videotape at the U.S. Attorney’s office. Hospital representatives saw the video for the first time on February 17, 2009. Regrettably, a misunderstanding between the hospital and investigators delayed further hospital-initiated notification to patients until March 18. To prevent delays in the future, Boulder Community Hospital will be more proactive with communication, including updates to this Web site. Q: Didn’t the hospital run a background check on this individual before he was hired? A: It is standard procedure at Boulder Community Hospital to conduct a pre-employment criminal background check in the counties and states where the applicant lived for the previous seven years. Daigle’s background check revealed no criminal records. We also check the National Crime Index and sex offender registry, which include searches on the Extended Parties List System (EPLS) and the U.S. Department of Health and Human Services sanctions list. No records were found for Daigle. Furthermore, we verified that he had an active registered nurse license in the state of Colorado and checked his professional references, receiving no negative information. Once these background checks are complete, an applicant is then required to complete a post-offer, pre-employment health screening, which includes both screening for infectious diseases and drug testing. Daigle underwent all of these tests and the results were all negative. Despite these precautions and many others, Ashton Daigle violated all measures of professional and personal accountability to circumvent the system and steal drugs. Q: What precautions are in place to keep hospital staff from stealing drugs? A: Pyxis is an automated medication dispensing system that controls and tracks usage of medications and narcotics. It is a popular system that many hospitals use to secure drugs and has been used by Boulder Community Hospital since 1996. Medications in Pyxis machines are accessed through a protected password or biometric, like a fingerprint, to allow specific medical personnel limited access to the requested drug. These machines are designed to limit medication access, document usage and waste and maintain inventory. The Pyxis system is constantly evolving to prevent misuse. Daigle manipulated an older version of our drug-dispensing machine during a small window of time before the hospital completed the installation of a new system. Q: How can a patient be sure this won’t happen again? A: While Boulder Community Hospital has used the Pyxis system for 13 years, we recognized the need to upgrade the system and budgeted $2 million in 2008 to complete three phases of installation. Starting in May 2008, the Pharmacy Department had been implementing new machines throughout the hospital, working on the installation of a new narcotic vault within the main pharmacy and training staff on related new procedures. Unfortunately, the new Pyxis Anesthesia System for the Surgery Department at Boulder Community Hospital was scheduled to begin installation at the end of 2008—which was after surgical nurse Daigle was caught stealing fentanyl. That installation was completed in February 2009. The new system for the Surgery Department utilizes an innovative dispensing drawer design that only allows access to the exact number of narcotic vials being requested. Any unused or unopened vials must be placed in a return bin that is accessible only to pharmacy staff. Any opened vials with remaining drugs must be properly disposed of with a witness. In addition, the new narcotics vault and Pyxis systems allow Pharmacy staff to run detailed reports on average medication usage. This allows Boulder Community Hospital to identify any personnel withdrawing abnormal amounts of drugs, over utilizing certain functions on the machine or not checking in drugs properly. These are just some of the specific changes that were underway before the fentanyl theft and have since been completed. The hospital continues to review security systems, pharmacy protocols, training programs and human resources policies to constantly evolve our ability to deliver maximum safety and the best possible care to each patient. We will continue to review our procedures to ensure they are working and look for new ways to improve patient safety. Q: On the videotape created by the U.S. Attorney’s office, Daigle talks about using “wasted drugs” prior to tampering with Pyxis machines. What does that mean? A: The term “wasted drugs” refers to any medication that is left over after a medical procedure. In Daigle’s videotaped interview with federal prosecutors, he explained that he began stealing wasted drugs from the hospital’s Surgery Department shortly after he was hired. While there is no reason to believe that his possible theft of wasted drugs had any impact on patients, the hospital is continuing to investigate the situation and taking steps to further secure our medications. The only crime that the U.S. Attorney’s office is currently prosecuting is Daigle’s tampering with the fentanyl in the Surgery Department’s Pyxis machines. Do you have a question that was not answered here? Please e-mail us. Media representatives can call Rich Sheehan at
303-441-0503. Return to Top
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