While nurses deserve patient gratitude and the highest praise for the valiant care they have provided during the coronavirus pandemic, a case in Nashville has raised difficult questions about if and when medical errors by professional caregivers should be criminalized.
Prosecutors have ruled some of the errors rise to the criminal level, after reviewing evidence against RaDonda Vaught, a former nurse involved in a fatal drug error in 2017.
Vaught, who was previously stripped of her nursing license, was found guilty, NPR reported, of “gross negligence of an intoxicated adult and negligent homicide after a three-day trial. She faces three to six years in prison for negligence and one to two years for negligent homicide as a defendant without a prior conviction, according to sentencing guidelines provided by the Nashville District Attorney’s Office. sentenced May 13 and her sentences will likely be served concurrently, district attorney spokesman Steve Hayslip said.
During his trial, authorities showed that Vaught, 37, “injected 75-year-old Charlene Murphey with the paralyzing drug vecuronium instead of the sedative Versed on December 26, 2017,” the Associated Press reported. “Vaught freely admitted to making several errors with the medication that day, but his attorney argued that the nurse was not acting outside the norm and that systemic issues at Vanderbilt University Medical Center were at least in part to blame for the error.”
Here are more details from the news agency on why prosecutors considered Vaught’s conduct so serious:
“Murphey had been admitted to the Neuro Intensive Care Unit on December 24, 2017, after suffering a cerebral hemorrhage. Two days later, doctors trying to determine the cause of the bleeding ordered a PET scan to check for cancer. Murphey was claustrophobic and was prescribed Versed for his anxiety, according to reports. When Vaught couldn’t find Versed in a vending medicine cabinet, she used an override and accidentally grabbed vecuronium instead.
“An expert witness for the state argued that Vaught violated the standard of care expected of nurses. In addition to taking the wrong medication, she failed to read the name of the medication, did not notice a red warning on the top of the medication, and did not stay with the patient to check for had an adverse effect, legal nurse consultant Donna said. Jones. Leanna Craft, a nurse educator at the neuro-ICU unit where Vaught worked, testified that it was common for nurses in those days to bypass the system in order to obtain medication. The hospital had recently updated an electronic records system, which caused delays in retrieving medication from automatic medication dispensing cabinets. There was also no scanner in the imaging area for Vaught to scan the medicine against the patient’s ID bracelet.
Vaught, NPR reported, also failed to distinguish that Versed, the prescribed tranquilizer, is a liquid, while the deadly vecuronium is a powder. The former nurse admitted her mistake and repeatedly apologized and expressed remorse for its consequences.
While in no way excusing his actions, nursing and other healthcare groups have expressed concern about the lawsuits against Vaught, arguing that mistakes happen in medicine and that healthcare personnel must be able to discuss it appropriately, so that problems can be resolved. Bruce Lambert, a patient safety advocate with a Ph.D. and professor at Northwestern University, told the AP in an interview before Vaught’s sentencing:
“This [case] will not only prevent nurses and doctors from reporting medication errors, but will also drive nurses out of the profession.
NPR reported this:
“The American Nurses Association released a statement…as the trial was pending, saying that nurses believe this case sets ‘a dangerous precedent…Transparent, fair, and timely reporting mechanisms for medical errors without fear of criminalization keep patient care environments safe.’ ”
NPR also reported this after the verdict, quoting Janie Harvey Garner, founder of Show Me Your Stethoscope, a Facebook nursing group with more than 600,000 members:
“Health care has changed forever. You can no longer trust people to tell the truth, because they incriminate themselves.
Certainly, as NPR reported, “Medical errors are typically dealt with by professional licensing boards or civil courts, and criminal prosecutions like Vaught’s case are exceedingly rare.”
Correct. In my practice, I see the harm patients experience when seeking medical services. The Vaught prosecution and the situation it addressed may have been so heavy-handed that it may not be the precedent-setting crime medical professionals fear. Prosecutors are rightly reluctant to pursue criminal charges against medical staff when they make mistakes.
But this case is a grim reminder that medical errors abound and that a return to pre-pandemic vigilance regarding patient safety is essential.
Just a reminder that before the world battled its worst infectious disease epidemic in a century, researchers found that medical errors were claiming the lives of approximately 685 Americans a day – more people than deaths from respiratory illnesses, d accidents, strokes and Alzheimer’s disease. This estimate came from a team of researchers led by a professor of surgery at Johns Hopkins. This meant that medical errors were ranked, before the days of coronavirus, as the third leading cause of death in the United States, behind heart disease and cancer.
Now, as Becker’s Hospital Review, an industry outlet, reported as part of its coverage of this case:
“Healthcare workers have been exhausted and exhausted from juggling the stressors of the pandemic and the added burdens of workforce shortages for over two years. These issues have serious consequences for employees and patients, as numerous studies link burnout and clinician stress to an increased likelihood of medical errors. The full picture of how COVID-19 has affected patient safety is still unclear, but emerging data on healthcare-associated infections and other forms of patient harm suggest that shortcomings significant events have occurred in the midst of the pandemic.
“The number of serious patient safety incidents reported to the Joint Commission jumped in 2021, reaching the highest annual level since the accrediting body began reporting them publicly in 2007. The organization received 1,197 sentinel event reports last year. [incidents that result in death, permanent harm, or severe temporary harm]compared to 809 in 2020. The most frequently reported safety event was patient falls, followed by delay in treatment and inadvertent retention of a foreign object.
Not good. Incidentally, to underscore a point raised by experts when discussing the convicted nurse’s case, medical malpractice suits have, indeed, served as a major avenue for patients with allegations of harm not only to obtain the significant financial relief they may need for long periods of recovery and rehabilitation, but also justice for the untold harms that have been done to them. For many of these brave people, it also means that doctors, hospitals, and other medical providers and institutions are finally addressing the systemic issues that are hurting and killing patients.
In the Tennessee case, the independent Kaiser Health News deserves to have explored the choices prosecutors and regulators made when reviewing not only the actions of former nurse Vaught, but also those of Vanderbilt University. Medical Center. State investigators, as KHN reported, had discovered that the powerful institution had a “heavy burden of responsibility” in a patient’s fatal drug. The hospital, critics say, was not held responsible for failing, as required by law, to report the incident and claiming the patient died of “natural causes”.
The hospital, KHN said, also “negotiated an out-of-court settlement with [the patient’s] family who forbade them from discussing the death publicly.
My firm and I have openly opposed the provisions of the regulations to prevent them from being disclosed and seen by the public. We strive to prevent them from being imposed on our clients by defendants who want to cover up their wrongdoing.
We have a lot of work to do to protect patients from medical errors and other preventable harms and to ensure that they receive appropriate redress in criminal and civil courts if they are the victims of medical error.