I have spent a lot of time thinking about this case from the perspective of (a) a nurse who has made a serious medical error, (b) a nurse who does occasionally pull meds on override, and (c) a nurse whose role sometimes sends me to MRI to administer medications to help patients get their scans.
I have a fairly high standard when it comes to judging a nurse irreconcilably incompetent (some would probably have made such an argument about me and my own error) and an even higher standard when it comes to criminal liability.
This case, however, is egregious on multiple points:
1) Pulling a medication on override isn't such a big deal to me. Confusing two medications simply because they start with the same two first letters... that's pretty bad...
2) Moving to the second point, any nurse with the least bit of experience with such medications would recognize that Versed doesn't require reconstitution but that vecuronium does. That's pretty significant to me because it suggests that there was a moment where the nurse must have had to deviate from her standard practice experience or simply didn't have the experience to do what was being asked of her and yet simply proceeded on without protest or asking for help - these being the common response from nurses that I observe... a community standard of sorts.
When she realized that she was looking at a powder in the vial, I wonder what was her thought process regarding how to reconstitute it. One would think that nearly everyone would stop at that moment and pull up their Davis guide or Lexi-Comp and figure out how much of what needed to be injected... and presumably seen some cautions.
3) Beyond those issues, though, I'm particularly troubled that apparently the nurse pushed the medication and simply left the patient. Any competent, experienced nurse giving midazolam would certainly hang around for a bit to monitor the patient, both for the intended effect of the medication as well as for the dangerous adverse events such as hypoventilation, laryngospams, and hypotension. Had the nurse been monitoring her patient rather than simply pushing a med, she would presumably have quickly realized that there was an emergent problem and initiated rescue interventions... bag the patient, call for help, and get them intubated.
4) What takes this case beyond my high standards, though, is the vial of vecuronium itself.
Unless Vandy is using some outdated supplier, the nurse had to remove the plastic top from the vial and ignore the words imprinted thereon: "Paralytic Agent". As if that weren't enough, when putting the needle or blunt through the vial's septum in order to reconstitute, she must have simply not looked at the words imprinted circumferentially about the septum: "Paralytic Agent."
This case is egregious in the extreme and does, in my opinion, meet the criteria for negligent homicide. Simply because she was working as a nurse in a hospital, with all the itinerant problems, stresses, and obstacles, isn't exculpatory.
Now, one could reasonably argue that nothing is served by criminal liability, particularly if she is never again permitted to practice nursing but that's an entirely different argument.
♪♫ in my ♥