San Jose’s auditor is recommending a slew of changes to improve drug storage and oversight protocols at the city’s fire department, following the April arrest of a captain for allegedly tampering with and stealing medication.
The incident spurred the department to request a review by the city’s auditor, which outlined seven recommendations to prevent that from happening again.
“These controls are in line with what we saw in other jurisdictions,” supervising auditor Alison Pauly said at last week’s Public Safety Committee meeting. “There are a few aspects of fire’s current inventory management practices that should be formalized into policy. These include clarifying the requirements for daily and periodic reviews of the controlled substance boxes, storage of medications on reserve apparatus, and the protocols for remote handoffs of medications.”
As part of an agreement with Santa Clara County Emergency Medical Services, the San Jose Fire Department provides advanced life support and has access to controlled substances, such as morphine and midazolam.
During the last fiscal year, the department responded to approximately 68,500 medical emergencies and administered drugs at 835 incidents, with morphine accounting for 76% of usage.
But in April, city officials knew something was amiss after finding vials had been tampered with and a paramedic also reporting that drugs were not having the intended effect on patients.
The Santa Clara County District Attorney’s Office charged Mark Moalem, a 23-year veteran of the fire department, with felony burglary and misdemeanor counts of possessing a controlled substance and being under the influence of a controlled substance. A search of Moalem’s home uncovered six fire department vial caps for morphine, four department vials of midazolam and four department caps of midazolam. Moalem is scheduled to appear before the Mental Health Treatment Court on Jan. 13.
The department’s inventory audit found evidence of tampering with more than 400 vials of drugs at 17 of the city’s 34 fire stations. Although Moalem’s appearances at other stations drew suspicions, prosecutors only charged Moalem with theft of medications from Station 4 on Leigh Avenue. A subsequent review by the Office of the City Auditor during the summer found no evidence of additional tampering or theft at the 17 fire stations and the central drug safe.
The tampering and theft incident also stoked tension between the department and Santa Clara County EMS, which accused the city of “serious policy and contractual violations” and noted that, despite suspicions of malfeasance dating back to 2023, the county was never notified.
“Concerningly, the San Jose Fire Department continues to demonstrate a lack of regard for patient and provider safety, as the EMS Agency has yet to receive an adequate response outlining the steps your department has taken to investigate the matter and implement corrective actions as repeatedly requested in conversations with you since April 16,” EMS Director Nick Clay wrote in a May 23 letter to San Jose Fire Chief Robert Sapien. “This lack of resolution not only undermines the integrity of our agreement but also poses legal, ethical, and public safety risks.”
As part of its recommendations, the auditor’s office said the department needed to formalize regular monitoring and physical security controls. It also called for the creation of a policy to notify Santa Clara EMS of “variances,” acknowledging that the fire department did not have the same requirement as Santa Clara County EMS policy dictates.
Since the tampering incident, Sapien said the department implemented a number of controls, including daily close inspections and redundant locking systems, that the auditor’s office believes should become formal policy. The department is also acquiring biometric safes to store medications, which would not only limit access to the drugs but also require documentation for why the safes were accessed.
“We fully understand the findings and fully agree with the associated recommendations, and are working to expedite implementation, the longest of which will be completing the procurement of those biometric safes and the associated policies,” Sapien said. “We have implemented what I would describe as hyper-stringent auditing on a daily basis – both daily and at any time there’s an exchange of responsibility for inventory or anytime there’s a use for access to vials. I think going forward, what we’re going to be evaluating, once the biometric safes are in place, is what is the frequency of auditing from there forward, because the daily and for cause audits do take a lot of time, and they’re really more access points than maybe are necessary and prudent.”
