A nurse places a patient’s chemotherapy medication on an intravenous stand at a hospital in Philadelphia. (Matt Rourke/AP)

Over and over for nearly two months, a patient at New Beacon Hospice in Birmingham, Ala., would push the button on her intravenous pump, hoping for a dose of medication to ease the excruciating pain caused by her liver cancer.

But relief never came. The patient, identified in court documents as D.N., continued to suffer from intense bouts of “breakthrough pain.” No amount of the drugs seemed to help.

Her nurse made several worried calls to ContinuumRx, the pharmacy that supplied IV bags to the hospice. “Something was not right,” the nurse told the pharmacy. Keep pushing the button, the pharmacy instructed, before swapping out the patient’s bag at least twice, according to prosecutors.

It didn’t work. Prosecutors say Johnathon William Click, the lead pharmacy technician for ContinuumRx, is to blame. They allege that Click spent nearly two years stealing opioid drugs that were supposed to go into IV bags for patients in palliative care. He is accused of siphoning morphine and hydromorphone from the pharmacy’s vials and replacing the liquid he took with saline or sterile water.

By the time they reached nurses, the medications were diluted to the point of being ineffectual. D.N. — whose pain went unrelieved until her death — was one of an untold number of Alabama patients in home care or hospice care who received the adulterated bags, according to prosecutors.

Click, 30, of Bessemer, Ala., is scheduled to be arraigned later this month in the U.S. District Court for the Northern District of Alabama after pleading guilty last week to one count of attempt to tamper with a consumer product. He faces up to 10 years in prison and a $250,000 fine. A defense attorney for Click did not immediately respond to a message seeking comment Monday morning.

“This defendant was willing to subject terminal cancer patients to intolerable pain in order to feed his own addiction,” U.S. attorney Jay E. Town said in a statement. “This is one more aspect of the epidemic problem America has with abuse of prescription opioids.”

According to a plea agreement filed Sept. 25, Click compounded the vast majority of IV bags that were distributed to hospices throughout the state until he was fired from ContinuumRx in September 2016. The bags are hooked up to pumps that allow patients in extreme pain to push a button and deliver a dose of opioid medication when they need relief. The maximum amount patients can receive every hour is set by a doctor.

Click told prosecutors he had a history of drug addiction and started experimenting with morphine and hydromorphone several years ago. At the pharmacy, he would secretly draw out leftover drugs from used vials that were supposed to be thrown out, according to the plea agreement.

It wasn’t until the end of 2014 that he started tampering with unused vials. Prosecutors said he would typically pull 20 cubic centimeters of the liquid drug and replace it with sterile water or saline. He would cover his tracks by taping or gluing the flip-top cap back onto the vials. He went undetected because he was the one person responsible for opening the vials and mixing them in the IV bags, according to the plea agreement.

Prosecutors said Click was well aware that he was taking crucial medicine away from terminally ill cancer patients, who made up the bulk of the patients ContinuumRx served.

“The defendant, as a registered pharmacy technician, knew that diluted opioids would not be as effective as undiluted opioids in relieving pain,” the plea agreement read. “As someone addicted to morphine and hydromorphone, the defendant was aware of the drugs’ effects on the human body.”

One patient who received a diluted bag from ContinuumRx was suffering from colon cancer, according to the complaint. A nurse from Alacare Home Health and Hospice called the pharmacy in August 2016 to report that the medication was not relieving his pain. Click fielded the call, knowing he had compounded the patient’s bag, prosecutors said.

Click also fielded multiple calls from the nurse who reported D.N.’s pain, according to the plea agreement. The pharmacy “could only recommend encouraging D.N. to keep pushing her bolus button,” prosecutors wrote in the document.

Other hospice nurses called Click reporting similar problems. Some of the patients had received what they thought were the maximum doses of pain medication but were still experiencing pain. In once case, Click could hear a patient moaning in pain in the background, prosecutors said. He suspected the patient had received a diluted bag but did nothing, according to the plea agreement.

One day in September 2016, one of Click’s fellow pharmacists saw him sneaking vials of morphine from a cabinet, prosecutors said. When the pharmacist checked the morphine vials later on, he saw that many had been tampered with. He also discovered vials of hydromorphone that appeared to have been opened and glued back in place.

ContinuumRx fired Click that month and immediately reported the tampering to the Alabama State Board of Pharmacy, according to prosecutors. The pharmacy was ultimately forced to destroy its entire inventory of narcotic painkillers because it couldn’t be sure which supplies were tainted.

A representative from ContinuumRx did not immediately respond to a message seeking comment on Monday.

Click was cooperative when state and federal drug investigators came to interview him, according to the plea agreement. He admitted to removing the drugs from the vials and described his process in detail, the agreement read.

Prosecutors said Click acted with “extreme indifference” to the patients. He knew that “D.N. and other hospice patients had received diluted morphine and hydromorphone from vials with which he had tampered,” they wrote. “Still, he continued to divert these drugs for his own personal use and gratification.”

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