Nurse Charged With Homicide

[Nurse Beth]

Radonda Vaught, a 35 year old nurse who worked at the University of Vanderbilt University Medical Center, has been indicted on charges of reckless homicide. Read Nurse Gives Lethal Dose of Vecuronium

Radonda is the nurse who mistakenly gave Vecuronium (a paralytic) to a patient instead of Versed. The patient died.

[mtnNurse., BSN]

6 hours ago, Wuzzie said:

12 hours ago, aflahe00 said:

aflahe00 said:

Why are we focusing on blame and not at all on process improvement? I am shocked by some of these responses honestly.

The lessons to be learned and the policies that need changed will not be accomplished in this way.

Wuzzie said:

Since the processes that were already in place were so blatantly ignored what makes you think new ones are going to make any difference?

Can you not imagine the possibility that this nurse was in fact a prudent nurse but inexperienced in the helper-nurse and orientation role she had, possibly in way over her head, and that a series of distracting pressures may have preceded her mindless moments to not think about what she was doing in that one medication administration task? Can you then not imagine how her working environment could make a difference in preventing future mistakes of this magnitude?

How about if inexperienced nurses (two years is not a heck of a lot of experience IMHO) aren't put in helper-nurse role or orienting new nurses to helper-nurse role? How about if ICU nurse could have dealt with her own patient in an environment that ensures every nurse gets an uninterrupted lunch break without causing someone else to double-up on patients? I'm sure we could all make long lists of ways to make a difference to prevent the type of mistake this nurse made. As much as everyone wants to think that no amount of safe working environment would have prevented this nurse from having her mindless moments leading up to the death, I believe the environment could have made all the difference. I believe if she'd had the ideal work environment (which of course is not likely to ever happen in this country), she perhaps would not have had her severe lapse of good judgement -- and if still she had become mindless, she would never have been in the situation that would have allowed her lapse of mind to cause a death. I'm not arguing she's not to blame. I'm not arguing it is solely the system's fault. But I do think if we all just brush it off with "that was a bad nurse who in every way failed to be a good nurse by bypassing med rights, and no change in the system can prevent that", we are ignoring all the failings in the environment that also led to that death. We are then saying that nothing can be done, we can't prevent a "bad nurse" from killing someone.

[JKL33]

I am one who thinks that there is more than one thing that might have made a difference here. I think there are multiple.

But. The fact is, it's time for a lot of nurses to step up their games. Way, way past time.

We don't have to have off-topic conversations at the Pyxis, we never had to do that. Many of us already have the practice of not doing it.

We don't have to acquiesce in patient care scenarios just because it might feel uncomfortable to make a professional decision. In this case, even if 5 other people around you act as if running down to PET scan and pushing something a mere task, you and I know that it is not a task, and can be the ones to just kindly and professionally inquire, hmmm...what are we pushing, and why are we doing it down there? And who will stay with the patient? If it doesn't seem right, don't do it!! And you don't have to throw a fit, you just have to be professional. There would've been nothing wrong with either 1) Collaborating with the ordering physician to see whether something else could be ordered or 2) Making the decision that the patient should come back to the unit if they must receive a medication that falls on the sedation continuum.

Most of all....we don't have to run around with our hair on fire over things that are not bona-fide patient-related urgencies. Business preferences are not emergencies. We have been taught how to prioritize. Running down to PET scan and performing the "task" of "pushing something" so that no one gets their panties in a bunch about the PET scan schedule getting off track is not good prioritization. As has already been pointed out, this lady was doing quite fine and was being downgraded and was off monitors. Maybe it's just the ED nurse in me, but if she doesn't get knocked out for her PET scan in the next 15 minutes, SO WHAT! Literally. Oh. Well.

If a patient in the ED does not get a STAT swallow screen from the ICU staff. SO. WHAT.

This is the kind of decision-making admins hate, and they love to vilify it by claiming it is senseless resistance. It works out very well when it keeps patients safe.

[Jory, MSN, APRN, CNM]

6 hours ago, Wuzzie said:

Except that she was a certified CV-ICU nurse with two years experience so it is not unreasonable to expect that she did know that the medication she thought she was giving had the potential for significant side effects including respiratory suppression.

My theory (because we don't know) is that she didn't even look at the package at all because she had it in her head she was giving versed. If she was certified, who would give a paralytic without respiratory present? Nobody. Even I don't think she was THAT stupid.

[TriciaJ, RN]

19 hours ago, Wuzzie said:

I get what you’re saying but where do we draw the line?

Drug calculation errors as mentioned above, pump programming errors, misunderstood orders, missing an order, etc.

Ignoring basic principals of medication administration that are drilled into our heads from the very beginning is not a mistake. For heavens sake she admitted to not even looking at the name of the medication on the vial. Who does that?

Yes, this is the part I have the hardest time getting my head around. The standard is to look at each med 3 times: 1. before putting your hand on it 2. when it's in your hand to make sure you have what you think you have 3. one last look before it goes into the patient.

This nurse did not look at the med EVEN ONE TIME. Not only that, the reconstitution instructions that she did look at called for bacteriostatic water. She used saline.

Whatever legal ramifications she faces, she really isn't qualified to practice nursing because she did not incorporate the very basics.

[Wuzzie]

13 minutes ago, Jory said:

My theory (because we don't know) is that she didn't even look at the package at all because she had it in her head she was giving versed. If she was certified, who would give a paralytic without respiratory present? Nobody. Even I don't think she was THAT stupid.

She admitted that she didn't even look at the vial.

[mtnNurse., BSN]

2 hours ago, Susie2310 said:

Some nurses appear to think that all "errors" in care that result in patient harm or death, however caused, should simply be dealt with informally, as a "systems error" with no legal consequences for the nurse.

I think it depends on the error and what led to the error whether there should be legal consequences. I explained why the charge of "reckless homicide" does not fit in her case, and at worst you could call it "criminal negligence".

Take the example someone gave a long while back of the doctor criminally charged for his role in the death of several babies over a period of a year or so. I read the link given about it, and it indeed sounded like it warranted criminal charges. He got off, by the way.

No evidence has been presented that this nurse chose (remember, to choose required first thinking of your choices) to put that patient's life in danger. We all know how bad she erred, we all know the safety checks of med passes she did not use. What we don't know is what was going through -- or rather not going through -- that mind of hers and what led her to be in that state of mind. To be charged with "reckless homicide", she had to consciously in those moments be aware of the fact that she was taking a chance on killing that patient. To be charged with "criminal negligence", she did not have to be aware of the fact she might be killing the patient, but only be aware of the fact she held a weapon in her hand, so to speak. Interpreting the law is a subjective thing, so of course we can disagree on which definition, if any, her behavior fits.

I believe she doesn't fit "reckless homicide" because it seems obvious to me that had she know she was possibly about to kill the patient she would have been aware enough to double-check the medicine. I believe she doesn't fit "criminal negligence" because I think she was being mindless and taking it for granted that she had the right medicine. I don't think she should be criminally charged; lose her license or other solutions maybe, but not criminally charged. But I can definitely see "criminal negligence" at least making more sense as a charge than "reckless homicide", which is the charge. And the abuse charge? That doesn't make sense unless she did it on purpose.

I'm talking about the law here and whether she should be charged. We have beaten a dead horse on how bad she erred and how it didn't meet professional standards of practice for her to make such a medication mistake, and how we can all blame her for that (some blame just her and some blame her and the system). But why do you not see what I'm saying about how the charge of "reckless homicide" does not fit? If you think it does fit then you are saying that she willfully, consciously gambled with that patient's life knowing full well in that moment that she might be killing that patient. -- I just don't see that as a likely scenario for a nurse. Sure, willful life-gambling people could be in any profession, but how likely is it that's what happened here?

[Wuzzie]

2 minutes ago, mtnNurse. said:

No evidence has been presented that this nurse chose (remember, to choose required first thinking of your choices) to put that patient's life in danger.

I go in to work every day with the awareness that the decisions I make as a nurse could very well harm and even kill a patient. That awareness brings an abundance of caution into my practice which makes me take the time to do things the right way...every. single. time.

[TriciaJ, RN]

4 minutes ago, mtnNurse. said:

I think it depends on the error and what led to the error whether there should be legal consequences. I explained why the charge of "reckless homicide" does not fit in her case, and at worst you could call it "criminal negligence".

Take the example someone gave a long while back of the doctor criminally charged for his role in the death of several babies over a period of a year or so. I read the link given about it, and it indeed sounded like it warranted criminal charges. He got off, by the way.

No evidence has been presented that this nurse chose (remember, to choose required first thinking of your choices) to put that patient's life in danger. We all know how bad she erred, we all know the safety checks of med passes she did not use. What we don't know is what was going through -- or rather not going through -- that mind of hers and what led her to be in that state of mind. To be charged with "reckless homicide", she had to consciously in those moments be aware of the fact that she was taking a chance on killing that patient. To be charged with "criminal negligence", she did not have to be aware of the fact she might be killing the patient, but only be aware of the fact she held a weapon in her hand, so to speak. Interpreting the law is a subjective thing, so of course we can disagree on which definition, if any, her behavior fits.

I believe she doesn't fit "reckless homicide" because it seems obvious to me that had she know she was possibly about to kill the patient she would have been aware enough to double-check the medicine. I believe she doesn't fit "criminal negligence" because I think she was b

eing mindless and taking it for granted that she had the right medicine. I don't think she should be criminally charged; lose her license or other solutions maybe, but not criminally charged. But I can definitely see "criminal negligence" at least making more sense as a charge than "reckless homicide", which is the charge. And the abuse charge? That doesn't make sense unless she did it on purpose.

I'm talking about the law here and whether she should be charged. We have beaten a dead horse on how bad she erred and how it didn't meet professional standards of practice for her to make such a medication mistake, and how we can all blame her for that (some blame just her and some blame her and the system). But why do you not see what I'm saying about how the charge of "reckless homicide" does not fit? If you think it does fit then you are saying that she willfully, consciously gambled with that patient's life knowing full well in that moment that she might be killing that patient. -- I just don't see that as a likely scenario for a nurse. Sure, willful life-gambling people could be in any profession, but how likely is it that's what happened here?

When we don't even bother to look at the medication we are giving the patient, we SHOULD know that we are possibly killing the patient. That should be uppermost in our heads any time we give any medication. That's why the 5 rights are thoroughly drummed into us.

Legal definitions are a different matter; that's all down to the State of Tennessee and how they see it. From a nursing standpoint, this wasn't an "error". This was egregious sloppiness. There's a reason we don't let PET scan techs (or housekeepers for that matter) administer these meds. There's a reason it requires a registered nurse. This nurse's actions defeated the whole purpose of education and licensure.

[Tenebrae, BSN, RN]

7 hours ago, Jory said:

Therefore, no...she did not "know" or "reasonably knew" what she had in her hands had the potential to actually kill the patient.

And ICU nurse who didnt know what vercuronium would do?

Eg kill a patient

I doubt it. I work in aged care, and have no need to ever use vercuronium and I know that it should not be given without ensuring the patient has an established airway eg being intubated or else it will kill

[Workitinurfava, BSN, RN]

Something new that could be implemented is there could be a hold on the med, and the pharmacy has to inquire about why you need an access code to pull the medication. Verification through them, multiple steps and than you can pull it. If someone ask me why i am pulling it, a real person, it will cause me to have to be in the present thinking a little more. For the patients sake things could be safer. There are killer nurses out here that purposely pull certain meds to kill patients. I am not saying she did, but improvements can always be made.

[Ruby Vee, BSN]

7 hours ago, Wuzzie said:

Except that she was a certified CV-ICU nurse with two years experience so it is not unreasonable to expect that she did know that the medication she thought she was giving had the potential for significant side effects including respiratory suppression.

There are ICUs and then there are ICUs. It wouldn't be unusual for a nurse with two years of experience to not have encountered Vecuronium before, although she should have known to monitor a patient to whom she had just given Versed. Two years, though, is a dangerous time in a nurse's career -- they've been around long enough to think they know everything they need to know, but not long enough to know what they don't know.

I don't think we should be crucifying a nurse for making a mistake, no matter how tragic the consequences. Fire her, require remediation for her to hang onto her license, even take her license. But charging her with homocide seems pretty excessive.

As a nurse who has made a mistake (and we've all made mistakes, whether we realize and acknowledge it or not), I know I engaged in YEARs of self-flagellation and still sometimes, decades later, I wake up and night remembering and castigate myself some more.

We have an important job and the consequences of mistakes are enormous. Perhaps one of the take-aways is that nurses (or students) who do not recognize, take accountability for and learn from their mistakes should not be in our profession.

[JKL33]

45 minutes ago, Tenebrae said:

And ICU nurse who didnt know what vercuronium would do?

Eg kill a patient

I doubt it. I work in aged care, and have no need to ever use vercuronium and I know that it should not be given without ensuring the patient has an established airway eg being intubated or else it will kill

Please....I'm asking nicely....please try to keep up with the convo.

She did a very wrong thing and therefore did not know that she had vecuronium in her hands. She should have known what she had in her hands. But she didn't.