RaDonda Vaught is seeking reinstatement of her Tennessee (TN) nursing license after a fatal medication error in 2017.
Updated:
TN state nursing board's 2021 decision to revoke her nursing license will be appealed in court on Tuesday, March 28. If the appeal is successful, she will face a retrial before the Tennessee Board of Nursing.
Nursing boards generally make decisions regarding the reinstatement of nursing licenses based on various factors, including the nature and severity of an offense, the rehabilitation efforts of the individual, and their ability to practice nursing safely and competently.
If RaDonda Vaught has completed the requirements (if any) and demonstrated that she could meet the standards of safe and competent nursing practice, then it may be possible for her to have her RN license reinstated. However, this decision ultimately rests with the state nursing board.
Most of us recall the RaDonda Vaught case in 2017 because it involved a fatal medication error, and she was charged with reckless homicide for the mistake. The decision to prosecute her made history because it set a precedent for criminalizing medical errors.
On December 26, 2017, RaDonda Vaught, a 35-year-old RN, worked as a "help-all" nurse at the Nashville, Tennessee-based Vanderbilt University Medical Center. She was sent to Radiology Services to administer VERSED (midazolam) to Charlene Murphey, a 75-year-old woman recovering from a brain injury and scheduled for a PET scan.
Charlene Murphey was experiencing anxiety, and her provider ordered Versed, a sedative, to help her through the procedure. RaDonda entered the letters "ve" for Versed (the brand name) in the automated dispensing cabinet (ADC) search field.
No matches populated the screen under the patient's profile, so RaDonda used the ADC override function and again entered "ve," this time mistakenly selecting vecuronium.
Vecuronium is a neuromuscular blocking agent, and patients must be mechanically ventilated when administered vecuronium. RaDonda reconstituted the drug and administered what she thought was one mg of Versed.
Unaware of her mistake, RaDonda left the patient unmonitored and went on to her next help-all assignment in the ED to conduct a swallow test.
Charlene Murphey was discovered about 30 minutes later by a transporter who noticed she wasn't breathing. She had sustained an unwitnessed respiratory arrest and was pulseless. She was coded, intubated, and taken back to ICU but was brain-dead and died within twelve hours.
Legal System
On February 4th, 2019, RaDonda was indicted and arrested on charges of reckless criminal homicide and impaired adult abuse.
On May 13, 2022, she was found guilty of criminally negligent homicide and gross neglect of an impaired adult, and sentenced to 3 years of supervised probation.
Board of Nursing
On September 27, 2019, the TN Department of Health (Nursing Board) reversed its previous decision not to pursue discipline against the nurse and charged RaDonda Vaught with:
On July 23, 2021, at the BON disciplinary trial, the Tennessee (TN) Board of Nursing revoked RaDonda Vaught's professional nursing license indefinitely, fined her $3,000, and stipulated that she pay up to $60,000 in prosecution costs.
Many opposed RaDonda Vaught being charged with a crime, including the American Association of Critical Care Nurses (AACN), the Institute of Safe Medicine Practice (ISMP), and the American Nurses Association (ANA).
If nurses fear reporting their errors for fear of criminal charges, it discourages ethical principles of honesty.
But should RaDonda be allowed to practice nursing again?
The (ISMP) felt strongly that revoking her license was a travesty and that the severity of the outcome wrongly influenced the decision. Contributing system errors were minimized, and RaDonda Vaught became the scapegoat, while Vanderbilt escaped full notoriety.
The ISMP said RaDonda displayed human error and at-risk behaviors but not reckless behavior. She did not act with evil intent and is a second victim of a fatal error. In a Just Culture, discipline is not meted out for human error.
Do you think RaDonda Vaught should be allowed to practice nursing again, and why or why not?
Thank you for your thoughts!
I should not have used the word "wrong". I should have used "misinformed". My apologies.
Rose_Queen said:Exactly! And what about the nurses in New Orleans following hurricane Katrina who didn't have functioning IV pumps and had to calculate rates in drops per minute? Nearly 20 years later, how many have become so reliant on technology that they can't calculate a
Rose_Queen said:Exactly! And what about the nurses in New Orleans following hurricane Katrina who didn't have functioning IV pumps and had to calculate rates in drops per minute? Nearly 20 years later, how many have become so reliant on technology that they can't calculate a drip rate?
We lost electricity the other day during some storms, no generator. I was the only nurse that knew how to calculate. We had 2 patients with antibiotics ordered, the MDs still wanted them given. The other nurses were in awe as I did both in a few minutes. One of them is a know it all, who actually doesn't know much. She slunk off after telling me that this couldn't be done with our pumps. I grabbed IV poles, old style lines, and abracadabra, magically did it...us old dogs still have a few tricks up.our sleeves?
MacNinni123 said:
What does this even mean?
also, most of us do not live in Tennessee. Tenebrae is posting from Australia (I believe). Just because you're in Maine does not mean you don't have access to the facts of the case. I encourage you to learn them before arguing things that are factually inaccurate.
NurseTechNurse said:Mind pointing out which posts you are referring to? For this thread, was there a post deflecting blame from RV?
Why not look at what could have done better from the hospital's angle? To your credit, whatever the hospital could have done better may not have affected RV's actions that day, though, in my opinion, it is worth looking at the hospital's actions, too, more so to learn from what they did wrong (if anything) and what could have been done differently.
If you have read the entire thread, you would find that people have already commented on what you reflect above. But, if you have any ideas about what Vanderbilt could have done to get RV to read the label, please feel free to comment. My mind is open
Tenebrae said:I have no interest in crucifying RV. I don't want her looking after patients
It doesn't matter because no one will hire her anyway. It's all moot. I never said she should return to any hands on clinical area. There are nonclinical things she can do that require a RN but people here don't even want her doing that. I think there was some kind of motive here with this post to get people's dander up and it has succeeded.
RN_SummerSeas said:I don't believe she should be crucified. Just as I don't believe this should ever have become a criminal case. That precedent will surely scare some people into not reporting, it removes the just culture that has been a part of healthcare that helps to increase safety and awareness. Don't get me wrong I don't think she is an angel who did nothing wrong, she made more than one error on that day with the worst possible outcome. But she didn't go to work intending to kill someone, she didn't plan with malice to cause harm. She is, after all, human and humans make mistakes from minuscule to massive proportions daily. I am sure you are all familiar with the case of Dr. Cook who was convicted of involuntary manslaughter when he was drunk driving and killed a 20 year old woman. He was able to leave prison, work in healthcare and go home to see his family on weekends. Many doctors have a belief that they will kill someone in their career, like it is a given, but we don't see them crucified or even punished when this occurs unless it is a physician with repeated errors and even that can take time, the case of Dr. Duntsch. I am in no way absolving her, just giving a different perspective. If you disagree that is fine, but hoping as professionals in the same field you all do so respectfully, so many times I have seen some nasty stuff happen between nurses online, thats such a shame.
Finally, a voice of reason. Thank you for your post.
Wuzzie
5,238 Posts
First, you weren't clear with what you meant by "AllNurses's Query" as that is not a term used around here so we had absolutely no idea you were basing your opinion on email blurbs of information. Also, you weren't being ignored. What you were saying was just wrong and you weren't willing to listen to those of us who actually have read the documents. You really should read them. They're eye opening. I know for many of us it was a wake up call to pay attention to our practice in all areas.