What Happened
Lindsey M. Francis, a registered nurse in the emergency department at Saint Francis Medical Center in Cape Girardeau, Missouri, admitted taking and injecting fentanyl left over from patient doses.
Francis told investigators she had taken and injected leftover fentanyl due to work and personal stress on multiple occasions beginning in June or July 2021. The conduct came to light on January 15, 2022, when a colleague discovered a used syringe in an emergency department locker room; a subsequent investigation found that a vial of fentanyl had been tampered with. When confronted by hospital staff, Francis admitted to the pattern. The total amount of fentanyl diverted was determined to be less than four grams.
She pleaded guilty in May 2023 to one count of unlawfully acquiring a controlled substance, a felony punishable by up to four years in prison.
What Went Wrong
- Leftover, "wasted" fentanyl wasn't verified as actually wasted. Francis's ability to keep and later use leftover doses suggests waste was not being witnessed and confirmed by a second person at the time of disposal.
- Detection was accidental. The case surfaced because a colleague happened to find a used syringe, not through any planned surveillance or audit of ED controlled substance use.
- Stress-related risk factors weren't addressed proactively. Francis cited work and personal stress as a driver — a known risk factor that peer support and wellness programs are designed to catch before it leads to diversion.
How It Could Have Been Prevented
- Require witnessed waste, with a second clinician confirming and co-signing disposal of any unused controlled substance, every time.
- Use tamper-resistant waste receptacles for controlled substances in high-volume areas like the emergency department.
- Offer confidential, proactive wellness and peer-support outreach for staff showing signs of stress or burnout, before it becomes a diversion risk.
- Periodically audit ED-specific controlled substance waste rates against unit volume and acuity benchmarks to catch outliers.
Related Guidance
- Policy Templates — Witnessed waste and tamper-resistant disposal policy templates.
- 15 Red Flags of Drug Diversion — Behavioral and stress-related indicators of diversion risk.
- Tough Issues in Diversion Prevention — Waste documentation edge cases in high-acuity units.
- Hospital Self-Assessment Checklist — Hospital self-assessment, 8 sections and 63 weighted items.