Nurse Charged With Homicide

mtnNurse., BSN · Feb 19, 2019

On 2/13/2019 at 11:02 AM, Crow31 said:
On 2/12/2019 at 9:30 AM, Horseshoe said:
If any of you follow ZDoggMD's Youtube channel, you may have seen his video on the Vanderbilt medication error. Like most of us, he was shocked and appalled.
After watching this, I saw he posted his reaction to the criminal charges. I was a little surprised at his passion, based on his original video.
His take will upset a lot of nurses here on AN.
One good thing about seeing these videos is that it reminded me of him and his channel. I binged watched a bunch of his videos and found a lot of them to be quite thought provoking.
OH MY GOSH THANK YOU, THANK YOU, THANK YOU FOR SHARING THIS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
His second video has been my whole point all along. Reading this responses and the responses people had to my comments was frustrating and depressing. Reading the comments I could see that nurses were not getting the magnitude of this situation.
THANK YOU! THANK YOU!

Thanks for posting this; I never heard of the guy but will watch more after seeing this. For those of you who haven't watched it but are curious, watch the first one if you want to hear him talk about how tragic the accidental death was and how many ways the nurse failed. Watch the second one if you want to hear him talk about how tragic it is for the nurse to be criminalized for her accident.

One thing I didn't agree with him on was when he said that she wasn't likely on 'auto-pilot' to use override -- if override was something she actually had a valid reason to do frequently (though we know there wasn't a good reason to use it in this case), then she could have been very accustomed to and therefore too comfortable with using it, and could have done so on 'auto-pilot'. Careless & mindless but not criminal.

My favorite thing he says is in the second one when he talks about how he wants to discuss how to prevent this from ever happening again, in a mindset of the whole system not just individual nurse, rather than focusing on blaming and shaming.

mtnNurse., BSN · Feb 19, 2019

1 hour ago, hppygr8ful said:
You keep arguing that this nurse was not experienced enough yet the public record shows that she was licensed in 2015 and has been a nurse for 4 years. While this is not a long time it is certainly enough time to have some seasoning and have developed some good common sense on the job. The other argument is that the hospital had an unsafe working environment or was understaffed. We will never know if that is true as we were not there and the fact that they had a extra help nurse shows that the hospital was trying to alleviate a staffing issue by having an extra nurse on duty to make sure people got breaks and or help where needed.

I thought she had 2 years experience at time of incident? And sorry, but I'm not convinced that having a helper-nurse run around to different departments indicates all is well, staff isn't overloaded with patients, people are getting their breaks, and help comes when needed. I've seen otherwise despite helper-nurses running around. Ok, a couple people have reassured me there actually exists hospitals with safe work environments and reasonable work expectations that are not understaffed. Wow, WHERE?! ?

Anonymous865 · Feb 19, 2019

46 minutes ago, mtnNurse. said:
I thought she had 2 years experience at time of incident? And sorry, but I'm not convinced that having a helper-nurse run around to different departments indicates all is well, staff isn't overloaded with patients, people are getting their breaks, and help comes when needed. I've seen otherwise despite helper-nurses running around. Ok, a couple people have reassured me there actually exists hospitals with safe work environments and reasonable work expectations that are not understaffed. Wow, WHERE?! ?

You keep arguing that the environment and staffing are to blame. You assert that she wasn't experienced enough to be in the helper role. The only evidence you present to support your argument is that everywhere you have worked nurses are so overworked as to present a danger to the patients.

The evidence that I have found includes:

Vanderbilt is licensed for 832 beds and has 4400 nurses. That is a very good ratio.

US News and World Reports reports how hospitals compare nationally. They report the nurse to patient ratio for hospitals as very low, low, average, high, or very high for how they compare to other hospitals nationally, Higher is better. They report that the nurse to patient ratio at Vanderbilt is VERY HIGH.

The nurse to patient ratio in critical care is 1:1-2.

You argue that she was inexperienced. Per Vanderbilt's job application website - any nurse with < 6 months experience must apply for and be accepted into their nurse externship program. The program is 1 year long and includes classroom, lab, and preceptor training. They have 3 cohorts per year. That sounds like a lot more training than most new grads get in their 1st job.

Vanderbilt's employee website says that nurses interested in becoming a preceptor must complete training on how to be an effective preceptor. If you look at their class schedule, the preceptor workshops are scheduled at least once a month. That certainly sounds better than what most hospitals do - "Hey. You're precepting today."

I definitely think Vanderbilt handled this whole thing incorrectly. It appears they covered it up to protect their reputation.

I don't see any objective evidence Vanderbilt is dangerously understaffed and that they are putting unqualified nurses in the role of resource nurse.

RV's lawyer may argue that at trial. S/he would have access to data that we don't. S/he might be able to get employees to testify to that.

If you have objective evidence that Vanderbilt (not most hospitals) created an environment that contributed to this death, I would be very interested.

I have looked. What I have found that is publicly available does not support your argument.

southern rn · Feb 19, 2019

1 hour ago, Anonymous865 said:
You keep arguing that the environment and staffing are to blame. You assert that she wasn't experienced enough to be in the helper role. The only evidence you present to support your argument is that everywhere you have worked nurses are so overworked as to present a danger to the patients.
The evidence that I have found includes:
Vanderbilt is licensed for 832 beds and has 4400 nurses. That is a very good ratio.
US News and World Reports reports how hospitals compare nationally. They report the nurse to patient ratio for hospitals as very low, low, average, high, or very high for how they compare to other hospitals nationally, Higher is better. They report that the nurse to patient ratio at Vanderbilt is VERY HIGH.
The nurse to patient ratio in critical care is 1:1-2.
You argue that she was inexperienced. Per Vanderbilt's job application website - any nurse with < 6 months experience must apply for and be accepted into their nurse externship program. The program is 1 year long and includes classroom, lab, and preceptor training. They have 3 cohorts per year. That sounds like a lot more training than most new grads get in their 1st job.
Vanderbilt's employee website says that nurses interested in becoming a preceptor must complete training on how to be an effective preceptor. If you look at their class schedule, the preceptor workshops are scheduled at least once a month. That certainly sounds better than what most hospitals do - "Hey. You're precepting today."
I definitely think Vanderbilt handled this whole thing incorrectly. It appears they covered it up to protect their reputation.
I don't see any objective evidence Vanderbilt is dangerously understaffed and that they are putting unqualified nurses in the role of resource nurse.
RV's lawyer may argue that at trial. S/he would have access to data that we don't. S/he might be able to get employees to testify to that.
If you have objective evidence that Vanderbilt (not most hospitals) created an environment that contributed to this death, I would be very interested.
I have looked. What I have found that is publicly available does not support your argument.

I have a friend/coworker who had a family member die at Vnderbilt.Without going into any details let's just say she wasn't surprised to here this story.She is convinced her family member died due to negligence.

Anonymous865 · Feb 19, 2019

1 hour ago, southern rn said:
I have a friend/coworker who had a family member die at Vnderbilt.Without going into any details let's just say she wasn't surprised to here this story.She is convinced her family member died due to negligence.

I know physicians who have sent loved ones to Vanderbilt when they thought they needed care that couldn't be provided in the patient's community.

On the other hand I wouldn't go to Vanderbilt, but I wouldn't go to any academic medical center. I don't think care from residents and students are in my best interest as a patient.

Both of those are opinions not evidence.

Unfortunately we can't get real data, because the medical community has convinced congress that incident reports are proprietary information so hospitals don't have to reveal this information.

I think that all healthcare organizations should have to report every near miss and every mistake to a national database, so that they can be studied.

By law every single cancer diagnosis gets reported to a state database and that information gets uploaded to a national database. The patient's name, address, ssn, diagnosis, occupation, marital status, treatment, health history, etc. is shared so that researchers all over the world can use the data for research. Because of pressure from the medical community, congress weighed the right of a patient for medical privacy against the best interest of society and decided that cancer patients don't get privacy.

Why should hospitals have more privacy than the patients they care for?

The only way to improve care is to study it, but that is not likely to happen and hospitals all over the country will continue to conceal their flaws.

nursebert, MSN · Feb 19, 2019

On 2/17/2019 at 9:49 PM, mtnNurse. said:
Yes, I agree with you we should look at each step and be conscious when administering, and seeing where mistakes were made and how to learn from them. But as far as her mindless unintentional failing goes and whether it warrants criminality, I see that as a ~30min. single horrific fallacious wrong-med-no-monitor mistake.
Yes, if only she had kept on high alert those entire 30 min. or so as we all know she should have.
Well, not much more we can likely say about that except that you don't agree with me nor I you. IMHO, she could've been the most prudent nurse in the world up until that tragic ~30 min. to an hour, however long those moments were between delegation and walking to ED.
Yes, every step is very important. I agree. I disagree those actions should criminalize her, and I've described why in other posts.
It sounds like you don't think she was ever a good nurse. We don't know if she was. If you do think she might have at least wanted to be a good worker and needed more lessons on becoming a good nurse...maybe it'd be a good idea for all nurses to get continual education on root cause analysis of fatal mistakes at least once a year? Maybe nurses could be encouraged by their employers to slow down, stay alert, take breaks to stay alert (and give them enough staff to do so), ask for help when needed (and give them enough staff to get the help) -- instead of being encouraged to speed up and take shortcuts and work their tails off 'til their brains are fried? If ideal conditions had been in place, we don't know whether this accidental death would have occurred. Just because some of you could never ever make the same series of step-skipping as she did does not mean that she could not have been prevented from accidentally causing this death, had environment and circumstances leading up to the death been different.

She is solely responsible for her negligence.

mtnNurse., BSN · Feb 19, 2019

11 hours ago, Anonymous865 said:
You keep arguing that the environment and staffing are to blame. You assert that she wasn't experienced enough to be in the helper role. The only evidence you present to support your argument is that everywhere you have worked nurses are so overworked as to present a danger to the patients.

I've also agreed many times I don't know but am giving the nurse the benefit of the doubt. I've asked people to give her the benefit of the doubt and use their imaginations to think of what conditions and circumstances could lead to her accident. If people could imagine any then maybe they wouldn't think this nurse should be criminalized. Some people can't imagine it being anything other than the nurse's fault and only her fault. They are giving the hospital and all systems within the benefit of the doubt rather than the nurse. Oh well on that, they can throw the holey-swiss-cheese root-cause-analysis idea in the garbage, unless someone only skips one safety check rather than multiple. I'm glad if the hospital provides a safe environment, has safe work load and expectations...sounds like a great place to work (though other posters earlier in this thread said otherwise). I've described why I don't think this nurse meets criteria for 'reckless homicide' and I also don't think she meets it for 'criminal negligence'. I still don't think so even if the hospital was as good as you might think. I don't think a nurse should ever be criminalized for an accident. BON should handle accidents. Leave criminal charges for criminals.

(side note: Regarding evidence you requested...I'm participating in an open conversation, not trying to publish an article; if this forum required citing evidence to back up my opinions, I wouldn't have time to participate; That said, it's great when people do have time and is interesting to read so thank you for the hospital info.)

Guest219794 · Feb 21, 2019

I am coming in late the discussion. I have read much of this thread, and a bunch of searchable articles, and still have no opinion. But a jury will be presented with actual evidence in a controlled environment, and will make a more informed decision.

A couple of questions for folks who feel strongly that she not be held criminally responsible.

How egregious would her actions have to have been before she should charged?

Do you feel the same about other jobs? For example, if a school bus driver had killed a bunch of children after the same level of disregard for established protocols, would you feel the same?

MrMidazolam · Feb 21, 2019

https://www.philly.com/opinion/commentary/radonda-vaught-nurse-hospital-errors-20190221.html

LilPeanut, MSN, RN, NP · Feb 21, 2019

Still skims over RV's negligence/culpability. The small dose of versed likely would not have caused an issue, and had it caused a problem, I would have been fully supportive that it was a systems issue.

But as licensed professionals, at some point, we have to have some responsibility for our actions.

Susie2310 · Feb 21, 2019

Medical errors (however caused) have been shown to result in large numbers of patient deaths annually. Many patients are harmed by medical errors annually. It has also been shown that patients frequently experience errors in care. Many errors in care go unreported, even in spite of a non-punitive "just culture." Medical errors that result in patient deaths are not currently reported on patients death certificates.

I conclude that the current voluntary system of reporting errors in care is insufficient to protect patients and that much greater regulatory oversight of health care facilities and of health care practitioners is necessary.

The argument has been made that if licensed health care practitioners face criminal charges for their actions this will result in reduced voluntary reporting of errors. I consider this more an excuse than a valid reason. It appears that new methods need to be devised to ensure that licensed health care professionals report their errors in care. In my opinion much greater oversight of licensed health care professionals' practice is needed by independent overseers, not by the health care industry.

Licensed health care professionals' have a professional and ethical duty to their patients, patients' family members, the public, and to the profession to report errors in care timely especially so that timely action can be taken by health care professionals to reduce the harm/injury to the patients affected; for example by close monitoring of the patient, administration of a reversal agent or other medication or other agent or transfer of the patient to the ICU, etc. When licensed health care professionals choose dishonestly not to report errors in care, there is no possibility to remediate the harm/injury that a patient may experience from the error/s.

Some errors in care are due to recklessness on the part of individual licensed health care professionals, and sometimes this can amount to criminal behavior. While we practice as part of a health care system we are always individually responsible for our own safe practice. Also, not all errors in care are due to "systems" errors; some are due to individual practitioner errors. Our number one priority should be to protect patients, not to protect licensed health care professionals who practice unsafely or to protect the health care industry. We have Standards of Care and we are taught medication administration safety procedures (Five/Six or more Rights) in nursing school; this is drilled into us in nursing school. Health care is a complex industry but Standards of Care exist for a good reason, for the protection of our patients.

Other professional occupations that have safety responsibilities to the general public are held to industry Standards of Practice and the licensed professionals in these occupations can be charged with criminal negligence when their actions demonstrate that they have violated safety standards and members of the public are harmed or killed as a result. Licensed health care professionals whose licensed professional practice is below the Standard of Care and results in harm/death to patients should not be treated differently or be exempt from criminal charges when after an appropriate investigation it is determined that criminal charges are appropriate.

Guest219794 · Feb 22, 2019

I admit to not reading all 57 pages on this thread, so maybe somebody has addressed this well. Why should this nurse not be charged with negligent homicide? Notice I used the word "charged" rather than convicted. The entire point of a trial is to see whether a person meets the legal standard for the definition of a crime. It creates a controlled environment in which all of the evidence can be presented and evaluated.

In my mind, this hinges on two central questions-

1- Should a nurse EVER be held to a criminal standard for causing unintentional harm?

2- Is this a case worthy of a trial to investigate whether that standard is met?

To me the answer to #1 is a clear yes. I believe this to be the case for any profession. If a person is responsible for the safety of others in any field, there is a point at which there lack of adherence to standards is a crime. This applies to nurses, doctors, electricians, raft guides, chefs.....

To answer #2, I looked up the definition of negligent homicide. In an earlier post I said I was on the fence. After reading these definitions, it seems clear to me that this nurse may well have met the standard to be charged. I, as well as everybody on this forum, don't know whether the evidence will support this charge.

What are types of negligent homicide?Professional negligence – Whenever the conduct of a professional while in the process or as a result of rendering services create circumstance that lead to the death of another individual, then that professional has committed negligent homicide.  A doctor, for example, may fail to follow standards of hygiene expected by society and his professional peers.  When this breech of professional conduct causes a deadly infection in a patient, it can be argued that the doctor’s negligence in providing sanitary conditions creates circumstances that lead to the patient’s death.  The doctor lacks malice and intent but is otherwise responsible due to his negligence.

Nurse Charged With Homicide

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