An employee of a Nashwauk nursing facility stole narcotic medications from four patients, sometimes replacing the missing drugs with over-the-counter Tylenol, according to a report from a state investigator.

The report from the Minnesota Department of Health’s Office of Health Facility Complaints found maltreatment was substantiated at Hillcrest Terrace in Nashwauk. Although the investigator found the facility in “noncompliance” with state regulations, only the individual employee was deemed responsible for the maltreatment. The employee was not named in the report, which was forwarded to Nashwauk police, the Nashwauk city attorney, the St. Louis county attorney and the Drug Enforcement Administration.

Jessica Fralich, Range division head for the St. Louis County Attorney's Office, said local law enforcement agencies have "active investigations" into the allegations.

Jim Clark, who represents Hillcrest owner Range Development Co., said Tuesday that facility staff uncovered the drug diversion last March and immediately reported it to state authorities. The employee was fired, Clark said.

The company had replaced its administrators in December 2018 and January 2019, Clark said, and the nursing director in Nashwauk had only been on the job a short time when the incident was uncovered. In its wake, Range Development hired a consultant for direction on how to increase oversight of medications, and the Hillcrest facilities have implemented those recommendations, he said.

“We've spent hundreds of thousands of dollars to make sure that everything is fixed and up to date following the recommendations of the consultants,” Clark said.

A second investigative report states that drug diversion was found involving a single client at Hillcrest Terrace in Hibbing. It’s not clear if that report involved a second employee or the same employee working at both facilities, but the descriptions of the theft of medications are similar. In both cases, the investigator’s report was concluded on Jan. 23 and posted online by the health department on Tuesday.

The report on the Hibbing case states that the victim suffered from pain related to dementia and osteoarthritis and had been prescribed an opioid to be taken as needed but no more often than every 12 hours. The client said she only takes the medication when it “hurt bad,” the investigator wrote and said “she trusted the staff to give her the right medication as ordered.”

But staff had discovered that the pills in the client’s pill case “appeared to be Tylenol 325 mg” rather than the prescribed drug. The facility’s nurse confirmed that the three remaining pills in the case were Tylenol, not the opioid pain reliever. Staff also discovered that the initials on the patient’s controlled substance log “were fraudulently recorded by someone else.”

The four cases cited in Nashwauk were similar. A client with knee pain, chest-wall pain, arthritis and lower-back pain had a prescription for Norco, a narcotic pain medication, to be taken up to twice a day as needed. The client reported she had not taken the pain medication for weeks, but the employee had signed out the medication four times during the previous month. That was co-signed by another employee, who told the facility manager that the signature was not hers.

Another client who had a fracture of the right femur and lower-back pain was supposed to be given a dose of the opioid pain medication hydrocodone three times a day. But again, staff discovered over-the-counter Tylenol instead of the prescribed opioid.

In both the Nashwauk and Hibbing cases, the investigator reported that an attempt to interview the alleged perpetrator failed because the former employee didn’t respond to a subpoena.

This story was updated at 2:53 p.m. Wednesday, Feb. 12, with additional information from the St. Louis County Attorney's Office. It was originally posted at 5:22 p.m. Tuesday, Feb. 11.