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RaDonda Vaught’s Arraignment - Guilty or Not of Reckless Homicide and Patient Abuse?

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tnbutterfly is a BSN, RN and works as a Content/Community Director @ allnurses.

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By now, most nurses have heard about RaDonda Vaught, a former Vanderbilt University Medical Center nurse who was charged with reckless homicide and patient abuse as a result of administering the wrong drug that killed a patient in December 2017. You are reading page 3 of RaDonda Vaught’s Arraignment - Guilty or Not of Reckless Homicide and Patient Abuse?. If you want to start from the beginning Go to First Page.

tnbutterfly is a BSN, RN and works as a Content/Community Director @ allnurses.

335 Likes; 13 Followers; 110 Articles; 192,322 Visitors; 5,282 Posts

2 hours ago, /username said:

I'm getting really sick of these posts.  By what is alleged in the public record, she bypassed multiple safety checks, was not aware of the medication she was giving, and exercised terrible judgement.   Not only does this make our profession look bad, but the way this forum admins and others are tripping over themselves to defend her doesn't make any damned sense. .  

Just to be clear, none of the allnurses Admins have posted their opinion regarding the RaDonda Vaught case.  We are just providing coverage and updated links to the latest news and videos.  Members are welcome to disagree as long as they respectfully express their opinions.  

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23 hours ago, Susie2310 said:

I posted the following comment to mtnNurse on two other threads.  To further the discussion I thought it appropriate to post it again:

"You keep making the point that nurses brains are subject to failure because we are humans.  By your logic all workers in all types of occupations should never be charged with any crime due to their negligence unless they deliberately intended to cause harm to the public.

 Following your logic airline pilots brains are subject to failure at any moment during an 11 hour flight, and the plane could crash if the pilot gets overwhelmed or distracted.  Think of all the many, many flights that take place all over the world, just in the course of one day, yet planes aren't crashing all over the place every day.  Should we conclude that airline pilots brains function better than nurses brains?  Or do airline pilots practice to higher professional standards? Nursing isn't the only profession with a lot of stressors, distractions, and responsibility/accountability.

I just had a licensed electrician work perform some work for me.  Should I assume that he/she may be under extraordinary stressors and be unable to perform safely?  I never thought that he/she might actually have been incompetent is his/her practice or might make a mistake that would lead to him/her ignoring basic electrical safety procedures.  That perhaps he/she might be negligent to the point that I will get electrocuted.  Oh, well, I guess I will just put it down to brain failure on his/her part. In which case, what is the point of professional licensure?  If a licensed electrician can't perform their job safely why should I bother using his/her services?

Why bother to have any professional standards for any professions at all?  Why bother with licensure?  If the public can't trust that a licensed professional will be able to perform to industry standards of safety, why should they bother using the services of a licensed professional?  Then we don't have professions, because everyone does the job equally incompetently/unsafely.

If you believe that nursing is a unique profession with extraordinary stressors such that nurses are unable to concentrate on their licensed activities to the point that they are unable to perform safely and must excuse themselves due to brain failure when they inadvertently harm or kill patients due to not being able to perform safely, why should anyone have any confidence in nurses ability to perform safe care?  Why should the public go to hospitals?  

You are saying something quite terrible, that perhaps you don't realize you are saying, and that is that the public shouldn't expect to rely on licensed professionals to meet industry safety standards.  You are saying that licensed professionals shouldn't be held criminally liable for failing to meet industry safety standards; that as long as they did not deliberately intend harm they should not face criminal charges and that their lapse of judgement/unsafe performance however caused should not result in criminal charges.

I ask you a question in return, why should the public have confidence in licensed professionals?  Why should I receive nursing care from you?  Do you see where this goes?  If the general public loses confidence that they will receive safe nursing care, do you think you can take for granted that they will continue to come to the facility you work at for their care?  Do you think you might lose your job?

Licensed professions rely on the confidence of the general public.  The reason licensed professionals get paid is that the general public trust in the standards of the professions and place their trust in the licensed professionals.  If you can't provide safe nursing care why should I come to the facility you work at for my care?  If a licensed airline pilot can't fly a plane safely, meeting industry safety standards, why should I fly with that airline?  If the problem is endemic to the airline industry, why should I fly at all?" 

 

Doesn't a pilot have a co-pilot to relieve him or her?

The electricians and other licensed pros are another matter, for which I have no answer at this moment.

Licensure and Board oversight are not guarantees of safe care.  The current status of  understaffing and of overburdening nurses is simply inexcusable and those who force too many patients upon a nurse are the ones who should be charged criminally when things happen. 

 

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Hoosier_RN has 20 years experience as a MSN and works as a Dialysis.

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3 minutes ago, Kooky Korky said:

Doesn't a pilot have a co-pilot to relieve him or her?

The electricians and other licensed pros are another matter, for which I have no answer at this moment.

Licensure and Board oversight are not guarantees of safe care.  The current status of  understaffing and of overburdening nurses is simply inexcusable and those who force too many patients upon a nurse are the ones who should be charged criminally when things happen. 

 

Other licensed professionals don’t necessarily have anyone else with them. I just had an electrician come to my home to do work, he was alone. I had to just go with he had the knowledge.

We can also blame staffing, but this nurse should have known she had never given this med. She should have read facility P&P before administering. And yes, I always do that with a med that I’ve never given, or that’s not familiar to me. It’s the way to not harm anyone. 

I’m sure she meant no harm, but if this were my loved one, the BoN would definitely know me! 

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On 2/20/2019 at 7:12 PM, Susie2310 said:

I posted the following comment to mtnNurse on two other threads.  To further the discussion I thought it appropriate to post it again:

Well, shoot, I just replied in another thread called 'I hope this is not the latest trend' -- can we please just pick one thread when it's a long post and if you want to comment in another thread, re-write your points in a new way so at least it's not the identical post to respond to? Sadly, I will follow your suit here to copy & paste my response -- I don't like doing so for the sake of people reading all threads, but I don't want your post to go unanswered if people are only reading this thread. You ask valid questions here and I give valid answers!

On 2/20/2019 at 7:12 PM, Susie2310 said:

"You keep making the point that nurses brains are subject to failure because we are humans.  By your logic all workers in all types of occupations should never be charged with any crime due to their negligence unless they deliberately intended to cause harm to the public.

I've wanted to stick to just talking about nursing rather than including other occupations because I don't know how well other jobs compare to nursing jobs, regarding how in many (most?) nursing jobs, the nurse would have to quit or be willing to be fired to keep her license in integrity. But your valid questions in your post made me think about other occupations. Ok, so here is what I think. If a well-meaning worker in any occupation who is doing their best to do their job, who does not maliciously set out to harm anyone, makes an honest mistake in the course of doing their job or accidentally acts in a negligent way (i.e. is negligent not by choice but due to being overworked, considering one person only has one set of eyes and hands, can only be in one place at a time, and only has so much brain-power to actively think about a limited amount of cases simultaneously), then the licensing agency should decide how to hold the worker accountable rather than criminal court. Such a worker is not a criminal and it doesn't do a lick of good in our society to criminalize these workers. If we look at the causes in those situations, and find that the employer asked the worker to meet impossible demands, with an impossible work load...we need to hold the employer accountable rather than the worker. Why? Because if we hold the workers accountable, that does not fix the place of employment, and just leads to the next round of workers falling into the trap. If we hold the place of employment accountable instead, and the employer is prevented from understaffing / overworking, then lo and behold those same workers are suddenly able to adhere to all standards of practice while doing their jobs. 

On 2/20/2019 at 7:12 PM, Susie2310 said:

 Following your logic airline pilots brains are subject to failure at any moment during an 11 hour flight, and the plane could crash if the pilot gets overwhelmed or distracted.  Think of all the many, many flights that take place all over the world, just in the course of one day, yet planes aren't crashing all over the place every day.  Should we conclude that airline pilots brains function better than nurses brains?  Or do airline pilots practice to higher professional standards? Nursing isn't the only profession with a lot of stressors, distractions, and responsibility/accountability.

From this analogy, I would conclude that the system of safeguards in which airline pilots do their jobs is a better system than that which nurses have to work within. I totally agree that nursing is not the only profession with stress, distractions, and accountability, and in fact I think there are worse. I consider a doctor's profession to be far worse regarding stress and distractions and higher responsibility; but doctors perhaps have a better understanding of the risk of harm and the risk of human error and are less likely to be criminally charged for accidents because they probably understand that accidents and unintentional negligence are not a matter of criminality but rather an issue for the medical board. 

On 2/20/2019 at 7:12 PM, Susie2310 said:

I just had a licensed electrician work perform some work for me.  Should I assume that he/she may be under extraordinary stressors and be unable to perform safely?  I never thought that he/she might actually have been incompetent is his/her practice or might make a mistake that would lead to him/her ignoring basic electrical safety procedures.  That perhaps he/she might be negligent to the point that I will get electrocuted.  Oh, well, I guess I will just put it down to brain failure on his/her part. In which case, what is the point of professional licensure?  If a licensed electrician can't perform their job safely why should I bother using his/her services?

Electricians get to focus on one job at hand at a time. Nurses in many (or most?) places of work are given unsafe obscene numbers of patients to guarantee safety for. I would trust a licensed electrician, but understand also that electricians are human so licensed or not, of course they could make a mistake. Making a mistake does not mean the person was incompetent -- that is WHY it's a mistake! The electrician perhaps had decades of fine-tuned skills to do something, then suddenly "whoops", did NOT mean to do that!

Ok, so what is the point of licensure -- I'd like for someone to answer that too! Because if I were a conspiracy theorist (which I'm not), I'd say it's so we can blame workers rather than employers when workers make mistakes in places of employment where they are set up to fail to save money! I don't believe that's the purpose of licensure (hope not). Isn't its purpose to protect the public from the worker as someone has said? --Then let the licensure agencies serve their purpose by holding workers accountable, and if the agencies aren't doing so, let the agencies be held accountable. Regarding why you should trust licensed professionals knowing they are human and might err and knowing they are held accountable to their licensing agencies...well, find out more about their employer -- if the licensed worker is given too much work, then common sense would tell us they aren't as likely to be able to do as well of a job. So as consumers, don't go to businesses who overwork or otherwise mistreat their employees if you can help it.

On 2/20/2019 at 7:12 PM, Susie2310 said:

Why bother to have any professional standards for any professions at all?  Why bother with licensure?  If the public can't trust that a licensed professional will be able to perform to industry standards of safety, why should they bother using the services of a licensed professional?  Then we don't have professions, because everyone does the job equally incompetently/unsafely.

Licensure alone cannot guarantee safe work. This seems like common sense to me because of work conditions I've seen. If a licensed worker is in a job requiring a work load so excessive that the worker cannot perform safely...then the licensed worker is supposed to quit or be willing to be fired in order to adhere to the standards of practice. So then we are faced with the conflict of interest between a worker wanting to adhere to the standards of practice and be a good nurse / electrician / pilot / etc. but who ALSO wants to be a good worker and who also understandably wants a good job to have a good quality of life in this country. So what do we do? If we criminalize the worker when they inevitably fail when faced with impossible work demands, that does NOTHING to prevent the next worker from failing. Regarding nursing, that does NOTHING to keep patients safe. On the other hand, if we change the work environment and expectations and whatever CAUSED a conscientious worker to fail, then we allow future conscientious workers to succeed in simultaneously being a good worker AND a good professional. 

On 2/20/2019 at 7:12 PM, Susie2310 said:

If you believe that nursing is a unique profession with extraordinary stressors such that nurses are unable to concentrate on their licensed activities to the point that they are unable to perform safely and must excuse themselves due to brain failure when they inadvertently harm or kill patients due to not being able to perform safely, why should anyone have any confidence in nurses ability to perform safe care?  Why should the public go to hospitals?  

Good question! The public should not have any confidence in a hospital to guarantee their safety if at that hospital there is an unsafe working environment, staff are given impossible work loads, there is not enough staff for the number of patients, staff are working 12 hour shifts without being able to take breaks, and other common assaults on the physical and mental limitations of human beings. That said, I do believe most nurses CARE and are giving it their absolute best to care in spite of horrid work conditions. I do believe somehow, against the odds, seemingly super-human nurses pull it off. Sometimes they don't. But we'll never hear about the times they don't when it's not reported, or if it's not fatal and no one even notices. I think the way ample articles and videos explain that "swiss cheese" model of how mistakes happen is a very good explanation of how things go wrong all the time but it's when a crucial sequence of the wrong things align that we get a bad enough outcome to notice.

On 2/20/2019 at 7:12 PM, Susie2310 said:

You are saying something quite terrible, that perhaps you don't realize you are saying, and that is that the public shouldn't expect to rely on licensed professionals to meet industry safety standards. 

I agree it is terrible that licensed professionals are often not able to adhere to their professional standards of practice because often the jobs available to them (recalling most of us need jobs to survive) make impossible work demands that cannot be met while adhering to those standards of practice. The public can't ever rely on a human to never make a mistake anyhow; that is why a good place of work would have many layers of safety catches in place. In the case of nurses who absolutely must have a sharp state of mind to work safely, I would say there are many failings of those needed safety catches, e.g. lack of sufficient breaks in a 12-hr work shift (and SO MANY MORE, just go see for yourself...). And YES it is terrible that the public cannot rely on any businesses to do anything with safety as a priority because most any business in this country has money, not safety, as its bottom line! That is unregulated capitalism at its worst -- create a system where the incentive is to be unsafe in order to make more money (yay for the USA!). I would very much like to continue discussion on how to improve the NURSING profession and don't want to get too political here but would talk more in depth politically on a different thread if you want to start one, if that's even permitted talk in these parts (without being shot 😄).

On 2/20/2019 at 7:12 PM, Susie2310 said:

You are saying that licensed professionals shouldn't be held criminally liable for failing to meet industry safety standards; that as long as they did not deliberately intend harm they should not face criminal charges and that their lapse of judgement/unsafe performance however caused should not result in criminal charges.

Agreed -- if it wasn't deliberate, then the licensing agency should deal with it not criminal court. Isn't that the point of the BON and parallel licensing agencies in other professions?? Save the criminal court for actual malicious criminals.

On 2/20/2019 at 7:12 PM, Susie2310 said:

I ask you a question in return, why should the public have confidence in licensed professionals?  Why should I receive nursing care from you?  Do you see where this goes?  If the general public loses confidence that they will receive safe nursing care, do you think you can take for granted that they will continue to come to the facility you work at for their care?  Do you think you might lose your job?

I think the public should lose confidence and should not go to the facilities in which staff is not given the environment to be able to perform safely, EXCEPT for the fact that medicine ALWAYS has risks vs. benefits. So if someone is having a heart attack, they're most likely better off going to a hospital than seeing what happens at home. What's the statistic, that hospitals are the third leading cause of death in this country or something like that? I'd recommend to the public to go to the hospital as a last resort. And to vote for people who care about changing our god-awful health care system. Facilities have financial incentive to employ fewer staff than the number needed to guarantee safe high quality care to every single patient every single day...this is our reality of most (or all?) places we work as nurses. I don't understand your last question about losing your job...if what, if we aren't hauled off to prison for a mistake then people won't trust us? We could still lose our jobs for a mistake...the BON could take away our licenses. Leave it in their hands to decide if the mistake or stray from standards of practice was just a rogue nurse being bad or because of the system or some of both, and how much to hold the nurse accountable -- but it's not an issue for criminality. Streets will not be safer to have conscientious, overworked nurses behind bars for their "crime" of doing their best to keep their jobs.

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6 hours ago, Susie2310 said:

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.

YES on much greater regulatory oversight of health care facilities being necessary! Just one of endless regulations we could think of to improve safety would be: mandated maximum number of patients to allow nurses to better care for each patient and reduce risk of mistakes!

Here's a question for you based on the rest of the comments you made. Let's say we just start throwing in jail everyone involved in medical errors. This will lead to greater safety because...how exactly? How will criminalizing nurses prevent other nurses from having accidents? People will be too afraid of jail to make a mistake? So killing a patient isn't scary enough, but then jail would be, is what you're saying? Jail is a bigger deterrent then KILLING a patient?? And besides, how to you deter someone from having an accident?? Does that question not defy the very definition of 'accident'??? 

 

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

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If nurses would refuse to practice unsafely and either unionize or just refuse to work at places where you say it is impossible to give safe care, then it would certainly help.  By taking and staying at a job and performing things they know from their education to be unsafe, that does not absolve them of responsibility.

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TriciaJ has 35 years experience as a RN and works as a Retired.

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It is the main purpose of the BON to protect the public.  But we've seen how BONs can capriciously issue draconian measures in some instances and be completely nonchalant in others.

 Professional licensing boards should never be the last word in professional accountability.  Any time any profession professes to "police itself" you are going to see instances of negligence or downright corruption. This is how "closed systems" can easily become. There should ALWAYS be accountability to outside entities no matter who you are.  It's part of the checks and balances of a relatively safe society.

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6 hours ago, /username said:

I'm getting really sick of these posts.  By what is alleged in the public record, she bypassed multiple safety checks, was not aware of the medication she was giving, and exercised terrible judgement.   Not only does this make our profession look bad, but the way this forum admins and others are tripping over themselves to defend her doesn't make any damned sense. .  

It makes sense to defend nurses involved in accidents from criminal charges if you think the BON should handle accidents and the criminal court should be reserved for malicious criminals. Of course, you have a right to not think this. If you're truly interested in why some defend her, there are what 3-4 threads now and plenty of well thought out various valid differing opinions.

Please don't make yourself sick...just get off the computer before that happens. 🤒

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17 minutes ago, LilPeanut said:

If nurses would refuse to practice unsafely and either unionize or just refuse to work at places where you say it is impossible to give safe care, then it would certainly help.  By taking and staying at a job and performing things they know from their education to be unsafe, that does not absolve them of responsibility.

Yes! Quit or be willing to be fired rather than work in such a place. That is what we should. Easier said than done for sure, and I don't know what advice to give those who need that job to stay in their house or feed their kids...do you?

I haven't seen anyone argue for the nurse to be absolved from her failings -- just that the BON should be the only entity to hold her accountable rather than criminal court.

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@mtnNurse. Your entire premise seems to be based on the assumption that the failure to safely practice by RV only happened because of working conditions set by the hospital and that she was working outside of her level of experience, again at failure of the hospital to require adequate experience for what was expected of her.

So...

Premise 1: For the sake of argument, would your opinion change if you learned that staffing was adequate, and the workload was light that day? 

Premise 2. Again, for the sake of argument, let's also assume that at the very least, she knew the basics of nursing implications regarding Versed, and was familiar with vecuronium

So take those two assumptions and pretend the facts are different than what you believe to be true. 

In addition, you learn that the BON has given her a pass....What then?

(I find it impossible to believe that a nurse could spend a year in ICU and not know those meds).

Edited by mtmkjr

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This^

Also, I asked a question of all of you who thought this should be handled by the BON. The BON has decided to do nothing. RV is not suspended or sanctioned. Her license remains active and unencumbered. She has not even been ordered remediation. This was after a 9 month investigation by said board so is unlikely to change. Do you think we should be okay with their decision? If charges had never been fired she would have gotten off scot free after killing a patient because of her egregiously stupid actions.  And she may still. I’m sorry but there are no circumstances that relieve us of our personal responsibility to practice in a prudent manner and if the board isn’t going to do anything somebody else should. 

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

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3 hours ago, mtnNurse. said:

Yes! Quit or be willing to be fired rather than work in such a place. That is what we should. Easier said than done for sure, and I don't know what advice to give those who need that job to stay in their house or feed their kids...do you?

I haven't seen anyone argue for the nurse to be absolved from her failings -- just that the BON should be the only entity to hold her accountable rather than criminal court.

The same thing they would do if they got fired for killing a patient because of their poor practices. 

I worked at a hospital with a very good reputation and was highly ranked for my specialty.  I saw some completely unsafe practices and people who were unwilling to change them. I had signed a 1 year contract - I made sure that *my* practices were not what the rest of the group was doing, and I got a new job that would start pretty much the moment I hit 1 year on the contract, and consistently kept reporting the unsafe and bad things I saw. 

Example: Preparing a tray for PICC insertion. They placed a non-sterile ABG syringe on the sterile tray.  "Oh wait! Did you realize that wasn't sterile on the outside?" (I knew it said it was sterile on the inside of the syringe, but it was in a perforated loose plastic bag, and the outside was definitely not sterile) "Oh really?  It isn't? Well, we've been putting these on our trays for years and haven't had issues".  Reported that to no less than 4 people.  When I left at the 1 year mark, people were still placing a non-sterile syringe on their "sterile" field prior to starting a supposed to be sterile procedure. 

If you were a school bus driver and the bus company told you to not use the flashers and safety gates and not stop at railroad crossings because they take too much time, would you do it, even knowing it could kill children?  Or if you were a housekeeper and were told to mix bleach and ammonia, even though you knew it would create chlorine gas and kill you and the other people there, would you do it? 

There are hotlines and whistleblower lines and places to report, and unionization is always a potential as well.  But you can't just throw your hands up and say "Well, I guess I have no choice but to give ***, substandard care". 

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