After COVID-19 vaccines were tossed, Knox Health Department starts new procedures

The Knox County Health Department has started implementing recommended new procedures designed to prevent another incident like the accidental tossing of 975 COVID-19 vaccines doses at the height of the pandemic.

A local accounting firm was hired by Knox County to look at the department’s processes after the Pfizer vaccines were lost. The firm, Pugh CPA, said a combination of checks and balances should be introduced to prevent similar errors.

A police investigation later determined no criminal activity occurred and that a health department staffer early this year inadvertently tossed out a box containing the doses, thinking it was full only of the dry ice that’s also shipped in a second box to keep the Pfizer vaccine at the required ultra-cold temperatures.

Pugh CPA sent its findings and recommendations to Mayor Glenn Jacob’s office on June 30. It laid out in detail the ways the firm studied how the department works and listed seven findings and recommendations.

“We appreciate the thoroughness of Pugh and the work they’ve done,” Dr. Martha Buchanan, director of the health department, said after Monday night’s Knox County Commission meeting. “We will work to implement the recommendations and actually have already started implementing six of the seven.”

Buchanan went on to say the final recommendation will be implemented soon.

After a review, the firm recommended that:

› The health department should adopt a formal, written accounting and shipping (ordering, receiving, distributing) procedure that is followed department wide.

› The building’s operations department should be crosstrained with support service and maintenance specialist jobs as it relates to the internal tracking and distribution of supplies. That way, employees can cover for each other when there’s an absence. ›

One employee was able to both order supplies (without approval) and was also the main employee receiving the supplies at the loading dock. The health department should create better internal controls so there is segregation of duties.

› The department should implement better oversight over ordering of medication and vaccines in the pharmacy department. The current policy allows for unauthorized orders from other departments.

› Security over inventory storage and the loading dock was lacking and should remain locked with a code given only to employees who work in the area.

› The department must be able to reconcile vendor invoices with packing slips and other receipts for supplies and medication, and the shipping logbook must have sufficient information to properly document invoices.

› The department must implement a formal inventory control system where someone can count inventory at any given time. What tracking system is available differs between departments. A department-wide inventory system is recommended.

Buchanan announced shortly after the vaccines went missing that she thought the vials were inadvertently thrown away when a staffer discarded a box they thought contained only dry ice used to keep the vials cold.

Pfizer representatives told Knox News in February that the company’s tracking records show someone at the Knox County Health Department signed for the vaccine shipment.

In mid-February, the health department asked Knoxville police to investigate what happened and launched its own internal review. The Tennessee Department of Health also launched a review.

Every shipment of 975 Pfizer vaccines comes in two parts: a box containing the vials, dry ice, temperature sensors and GPS trackers to ensure the vaccines don’t go bad or get lost, and a box containing additional dry ice to keep the doses at the required ultra-cold temperatures.

Knox County didn’t need the dry ice because it has its own ultra-cold storage capabilities and discards it.

“We will work to implement the recommendations and actually have already started implementing six of the seven.”

— DR. MARTHA BUCHANAN, DIRECTOR OF THE HEALTH DEPARTMENT