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Nurse Charged With Homicide

Nurses   (39,126 Views 676 Comments)
by Nurse Beth Nurse Beth, MSN (Advice Column) Writer Innovator Expert

Nurse Beth has 30 years experience as a MSN and works as a Nursing Professional Development Specialist.

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Nurse Charged With Homicide

  1. 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?

    • She should not have been charged
      367
    • She deserved to be charged
      106

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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.

Edited by JKL33

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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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LilPeanut has 8 years experience as a MSN, RN, NP and works as a NNP.

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1 minute ago, JKL33 said:

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 (and have been) quibbling 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.

I disagree. There was specifically a warning to not override outside of an emergency; there was no emergency. It may not have been uncommon, but that doesn't make it safe practice or ok, especially considering how she handled the medication after. Versed is a known sedative, though the dose prescribed was mild, pretty much any of the drugs available on override are potentially dangerous, calling for heightened awareness and care when handling them, if you are in an emergent situation. 

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juan de la cruz has 27 years experience as a MSN, RN, NP and works as a Adult Critical Care Nurse Practitioner.

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10 minutes ago, Workitinurfava said:

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

See in the institution that I work for, patients have orders for the level of monitoring required because each one of those monitoring modalities translate to billable charges for the hospital stay. Assuming that the pt had orders for transfer to Step Down, in our case, she would have continuous telemetry and pulse oximetry written on the orders. I frequently get asked by nurses who are transporting their patient out of the unit if they can do that without a monitor. If I say "sure, why not" they insist on an order that says "may go off the unit for PET scan without telemetry monitor". That's what I know from my perspective.

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14 minutes ago, LilPeanut said:

I disagree. There was specifically a warning to not override outside of an emergency; there was no emergency. It may not have been uncommon, but that doesn't make it safe practice or ok, especially considering how she handled the medication after. Versed is a known sedative, though the dose prescribed was mild, pretty much any of the drugs available on override are potentially dangerous, calling for heightened awareness and care when handling them, if you are in an emergent situation. 

Wrong. It said it should be used for STAT orders. Big difference, as I explained earlier in this thread or the other.

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Override does not represent a lockbox where dangerous things are kept.

The converse is also true, if a medication is on a patient's profile, it doesn't matter how dangerous it is, override is not required to obtain it - although other institution-specific safeguards may be in place.

Edited by JKL33

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On 2/12/2019 at 5:52 AM, Jory said:
On 2/11/2019 at 11:16 AM, mtnNurse. said:

I do think I'm more prone to want to give her the benefit of the doubt (again, not in excusing what she "should have" done as a nurse but excusing that what she did do is not criminal behavior) than some of you awesome superstar critical care nurses who have decades of experience under your belts, because it's more recent in my mind how overwhelming the first couple years of work are. Maybe she didn't have enough experience to be in the resource role she was in. Maybe she was striving so hard to be a "good worker" and didn't know yet how to prioritize better and how to stand up to pressures to work faster. Can any of you try harder to imagine what that day was like for her, and so imagine that perhaps consequences such as loss of licensure is warranted, but years in prison and life-time label as felon for this is cruel and unusual punishment? 

1.  It is criminal behavior because it meets the legal criteria.  You seem to be on this bandwagon that intent had something to do with it.  It doesn't. She didn't intend to kill the patient, but she intentionally bypassed MORE THAN ONE checkpoint that caused that patient's death.  

Whether it meets the criteria is a matter of interpretation. No, as I've said before, if intent had something to do with it then that's called murder which she was not charged with. But we are interpreting the lesser charge of reckless homicide differently. I'll re-post my previous explanations of my interpretation if you're interested. I don't agree she meets the legal criteria for "reckless homicide" or even for "criminal negligence". 

On 2/12/2019 at 5:52 AM, Jory said:

2.  She had a certification for the area where she was working.  We hold certifications in high regard in our profession.  She can't claim ignorance after she passes those kinds of tests. She's had also been a nurse for about 3 1/2 years.  Not a new grad.

Yes, we all agree on what she "should have known". Again, based on interpretation of the law, this does not make her a criminal. Interpretation of the law is subjective. 

On 2/12/2019 at 5:52 AM, Jory said:

3.  There is ZERO evidence in the CMS report that she was overwhelmed or rushed.  This is an assumption made by many with no evidence to support it.  She simply didn't want to wait for the medication to be verified by pharmacy.  She didn't have the chart in front of her...patient could have easily had an allergy to versed or an equally fatal drug interaction.  She was not in an emergency situation. 
 

Agreed, we don't know how rushed she was or what was going on in those moments that led her to be so mindless. Also, she might have (wrongly) put all faith in the nurse who delegated by assuming that nurse ensured it was the right med for the right person for the right reason, etc.

On 2/12/2019 at 5:52 AM, Jory said:

4.  You are also assuming, again, she is going to spend "years in prison".  It has a 2-5 year POTENTIAL sentence and the judge absolutely has the leeway to suspend 100% of it if he/she wants to.  My guess is she won't spend one day there or if it is, a very short period of time.  

I don't know whether she'll spend years in prison -- but it seems logical to me that people who believe she should be criminally charged also believe it is acceptable for her to spend however much time in prison might accompany a guilty sentence with those charges. I hope you are right that she won't spend one day behind bars; I also hope she won't have 'felony' on her record.

On 2/12/2019 at 5:52 AM, Jory said:

You are still not answering a very obvious question:  How much negligence are we going to be OK with in our profession?  How much complete disregard for practice standards will we tolerate?  

I did answer that in a previous post answering Wuzzie's question "where do we draw the line". I'll add more to what I said before. I think if a facility fails to give us the safe environment, safe work load, and safe work expectations that would allow us (and especially allow new or inexperienced nurses) to practice up to standards and not cut corners EVER...if a facility makes being a "good worker" incompatible with being a "good nurse"...then if a nurse in those conditions accidentally kills a patient, the nurse should not be criminally charged. Lose license or other consequences maybe, but not criminally charged.

 

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On 2/13/2019 at 12:50 AM, SeasonedOne said:

"Reckless homicide is a crime in which the perpetrator was aware that their act (or failure to act when there is a legal duty to act) creates significant risk of death or grievous bodily harm in the victim, but ignores the risk and continues to act (or fail to act), and a human death results."

I interpret this to mean that the perpetrator had to be aware, in the moment of harming, that there was a significant risk of death or grievous bodily harm in the victim. There is a difference between aware and should-have-been-aware, and it seems therein lies the difference in criminality. I think she was being mindless so not aware she was about to harm that patient, so I don't think she's a criminal. I hope the court interprets the law in this way and dismisses all charges.

On 2/13/2019 at 12:50 AM, SeasonedOne said:

Perhaps better questions to ask may be... "Did this nurse follow the usual and accepted practice guidelines?  Would her education, knowledge and experience support her decision making and actions?  Was facility procedure followed?  The answers to those questions will determine if she in fact was reckless in the death of this patient. 

I'm not sure how answering those questions will answer whether she was aware...based on your definition of reckless homicide. Your questions would just answer whether she should have been aware.

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juan de la cruz has 27 years experience as a MSN, RN, NP and works as a Adult Critical Care Nurse Practitioner.

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15 minutes ago, JKL33 said:

ALL DRUGS ARE AVAILABLE ON OVERRIDE.

And that's the unfortunate reality of this tragedy. I fortunately work for an institution that don't have vecuronium or pancuronium on the formulary. We use rocuronium for intubation, cisatracurium for NMB bolus and drip. If I type VE to order a medication on Epic, all that shows up are VErsed and ProVEntil and that's searching for both generic and brand.

I don't know how familiar RV is with vecuronium as a relatively new nurse. Did she think that was Versed under another name? (I know stupid!), was that a particular Pyxis she's never used before because all along she's been overriding Versed and not getting "vec" because "vec" is only stored in a dedicated Pyxis?

It doesn't excuse her blatant disregard for safety but it illustrates how easy it is for a distracted and inattentive albeit careless nurse to make that error.

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LilPeanut has 8 years experience as a MSN, RN, NP and works as a NNP.

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4 minutes ago, JKL33 said:

Override does not represent a lockbox where dangerous things are kept.

The converse is also true, if a medication is on a patient's profile, it doesn't matter how dangerous it is, override is not required to obtain it - although other institution-specific safeguards may be in place.

The versed was not a STAT order. Override represents medications that are needed in a code or emergent situation. (aka stat) All of those medications if not given properly can kill someone. 

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Jory has 10 years experience as a MSN, APRN, CNM.

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14 minutes ago, mtnNurse. said:

Yes, we all agree on what she "should have known". Again, based on interpretation of the law, this does not make her a criminal. Interpretation of the law is subjective. 

 

There is no "interpretation" here.  Any first year law student could tell you what reckless homicide is...it is when your NEGLIGENCE causes the death of another human being.

There is nothing difficult, hard, or confusing about those words.  

It's not even up for debate...those that actually have law degrees and practice law for a living have already made this decision and that is why she has been charged.  Other nurses have been charged and convicted for similar actions.  There is even case law to back it up. 

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Jory has 10 years experience as a MSN, APRN, CNM.

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8 minutes ago, juan de la cruz said:

 

It doesn't excuse her blatant disregard for safety but it illustrates how easy it is for a distracted and inattentive albeit careless nurse to make that error.

We don't know that she was distracted.  There is nothing in the CMS report to demonstrate that.  

There are three types of pharmaceutical needs: Emergent, Immediate/non-emergent, routine.

Anything that is not emergent, you need to wait until it is loaded by pharmacy...period.  That would have prevented this entire cascade from happening.  Do you know how many times I have pulled a medication on override that wasn't emergent?

Never.  In 10 years, never.  Have people got impatient? Upset? Irritated?  Yes, yes, and yes.  But it is for their own protection as well as mine.  

What's going to happen is eventually the Joint Commission is going to have a regulation where you'll need to start entering tons of codes or a second badge scan for even emergent drugs if nurses keep pulling drugs on an override just because they are too impatient to wait.  

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