After getting an unfavorable Nursing Board decision, it is unusual for a nurse to appeal the matter to a court.  It is even more unusual for such an appeal to make it all the way to the state Supreme Court.  However, Appellants Christine Mulry Francis and Angela L. Caldwell DeBenedictis did just that.

The facts of this case are very interesting.  Nurses Francis and DeBenedictis were employed in supervisory roles in a Delaware correctional facility where a patient inmate was being administered a very pricey hepatitis C pill costing $1,000 each, and could only be provided in lots of 28.  Because of the high cost of the pills, 2 on-duty nurses (neither Francis or DeBenedictis) were required to count the medications just as if it were a controlled substance.

While performing a count, 1 nurse accidentally tipped over the pills, spilling 12 of them onto the floor.  Both nurses believed the dozen pills, valued en toto at $12,000, should be wasted because the medication had hit the floor, and deposited the medication in the sharps container.

When pharmacy was contacted to provide more of the pills, they hit the roof!  After the pharmacy, a private company, contacted their superiors about the incident, instructions were delivered to supervisory nurse Francis to remove the pills from the sharps container and return them to their original container.  Ms. Francis asked Ms. DeBenedictis to join her as they complied with the order and placed the pills in a paper towel before restoring them for later use.  The patient inmate was never informed of this incident.

When one of the nurses originally involved in the attempted wasting learned that the pills had been retrieved and given to the patient inmate, she reported the matter to the Delaware Division of Professional Regulations.

After an investigation, Francis and DeBenedictis were charged with violating the Nurse Practice Act in “[F]ailing to take appropriate actions to safeguard a patient of incompetent, unethical or illegal health care practice.  Aiding abetting and/or assisting an individual to violate or circumvent any law or duly promulgated rule and regulation intended to guide the conduct of a nurse or other health care provider.  Failing to appropriate action or to follow policies and procedures in the practice situation to safeguard the patient.”

In the hearing, a nurse expert was called who stated that the nurses had a right to rely on the pharmacist to retrieve the medications.  The Hearing Officer “found that disposing of medication that falls on the floor is an accepted standard of the nursing profession and that retrieving those pills from the sharps container … violated the standard of care.” 

The Hearing Officer concluded that both supervisory nurses violated the standard of care and placed their licenses on probation for 90 days as well as requiring them to have continuing education in the areas of pharmacology and nursing ethics.

The nurses appealed to the Superior Court, which set aside the Board’s decision because no harm came to the patient inmate.  Then, upon appeal to the state Supreme Court, its October 2, 2018 ruling was that the Board had been acting properly and the Supreme Court returned the matter to the Board for further recommendations.

I cannot believe the time and expense that must have gone into this case.  It is difficult to appeal these decisions because the Board does have so much discretion.  The nurses in this case should not rely on the directions of pharmacy but need to use their own common sense.  No one would want to ingest medication, which hit the floor and was tossed into a contaminated sharps container.  However, as nurses, none of us wants any action on our licenses, because nursing is part of our identity.

I would like to hear your thoughts, which you are invited to post below, on this interesting case.