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Keene, N.H.-based Cheshire Medical Center will pay $2 million in connection with an incident in which gallons of fentanyl solution were lost or unaccounted for in a four-month period.

The investigation began after a nurse stole 23 intravenous bags of fentanyl solution from a dispensing machine, according to a June 21 Justice Department news release. The hospital disclosed the theft to the DEA in February 2022 and later reported that an additional 634 bags were unaccounted for.

Cheshire Medical said it beefed up security in February and March of 2022 to avoid similar losses, but state regulators said another 11 bags were lost between March and June. The nurse who allegedly stole the drugs died March 3, 2022.

In April, the DEA conducted an audit of the eight controlled substances at the inpatient pharmacy. The audits found an additional 17,961 missing controlled substance units and several “record-keeping deficiencies, such as failing to maintain accurate purchase and dispensation records.” The hospital also failed to regularly review reports to look for possible diversion and did not enforce various controlled substance security policies, the release said.

Since the investigation was launched, the chief nursing officer, pharmacy director and a pharmacist were disciplined and no longer work at the hospital, New Hampshire Public Radio reported June 21.

Chief Nursing Officer Amy Matthews, DNP, RN, had her license temporarily suspended in May 2022, though it was reinstated in June 2022. However, she was replaced as CNO in June 2022.

Melissa Siciliano, PharmD, the hospital’s pharmacy director, temporarily had her license suspended, but it was reinstated by June 2022. On July 20, she reached a settlement agreement with the state’s pharmacy board in which she admitted to failing to control all drugs issued or dispensed in the pharmacy and to not properly supervising employees with prescriptions. Under the agreement, she must pay a $1,000 fine, participate in education courses on controlled substance security and is prohibited from serving in a pharmacist-in-charge role for three years.

The $2 million the hospital is set to pay resolves allegations that it violated the Controlled Substances Act.