As of Wednesday, Brewster’s multi-state license was “under investigation” in Kentucky but was otherwise unrestricted, meaning she could still work as a nurse in much of the country. It’s unclear where else Brewster may have worked as a travel nurse, including in the seven months after she was first charged with tampering in Tennessee.

Brewster could not be reached for comment, and it is unclear whether she has a lawyer. An attorney in Knoxville, listed as Brewster’s attorney in records filed with the Tennessee Board of Nursing, denies representing the nurse.

One hospital that has relied heavily on traveling nurses during the pandemic is Johnson City Medical Center. Ballad Health, which owns the hospital, said last summer that the pandemic increased the number of travel nurses the company employs from about 150 to 400.

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Brewster was one of those employed. She was employed by Jackson Nurse Professionals, a traveling nurse company in Orlando, Florida, and worked at Johnson City Medical Center for three months before the alleged tampering was discovered, according to records.

Ballad Health chief executive Alan Levine told KHN that another nurse marked a suspicious vial in the hospital’s medical cabinet and an internal investigation linked the vial to Brewster.

“She’s removing Dilaudid and replacing it with another substance that looks like Dilaudid and replacing the vial in the Omnicell system,” Levine said. “One of our nurses noticed something in one of the vials looked different and immediately notified the pharmacy.”

Ballad Health fired Brewster and alerted law enforcement and the Tennessee Department of Health, according to a statement from the company. It sent five Dilaudid syringes to the Tennessee Bureau of Investigation’s crime lab, confirming that the amount of drug inside “doesn’t match the manufacturer’s label,” according to the nursing board’s documents.

The hospital reported that it also attempted to drug test Brewster. She initially provided an insufficient urine sample, and then after providing a second sample, Brewster “accused the lab technician of corruption” by snatching the sample from him and pouring it into the sink, the documents say.

“this is mine*** [sic],” Brewster said as he retrieved the samples, according to the document.

The Tennessee Department of Health filed a professional disciplinary case against Brewster with the Board of Nursing on March 31. She is scheduled to appear at a board hearing on Aug. 24 and risk losing her nursing license.

At some point, after she was fired from Johnson City Medical Center, Brewster began working at Raleigh General Hospital, an unrelated hospital about 120 miles north of Beckley, West Virginia.

Last month, the hospital reported to the West Virginia Board of Nursing that vials of Dilaudid in its medicine cabinet appeared to have been tampered with under the board’s order to suspend Brewster’s license. The tops of some vials were missing, while others were marked with residue that “looked like glue,” the committee said.

The internal investigation again “directly” led to Brewster, according to the board’s order.

General Rowley “handled many vials of Dilaudid to protect patients from contamination” and provided some vials to law enforcement for testing. Results have not been disclosed.

Jackson Professional Nurse did not respond to a request for comment. It is unclear if Brewster still works for the company.

The Raleigh General Hospital in West Virginia said in a statement it was still investigating Brewster and cooperating with authorities, but declined to answer questions about the case.

Kaiser Health News is a national health policy news service. It is an independent editorial project of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.