Nurse Charged With Homicide

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  1. Should Radonda Vaught, the nurse who gave a lethal dose of Vecuronium to patient at Vanderbilt University Medical Center, be charged with reckless homicide?

    • 395
      She should not have been charged
    • 128
      She deserved to be charged

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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.

26 minutes ago, Jory said:

There are a variety of very small medication storage/dispensing options. I just wonder if these types of drugs that would only be used in true emergency should be kept on non-critical floors in a separate system

Correct me if I am wrong but in this case the Pyxis WAS in the ICU, right?

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Specializes in Psych, Addictions, SOL (Student of Life).

I have followed this thread with interest. Having done my research and talked to my sister (a former criminal prosecutor) I would have to say that the wheels of justice are turning exactly as they should. Had this patient survived in a vegetative state the nurse would have likely faced charges of reckless endangerment because while she may not have meant to harm the patient she clearly acted outside her scope of practice and her patient died as a result. Therefore Involuntary manslaughter or criminally negligent homicide are appropriate charges.

This is exactly why safeguards are put in place and why nurses and caregivers should never employ "work arounds" or "shortcuts" no matter how busy they are. Had the nurse monitored her patient after giving any sedative (Standard of care) she would have clearly seen that something was terribly wrong and could have acted accordingly.

People die all the time because of other people's stupid careless actions - the fact that they didn't mean to do harm does not negate the harm that was done. Babies left in hot cars die and the parent states "I forgot, I was exhausted etc..." People cry out "Isn't losing their child punishment enough?" No it's not.

Criminal negligence is just that. This nurse will likely never see a day of jail time as this was first offense but she will never be placed in a position of trust to cause harm to anyone else. The GoFundMe page sickens me as it shows this happy young woman complaining of how the legal system is doing her wrong and we are all supposed to feel so sorry for her that we will be moved to help pay for her mistake.

The one thing that my daddy always stressed to me and that I have stressed to my own child is that one must always be willing to take ownership and responsibility for his/her own actions

Off my soapbox now

Hppy

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
21 hours ago, juan de la cruz said:

The variability in quality of care I do agree on. Maybe what was meant was that there are strong union protections in many hospitals. For instance, nurses can fill out an "Assignment Despite Objection" form as a way to tell the manager that "yes, I'm not going to abandon my patients but you're putting me in an unsafe situation and you can be held liable if something were to happen".

At my last hospital job it was called the "Staffing Request and Documentation" form. I used it whenever they royally screwed us on staffing. Sometimes the blank forms would magically disappear. Putting the information on plain paper works just as well, as long as it is routed to the appropriate entities.

I strongly encourage nurses to use some form of this whenever you have issues with your assignment being unsafe. If something bad does then happen on your watch, it's a lot harder to be thrown under the bus when you've already voiced your concerns and requested help.

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2 hours ago, hppygr8ful said:

Had the nurse monitored her patient after giving any sedative (Standard of care) she would have clearly seen that something was terribly wrong and could have acted accordingly.

This! This is where the line was crossed. This is what takes it from a med error to recklessness. This is the part that cannot be explained away. This is the part that justifies the charges. You don’t give an IV push medicine, especially one that is classed as a sedative, without monitoring for adverse reactions. Period!

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
42 minutes ago, Wuzzie said:

This! This is where the line was crossed. This is what takes it from a med error to recklessness. This is the part that cannot be explained away. This is the part that justifies the charges. You don’t give an IV push medicine, especially one that is classed as a sedative, without monitoring for adverse reactions. Period!

...and I guess in the absence of institutional policy and procedure, it's best for us nurses to familiarize ourselves with any presence of US Boxed Warnings or Black Box Warnings that the FDA attached to common medications we use in our practice. In the CMS report, both RN#1 and RN#2 did not feel the indication for portable monitoring equipment for the patient or at least did not initiate it. The US Boxed Warning for midazolam (Versed) states:

ALERT: US Boxed Warning

Respiratory depression and personnel/equipment for monitoring and resuscitation:

Midazolam has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings; airway obstruction, desaturation, hypoxia, and apnea have also been reported, most often when used concomitantly with other CNS depressants (eg, opioids). In some cases, where this was not recognized promptly and treated effectively, death or hypoxic encephalopathy has resulted. Midazolam should be used only in hospital or ambulatory care settings, including physicians' and dentists' offices, that can provide for continuous monitoring of respiratory and cardiac function (ie, pulse oximetry). Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation, and personnel trained in their use and skilled in airway management should be assured. For deeply sedated pediatric patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure.

This begs the question of whether the provider, who was tasked with prescribing the medication, was aware that the patient left the unit without a portable monitoring equipment.

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Specializes in NICU/Neonatal transport.
Quote

“We do not feel that any practitioner who has not intentionally disregarded what they knew to be a substantial and unjustifiable risk should be disciplined, let alone be charged with criminal homicide,” Cohen wrote in a statement.

This is an interesting quote from the medication safety people. They are opposed to the charging of RV but arguably, overriding the pyxis in a non-emergency, without taking any safeguards whatsoever, constitutes a intentional disregard for a substantial and unjustifiable risk.

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18 minutes ago, juan de la cruz said:

This begs the question of whether the provider, who was tasked with prescribing the medication, was aware that the patient left the unit without a portable monitoring equipment.

I highly doubt it. I would imagine he thought she was being transported like every other ICU patient he’d seen...on a monitor with a nurse in attendance. No reason for him to think otherwise.

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On 2/11/2019 at 2:17 PM, Susie2310 said:

The general public has the right to be protected from licensed health professionals who practice below the standard of care and cause or contribute to patient injuries/deaths.

I agree, and I also think that licensed health professionals have a right to be protected from criminal charges when a facility fails to provide safe working environments, safe workloads, and safe work expectations. If the facility had provided all these things that would promote good nursing care, would this nurse have been in helper-nurse role or was she too inexperienced for that? Would there have been a med scanner in radiology (yes, we will never know if she would have chosen to use that scanner had there been one...but just maybe)? Would the dead patient never have been subject to the careless nurse because the patient's primary nurse would not have been overloaded to the extent that she couldn't attend to the patient while in radiology? We could think of lots more of such questions.

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4 minutes ago, Wuzzie said:

I highly doubt it. I would imagine he thought she was being transported like every other ICU patient he’d seen...on a monitor with a nurse in attendance. No reason for him to think otherwise.

Is it assumed or would the doctor need to put it in an order?

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17 minutes ago, LilPeanut said:

This is an interesting quote from the medication safety people. They are opposed to the charging of RV but arguably, overriding the pyxis in a non-emergency, without taking any safeguards whatsoever, constitutes a intentional disregard for a substantial and unjustifiable risk.

There are several other elements that more directly speak to the disconnect in their statement than using override function on pyxis does. As has been discussed multiple times, override function has historically been heavily used for various institution-specific reasons.

She used override because she mistakenly believed the order hadn't made it to the patient's list of profiled meds, and she knew very well what the alternate method of acquiring meds under such circumstances was, likely because it is not uncommon to acquire them that way.

I would say the element of it being a known sedative medication that was administered by IV route and then not properly monitored (via surveillance at the least) speaks to a precaution that she should have been well aware of, as do the 5 Rights. We can quibble over whether such oversights were done with via the spirit of cognizant intent, which may be how her lawyers choose to argue it. I don't know.

But the override thing is neither here nor there.

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On 2/11/2019 at 7:33 PM, HomeBound said:

I am the last line of defense between my patient and all the bad things.

This is what bothers me about RV. It is her job to know. It is her job to protect patients even from herself.

You sound to me like a very experienced nurse and a very good one. But what it sounds like to me when you say "this is what bothers me" is that what bothers you is how inexperienced this nurse was. What if it takes more than two very overwhelming years in an understaffed hospital to learn how to prioritize patient safety over unreasonable demands of your boss?

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