County of Door HUMAN RESOURCES County Government Center 421 Nebraska Street Sturgeon Bay, WI 54235 Kelly A. Hendee Human Resources Department (920) 746?2306 khendee@co.door.wi.ue March 24, 2014 Chris Jeanquart EMT?Paramedic RE: Disciplinary Action Discharge from Employment Dear Mr. Jeanquart: Door County's investigation is judged complete. it has been determined that, by virtue of your acts and omissions from on or'about January 9, 2014 February 5, 2014, you engaged in conspicuously bad, and arguably flagrant and dishonest, misconduct. Grounds for this determination are set forth in the records, reportsfand transcripts (of persons interviewed) that resulted from the investigation (a complete copy of which were provided at 'the Loudermill meeting on March 20, 2014 and incorporated by reference herein), and include the following: A. Tampering with Fentanyl Vials. 1. 0n?Thursday January 9, 2014 you went to the Door County Medical CenterPharmacy and picked up, among otherthings, ten (10) Fentanyl vials and then transported these vials to the Central Station (319 South 18th Avenue, Sturgeon Bay, Wisconsin) and placed these vials in the locked refrigerator. . 2. On Thursday January 9, 2014, or sometime thereafter, you went to the Door County Medical Center Pharmacy and obtained foil seal. . 3. Sometime from January 9, 2014, through January 20, 2014 you tampered with Fenta vials. Specifically, you: retrieved the Fentanyl vials from the locked refrigerator situated at the Central Station; removed the protective caps from the vials and applied glue (not approved for medical use) to the underside of each protective cap and reinstalled the protective capsg; injected glue (not approved for medical use) underneath the protective cap of each vial; placed a foil seal overthe top of each vial; a? returned the vials that you tampered with to the locked refrigerator. 4. By virtue of your tampering, you created an unacceptable risk that the vials of Fentanyl were contaminated and not sterile. B. Diversion of Fentanyl from Vials that You tampered With. C. [Ti 1. Your misappropriation of Fentanyl from approved and/or legitimate patient usage, through substitution or theft. 2. The red flags that point to you as a (or the) culprit include: a) Your prior reporting and subsequent discovery of a ?missing? which showed clear evidence oftampering and diversion. . b) Your access to, and custody and control of, the Fentanyl vials at issue here. c) The'Fentanyl vials at issue here showed no evidence oftarnpering or diversion prior to your tampering with the same. d) Subsequent to your admitted tampering, it would have been virtually impossible to remove Fentanyl from the vial and substitute without damaging the foil seal, protective cap and/or vial..l\lo such damage was noted. e) Subsequent to your admitted tampering, there was at least one patient complaint about pain control or reporting decreased pain control a?er being administered Fentanyl. A number of the vials, that showed evidence of your tampering, were tested. These tests (initially field tests, which were follot-ved?up with testing performed by NMS Labs) revealed and subsequently confirmed the finding of diversion. 3. The evidence indicates that it is highly probable, and We are reasonable certain, that you are the primary culprit with respect to the divarsion of Fentanyl. rentanyi vial (in October 2013) You Knowingly Placed these Tempered and/or Adulterated Vials of Fentanyl, into Service. 1. By your actions, as described herein, you left these vials of Fentanyl in the system, to be used by unsuspecting EMT~Paramedics on unknowing patients members ofthe general public). 2. In so doing, you exposed patients members of the general public) to the unacceptable and adverse risk of being administered contaminated and/or compromised medication. 3. Two patients (and possibly more) actually received contaminated (not sterile) and/or medication (incorrect dose of, or something other than, Fentanyl). In one ofthe instances, you were one (oftwo) EMT-Paramedics administering emergency medical serviCes to the patient. 4-. If one makes the reasonable assumption that the patients required the drug (here Fentanyl) that was intended to be administered to them, the absence ofthe drug entirely or dilution of the drug such that they receive a dosage less than that intended would likely result in the patient experiencing undue pain and/or anxiety, at least temporarily. You engaged in conduct, as described herein, that was dangerous or detrimental to the health or safety 0 a patient orto members of the general public; You engaged in conduct, as described herein, that wasmj authorized by the EMS Operational Plan, EMS Policies and Procedures (including Controlled Substance Documentation and inventory Procedures and/or 235.0 Incident Reports), the EMS Director, or the EMS Medical Director. You engaged in Conduct, as described herein, that did not constitute legitimate EMS (EMT?Paramedic) practice and was not otherwise authorized by law. - You failed to report or document your actions until January 29, 2014, When you approached Anthony Luchini (Acting Director and Operations Manager of Door County EMS) at the Central Ambulance Station. At that time you informed Mr. Luchini that you had placed glue under and placed foii seal over the protective caps on the vials of Fentanyl. You also acknowledged that you should have not done this. . As an EMT?Paramedic, you have the highest level of education, training, certification or licensure..ln fact, EMT~Paramedics are the only EMS personnel authorized to administer controlled substances, such as Fe ntanyl, to patients. - . . - .- 3 I 1. You?ve been a working EMT?Paramedic for more than 18 years. During this time per rod you nave successfully completed numerous courses of instruction and training, including the education and training required for certificate or license renewal. J. You knew, or reasonably should have known, based on your education, training, experience, and certification or licensure, that: l?A The primary purpose of the protective cap on each vial of Fentanyl is to safeguard against contamination; - 2. Once the protective cap is damaged or removed, or a foreign substance(such as glue not intended for human use) is introduced to the underside ofthe protective cap, there is potential for contamination and the vial is compromised; That a compromised vial of Fentanyl is not to be administered to a patient, rather such should be removed from service and wasted; gird A. That tampering with or the diVersion of a controlled substance is neither lawful nor appropriate. UJ K. Nothing, in your education, training or experience would even hint or suggest that your conduct, as described herein, was remotely appropriate. Rather-than the exercise of an abundance of caution that is required in matters involving controlled substances and emergency medical care, your conduct, as described 4 herein, retlects ot the very least negligence the failure to take the care that a responsible person usually takes) if not recklessness. L. As an EMT?Paramedic, you are subject to Ch. 256, Wis. Stats. and Ch. DHS 110 Wis. Adm. Code. You engaged in conduct, as described herein, that was inconsistent with the standards set forth in Ch. 256, Wis. Stats. and/or Ch. DHS 110, Wis. Adm. Code, including conduct described in Sec. 110.54, Wis. Adm. Code. M. As an EMT-Paramedic, you are held to minimally acceptable standards of conduct, including those. described in Ch. 256, Wis. Stats. and Ch. DHS 110 Wis. Adm. Code. These standards of conduct are reasonably necessary for the protection of patients and the public. Your conduct, as described herein, falls far short 0 these minimally acceptable standards of conduct for any EMT~Paramedic, much less one with your education, training, and experience. i ,c N. Other factorsjudged to be aggravating include: Your conduct, as described herein, was deliberate over a period oftime, and not the result of a mere momentary lapse ofjudgment. I 2. Your conduct, as described herein, has an element of dishonesty. This includes: constructing and perpetuating the that there was a significant issue with Fentanyl viai caps, and creating a ?problem? to fit your ?solution? (glue and foil); offering inaccurate explanations and assurances to co-workers to avoid suspicion and detection; gild diversion and substitution, which involves representing the vials as containing. a specified quantity of Fentanyl while knowing full well the vials do not. Your most egregious misconduct, tampering and diversion, involved acts of commission not omission. This is a situation where the commissionuomission distinction makes a difference and indicates an intent on your part to tamper with and divert Fentanyl from the vials. SJ.) 0. Door County EMS Medical Director Dr. George MD has or will withdraw your credentials, consistent with Sec. DHS 110.52i6) Wis. Adm. Code. 1. Being credentialed,'per DHS 110.52 Wis. Adm. Code, is a condition precedent to an individual providing emergency medical care as an EMT?Paramedic for a particular emergency medical services provider. .- 2. As a consequence of the withdrawal of your credentials, you are no longer able L0 perform the essential functions of yourjob emergency medical care) with Door County EMS. P. Door County EMS must, per DHS 1.1052(7) Wis. Adm. Code, notify the Wisconsin Depaleth Health Services that its Medical Director has withdrawn your credentials. The Wisconsin DHS, in turn, may conduct an investigation and take enforcement action against you as it deems appropriate- consistentwith Ch. DHS 110, Wis. Adm. Code. 1. Such enforcement action includes warning letter, reprimand, limit the actions you would otherwise be authorized to perform, refuse to renew, suspend (summarily or otherwise) or revoke an individual's certification, license or permit. - 2. The Wisconsin DHS action(s) may result in your being unable to perform emergency medical care in Wisconsin. U.S. Department ofiustice Drug Enforcement Administration 1. DEA has regulatory authority over emergency medical service providers. 2. Door County EMS is required to notify DEA of any suspected controlled substance tampering or diversion. DEA may initiate an investigation. Enforcement action (informal or formal) by the DEA may result. R. The potential conseqUences of your conduct, as described herein, to Door County EMS are significant. These - I .- - . potentral consequences Include: enforcement action (by DHS or DEA) and l'ESUlLlI'lg monetary nnes and injunctive relief; placing Door County approval to operate in jeopardy; and placing Door County at risk for civil liability related to patient care. Just cause exists for disciplinary action. This letter is intended as a written notice of your discharge rrom employment with Door County effective March 24, 20111.. A copy of this letter has been furnished to Michael Woodzicka, Please contact me if you have any questions or comments. Respectfully; KellyHen ee Human resources Director_ .cc: Michael Woodzicka, Human Resources Department File Danny Williams, Director, Door County EMS Dr, George MD, Medical Director, Door County EMS Grant P.Thomas, Corporation Counsel I acknowledge recer' of the original of-thfs letter this day of 2014. ?erc" . 7157'? Chr/r's Jeanqu rt. Emergency Sewices ot Door County 319 S. Sturgeon Bay, WI 54235 COPY re: Withdraw ot Credentialing 110.52 Wisconsin Administrative Code] George MD Medical Director Chris Jeanquart Mr. Jeanquart: This letter is intended as notice that, effective March 24, 2014; your credential is hereby withdrawn pursuant to DHS 110.52 Wisconsin Administrative Code. You are no longer authorized to provide emergency medical care for Door County Emergency Medrcal Services. i have determined that you engaged in condUct that is dangerous or is detrimental to the health or safety of a patient(s) or member?(s) or" the general public, while acting under the authority or" your certificate or license for Door County Emergency Medical Services. Grounds for this determination are set forth in Door County Human Resources Director ?Hendee?s March 24, 2014, letter of discharge _a_ng the records, reports, and transcripts (of persons interviewed), resulting from Door County?s investigation, all of which are incorporated hereinby reference. Consideration was given to withdraw or" your credentials for remedial training. in light of the nature of your miscondUCt, haVe concluded that remedial training is not an appropriate or viable option. As mandated, the Wisconsin Department of Health Services will be notified that have withdrawn your credential; DHS may proceed with an investigation and take whatever action it deems necessary consistent with DHS 110.53 110.58, Wisconsin Administrativ ?er. I . fGe?rge Medical Directer, Dag County Emergency Medical Services