Radonda Vaught Trial

[tnbutterfly - Mary]

"Fourteen Nashvillians were chosen Monday, March 21, 2022 to sit as a jury in the case of RaDonda Vaught, a former Vanderbilt University Medical Center nurse charged in the death of a patient. She faces charges of reckless homicide and impaired adult abuse in the 2017 death of Charlene Murphey."

For more on this story, see

Jury chosen in homicide trial of ex-Vanderbilt nurse RaDonda Vaught after fatal drug error

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

Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

What do you think the verdict should/will be?

[mtmkjr, BSN]

1 hour ago, Emergent said:

There have been criminal prosecutions in other professions when someone's negligence causes death or destruction. I googled this one and thought it had some similarities. The pilot wasn't accused of being inebriated, but blew past several safety rules. If you read the rest of the article he says that the electronics were failing. I don't know the outcome of this, but I thought it was a worthy comparison to a nurse who ignored the standard of care and had a disastrous outcome.

Should people ever be prosecuted when their errors due to negligence cause great harm? Why should a nurse be exempt?

Ship's Pilot Charged

 

Yes, agree. Not sure why nurses should be immune when reckless actions result in someone's death.

Another example:

https://www.cnn.com/2022/03/18/us/florida-bridgetender-manslaughter-charge/index.html

In this case the supervisor directed The bridge operator to make a statement that didn't align with the facts. I believe the supervisor should also have been charged in some way but that does not take away the negligence and culpability of the bridge operator.

It is so clear when another profession makes an egregious error that has criminal implications. For some reason nurses tend to be blind to their own. 

Everybody understands that people make mistakes. Nurses make medication errors, and we learn from those and move on. 

As I've said before Radonda did not make a "medication error".

[LifeandHealth]

I believe Mrs. Murphy suffered before she died. I am so saddened by the thought of that. I ache for the family. 

Bear with me here. I am aware that people can and do fall into ruts on their job and automatically do things mindlessly.  This can lead to errors. If direct care clinicians, practitioners would just stand our ground and not fall into a mindset of got to get it done, rushing through and ignoring processes for the outcome, then we can force the system to change. 

We are not robots and should not even try to function as such. We should show all the care and concern over each patient as if we are the patient.  If we are going to be threatened to be replaced by AI, robots then let it go forth. I am willing to bet that robots will not be error free because they are created by who? Humans who are prone to errors. 

[MunoRN, RN]

On 4/7/2022 at 9:29 PM, Susie2310 said:

In regard to your second paragraph above, I can't see that errors/misjudgments in care that involve medications with a generally low potential for harm would be treated exactly the same as those involving medications that are known to have a high risk of injury/harm to the patient and I disagree with your statement about a precedent being set.

 

A legal precedent is a principle a court case holds to be true, which makes that principle what is called "common law" until it is successfully challenged and overturned.

The basis of a negligent homicide conviction is that an act or acts of gross negligence result in a death.  Gross negligence is also a crime, the criminality and terminology varies some by state, but typically the first act is a misdemeanor, every subsequent act is a felony.

The D.A. provided a detailed list of what was (successfully) argued to be individual criminal acts of gross negligence:

Based on this, taking the wrong medication out of the ADC, even if you recognize you have the wrong med prior to administering it, is a crime, as is simply using the override function of an ADC.

The particular medication that was incorrectly removed doesn't determine whether gross negligence occurred, I'm not really sure how that would work since you can't really choose a specific medication to incorrectly remove.

On 4/7/2022 at 9:29 PM, Susie2310 said:

 

We know that errors/lack of judgment in care that result in harm to patients are not uncommon (let alone near misses), and my understanding is that the great majority of these are estimated not to be reported.  While Just Culture and methods that facilitate and encourage reporting are of value, in my view this seems to be a strategic moment where new patient safety studies should be done with the goal of finding new methods/innovations to prevent both errors/lack of judgment in care that result in harm to patients and to  identify errors and lack of judgment in care promptly in real time in order to promptly take appropriate patient interventions to mitigate the harm of these errors/lack of judgment in care, and to reduce reliance on voluntary systems of reporting by health care professionals.    

I think that new external oversight of facilities in regard to patient safety could be beneficial for patients and that much can be done moving forward in regard to patient safety if there is the industry will.

And that's the problem, "to identify errors and lack of judgment in care promptly in real time in order to promptly take appropriate patient interventions" generally requires the nurse who has identified the error to report it, making them weigh the apparent risk to the patient with admitting to a possible felony doesn't facilitate that.  

And there are certainly mechanisms to both reduce the risk of errors, and to identify errors immediately following the error to appropriate treat the patient, but those mechanisms also largely rely on those deficiencies being reported by the end users the systems (nurses).

To back to a system without this feedback is to back to the dark ages of patient safety.  So if you're appalled dismayed by what happened to this patient, making it more likely this will happen to more patients doesn't make much sense.

[MunoRN, RN]

10 hours ago, Emergent said:

There have been criminal prosecutions in other professions when someone's negligence causes death or destruction. I googled this one and thought it had some similarities. The pilot wasn't accused of being inebriated, but blew past several safety rules. If you read the rest of the article he says that the electronics were failing. I don't know the outcome of this, but I thought it was a worthy comparison to a nurse who ignored the standard of care and had a disastrous outcome.

Should people ever be prosecuted when their errors due to negligence cause great harm? Why should a nurse be exempt?

Ship's Pilot Charged

 

The criminal charges he was ultimately pled guilty to was reportedly based on his use of multiple prohibited medications, which he appeared to recognize would not be allowed while piloting a vessel because he left them off his medical declarations.  The list was impressive but the big ones were lorazepam, vicoden, darvon, and codeine.  The other criminal act was that he and the crew abandoned ship rather than attempting to mitigate the effects of the crash.

Had Vaught been under the influence of impairing medications that she was aware she should not be taking, and in addition to that recognized that she had given Murphy a paralytic and failed to take action, then absolutely, that's criminal.

 

[MaxAttack, BSN, RN]

41 minutes ago, MunoRN said:

The D.A. provided a detailed list of what was (successfully) argued to be individual criminal acts of gross negligence:

Based on this, taking the wrong medication out of the ADC, even if you recognize you have the wrong med prior to administering it, is a crime, as is simply using the override function of an ADC.

This paper says there were 18 mistakes that AMOUNTED TO gross negligence, not that there were 18 instances of gross negligence.

No one's being criminally charged for holding the wrong medication in their hand.

[MunoRN, RN]

1 minute ago, MaxAttack said:

This paper says there were 18 mistakes that AMOUNTED TO gross negligence, not that there were 18 instances of gross negligence.

No one's being criminally charged for holding the wrong medication in their hand.

That's not a thing, there is no number of non-crimes that become a crime.  An act is either a crime or it isn't, the severity of an individual act can determine the degree of that particular crime.  So according to the law, how many errors equals a criminal act, where is that defined by law?

[MaxAttack, BSN, RN]

1 minute ago, MunoRN said:

That's not a thing, there is no number of non-crimes that become a crime.  An act is either a crime or it isn't, the severity of an individual act can determine the degree of that particular crime.  So according to the law, how many errors equals a criminal act, where is that defined by law?

A lawyer you are not. They were showing that there were so many errors that what happened was elevated to a level of reckless disregard for safety. I'm not going to argue law with you but I can guarantee you our legal system is not as black and white as you think it is.

You are free to think that holding an incorrect medication is a crime but that is 100% not what that paper that you referenced says.

[Susie2310]

1 hour ago, MaxAttack said:

This paper says there were 18 mistakes that AMOUNTED TO gross negligence, not that there were 18 instances of gross negligence.

No one's being criminally charged for holding the wrong medication in their hand.

Thank you.

[MunoRN, RN]

1 hour ago, MaxAttack said:

A lawyer you are not. They were showing that there were so many errors that what happened was elevated to a level of reckless disregard for safety. I'm not going to argue law with you but I can guarantee you our legal system is not as black and white as you think it is.

You are free to think that holding an incorrect medication is a crime but that is 100% not what that paper that you referenced says.

Civil law is not black and white, criminal law makes a point of being clearly defined.  Negligent homicide is defined as criminal negligence that results in death, if the prosecutor didn't think that the individual acts, not cumulative, that led up to the death should be considered gross negligence then it's certainly odd that's exactly what the prosecution argued.  

The Vaught case is clearly suited to a Civil case, specifically a malpractice case.  And no, I'm not a lawyer, but Sarah Beth Meyers is former Federal prosecutor who called the case a "miscarriage of justice" since it was a medical malpractice case, not a criminal case.  P. Danielle Nellis, also a former prosecutor, called it a "classic medical malpractice issue".  

[klone, MSN, RN]

Muno, you're being ridiculous in your arguments,  to the point of devolving into complete pedantry. I also think you realize you're being utterly pedantic, but are doing it for show or amusement. Someone only pulling the wrong med out of the Pyxis is not going to get charged because nobody is going to die from the mere action of pulling the wrong med out.

[MunoRN, RN]

9 hours ago, klone said:

Muno, you're being ridiculous in your arguments,  to the point of devolving into complete pedantry. I also think you realize you're being utterly pedantic, but are doing it for show or amusement. Someone only pulling the wrong med out of the Pyxis is not going to get charged because nobody is going to die from the mere action of pulling the wrong med out.

I suppose I do make a point of having a reasonable understanding of relevant topics, if that's something you see as a character flaw then as my teenage daughter says, constantly, you do you.

If the alternative to the scorn of being called pedantic is to take the position, without much of an attempt to support it, that the various reliable sources on this are wrong, whether it's ISMP, criminal prosecutors, or ASHRM (here and here), then sure, I'm pedantic.  

[Susie2310]

This is the scenario that I  understand is being postulated by some people: 

Due to the verdict, the great majority of licensed health care practitioners will no longer report errors/misjudgments in care that result in patient harm or have the potential to result in patient harm, as licensed practitioners will be likely to choose not to be honest, ethical, patient advocates, who hold their duty of care to their patients first and foremost, as they will fear legal repercussions (in actuality, the risk of legal repercussions already exists in law for errors/misjudgments in care that amount to negligence, gross negligence, and criminal negligence).

Also, my understanding is that currently, the great majority of errors/misjudgments in care that result in patient harm or have the potential to result in patient harm, are estimated not to be reported.  

So, if, due to the verdict, the situation in the first paragraph proves to be true, and fewer errors/misjudgments in care that are either: certain to harm patients, likely to harm patients, have the potential to harm patients, or have low potential to harm patients, are reported (and if it is true that the majority of errors/misjudgments in care that result in patient harm or have the potential to result in patient harm are not reported anyway), it's possible that the number of errors/misjudgments in care that go unreported by licensed health care workers could become truly abysmal and it's also possible that there will be no significant changes in the number of errors/misjudgments in care that are reported.

Further, my understanding is, on the above basis, that what is being suggested by some, is that if the above situation happens, this will have even worse effects on patient safety, so therefore, even if a licensed health care practitioner is found to have committed gross negligence or criminal negligence, some people don't want normal legal consequences to follow; they want something else to happen - I'm not sure exactly what they want to happen, but it seems they want something that will magically happen to spirit away the verdict. Some people say they think that a situation (where it is estimated that the great majority of errors/misjudgments in care go unreported) where a voluntary, non-punitive culture, exists for reporting, is best for patient safety but that the verdict undermines this.

It's also possible that some people who work in the health care industry are uncomfortable at the possibility that they could be held accountable in similar circumstances, and that they fear for their own practice.  That's very human; we tend to think of how things could affect us.

In regard to patient safety I already suggested:   New patient safety surveillance by external regulatory authorities; new patient safety studies focusing on preventing errors/misjudgments in care that have the potential to harm patients; use of new methods/innovations to detect errors/misjudgments in care with the potential to harm patients in real time; with the aim of reducing reliance on voluntary reporting of errors/misjudgments in care.  If some licensed health care workers are so affected by the verdict that their ability to provide safe care and to be accountable for the care they provide is compromised, then it seems to me that facilities will have to do something to ensure safe care is provided.

I believe that licensed health care professionals, when, through objective evidence and proper process, have been shown to have committed gross negligence or criminal negligence, should face charges as other licensed professionals in other fields do when they are determined to have breached the duty of care they have to the public with harm resulting to member/s of the public.  I don't believe that trying to circumvent/circumventing this process aids in the goal of patient safety.