By Alex Rickert, Jim McCarthy and Mandy Miles
An audit of Monroe County Fire Rescue’s controlled substances procedures, released May 11 by the county’s Clerk of the Court, reveals glaring breakdowns in oversight that allegedly enabled a chief flight nurse with the county’s Trauma Star life-flight service to steal more than 200 vials of fentanyl, Dilaudid, ketamine and other narcotics.
Lynda Rusinowski, 56, had worked as chief flight nurse for Monroe County Fire Rescue (MCFR) until until she was taken to rehab by another MCFR employee and eventually suspended and arrested in September 2022. Her felony charges are still making their way through the courts. According to her arrest warrant, Rusinowksi “admitted to stealing the drugs for her personal use,” while she was en route to rehab in West Palm Beach.
The Monroe County Sheriff’s Office initially reported Rusinowski’s arrest, adding that officials with MCFR received an anonymous tip in late July 2022 about Rusinowski altering controlled substance inventory logs in an effort to pilfer the drugs. As chief flight nurse, she was an employee of Monroe County Fire Rescue, not the Sheriff’s Office.
Monroe County Fire Rescue is in charge of the flight nurses, Trauma Star’s medical supplies, patient records and oversight of all three. The Monroe County Sheriff’s Office is in charge of the pilots and the three Trauma Star helicopters that annually transport 1,200 to 1,300 patients, often with life-threatening conditions, to mainland hospitals, Sheriff Rick Ramsay told the Keys Weekly on June 12.
The audit report notes no wrongdoing on the part of the Monroe County Sheriff’s Office, but is highly critical of Monroe County Fire Rescue and senior county administration.
In the two months following Rusinowski’s arrest, MCSO also arrested paramedics Harold Jaesson Perez, 34, and Damian Roberto Suarez, 44, for allegedly lying to detectives about knowledge of Rusinowski’s potential thefts and deleting text messages related to the investigation. Their cases are still ongoing as well, with separate hearings scheduled this month. Suarez and Perez continue to work for MCFR, Sheriff Ramsay said, but he added that they will never again work aboard a Trauma Star helicopter.
Audit finds 623 missing narcotics vials and critical deficiencies
In early August 2022, former MCFR Chief Steve Hudson formally asked the county’s Clerk of the Court to conduct an internal audit of the department’s emergency medical services’ system performance and controlled substance inventory records from June 2021 through July 2022.
Hudson officially retired in December 2022.
The audit details a total of 623 vials of controlled substances missing from inventory logs during the audit period, including 242 vials of Dilaudid and 219 of fentanyl. (According to the U.S. Drug Enforcement Administration, fentanyl is a controlled substance, “a potent synthetic opioid drug approved by the Food and Drug Administration for use as an analgesic (pain relief) and anesthetic.”) Though it acknowledges that some discrepancies could be due to sloppiness in record-keeping, which are extensively criticized throughout the report, it estimates that 246 missing vials – including 91 of fentanyl and 84 of Dilaudid – were likely stolen via the intentional falsification of records.
The nearly 80-page audit report, submitted by interim internal audit director Pam Radloff and released on May 11, details massive discrepancies in controlled substance inventory records due to theft, stating that “controlled substances were being diverted by MCFR staff along with a widespread lack of management oversight.”
The report cites a lack of attention by MCFR Medical Director Dr. Sandra Schwemmer as a “primary reason that the chief flight nurse’s alleged drug diversion activities went undetected for so long.” Schwemmer was counseled three times by then-Chief Hudson about proper procedures and oversight, according to the audit report.
The same report criticizes the “sloppiness of MCFR’s inventory and patient care records” and finds that “County Administration (did) not have effective preventive or detection measures to ensure … that controlled substances are secure from drug diversion.”
The report describes “significant breach of controls,” as staff responsible for managing the narcotics inventory at the Trauma Star supply room were the same individuals managing inventory counts on each helicopter.
“When personnel are destroying drugs, there’s supposed to be a witness present to affirm that they’re properly destroyed,” Ramsay told the Keys Weekly. “But in this case, (Lynda Rusinowski) would say she destroyed the drugs, then get someone to sign off that they had witnessed it.”
The audit further cites a lack of oversight that failed to catch an “extraordinary” amount of wasted narcotics. Of 88,143 micrograms of fentanyl recorded as dispensed during the audit period, 43,734 (49.6%) were recorded as wasted. The report cites a 2013 National Institutes of Health study showing that, on average, 22.2% of drugs dispensed become waste.
The audit states that interviews with MCFR employees conducted by Sheriff’s Office investigators “clearly revealed” the absence of a support structure within county government that employees could use to safely report their suspicions.
“The interviews … revealed that the chief flight nurse had for months exhibited warning signs that she could be diverting drugs and possibly experiencing a substance abuse disorder,” the report stated. “Had County Administration … implement(ed) basic drug diversion preventive and detective measures, they likely would have been alerted years ago that they should have kept a close eye on the activities of the chief flight nurse.”
One such example: in the calendar year 2021, Rusinowski’s base pay was $71,386. Working more than 2,100 hours of “overtime” and “premium overtime” throughout the year, with zero vacation or sick days, her gross pay for the year totaled $180,967 – 253.5% of her base pay.
“There were so many red flags and checks and balances that were overlooked,” Sheriff Ramsay said. “This was a complete failure and breakdown of oversight. Supervisors should have been looking at the amount of drugs being used by each flight nurse on duty. Almost all of the nurses had a basic mean average of drugs they used for patients, while the chief flight nurse was using 10 times that norm. There were so many procedural violations, and then there were orchestrated efforts to derail our investigation. But we’re the ones that put a stop to it.”
Ramsay reiterated, and the audit report verifies, that there was no wrongdoing found on the part of the sheriff’s office.
County responds to audit
“We always welcome audits,” County Administrator Roman Gastesi told the Keys Weekly on Tuesday, June 13. “In this case, the previous fire chief, Steve Hudson, requested it. The good thing about audits is you get somebody to take an independent look at the organization and the functions, in this case it was controlled substances.
“What we enjoyed about the audit was the corrective actions taken from the recommendations are something we’re already doing,” Gastesi said. “For example, with inventory control, we have an electronic system. That in and of itself will resolve the issue.
“In this case, it was just one person that was unfortunately ill. I’m glad to report she’s been rehabbed,” Gastesi said. “It got out of control. We still had enough controls to catch it. There’s always room for improvement with any operation. Anybody can always improve. I’m glad to say we improved our operation.”
Monroe County Fire Chief James Callahan said everything recommended in the clerk’s audit report was implemented before its May release.
“We’ve improved the whole process of drug delivery, monitoring and accountability. We went to a new system for accountability that’s much stronger and better so it can be counted and measured more timely. We’ve done a number of things to make the system safer and stronger.”
Ongoing legal proceedings
Rusinowski, who pleaded not guilty last September, has a pretrial hearing on June 29 in Marathon. She faces two counts of grand theft of a controlled substance, two counts of obtaining a controlled substance by fraud and two counts of official misconduct.
Perez had a hearing scheduled this week, on Wednesday, June 14 in Marathon before Judge James Morgan. Suarez is set to be in court on Thursday, June 29 for a hearing in Marathon before Morgan. Both were charged with obstructing justice and destroying evidence, both third-degree felonies. Both pleaded not guilty.
Their charges stem from text messages they allegedly deleted from a group chat that described their concerns and suspicions about Rusinowski’s drug theft. Both reportedly lied to investigators at first, saying they had no idea about the charges against Rusinowski and knew nothing about drug theft or altered supply logs. A forensic dive into their phones was able to restore the deleted group chat and show their discussions and suspicions.
Suarez and Perez remain employed with Monroe County Fire Rescue. Callahan said the two are only responding to fires and wrecks and aren’t doing anything related to EMS, Trauma Star or patient care.
After retiring in May 2021, Callahan returned as fire chief in January 2023 following Hudson’s retirement last December. Callahan said Suarez and Perez were suspended with pay as he returned. He felt they should come back to work, albeit on a limited capacity with no involvement in administering drugs. Callahan said they’re awaiting the results in court before deciding what’s next for Perez and Suarez.
For a full copy of the audit, click here.
