Should RaDonda Vaught Have Her Nursing License Reinstated?

[Nurse Beth]

RaDonda Vaught Seeking Reinstatement of Nursing License

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.

Background

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.

Charges and Convictions

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:

• unprofessional conduct,
• abandoning or neglecting a patient, and
• failing to document the error.

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. 

Controversial

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!

[mtmkjr, BSN]

MacNinni123 said:

Yes...and if it must be that quick...we have crash carts...

Not necessary to break into the crash cart unless coding 

[subee, MSN, CRNA]

toomuchbaloney said:

I think that when crimes are committed that the perpetrators should be charged with breaking those laws.  Laws should apply to everyone.  

Right now I have mixed feelings about charging a heathcare practitioner with a criminal action unless it can be proven that it was done with deliberation.  I think a case of negligent homocide would be the correct charge in this particular case but I also understand that it could lead juries to convict nurses of a crime less for errors less chilling than this one.  I understand why plenty of people would believe that losing your livelihood and your reputation is not be a commensurate consequence for negligent homocide, but then, what is?

[aynRN513]

I have a couple points re: RaDonda Vaught. First, I find it hard to believe that there is no policy or SOC for administering sedatives. If there is not, then that is a separate issue. Second, Ms Vaught was either extremely careless or extremely (for lack of a better word) ignorant when she administered the Vecuronium instead of Versed. If she was not familiar with the medication then she should have looked it up or called pharmacy or a co-worker. As I teach new graduates & hires, we (nurses) are the last stop of safety. It does not matter if the MD/APP wrote the order incorrectly & it passed through pharmacy and was filled incorrectly, we are the ones who administer the med so you better make damn sure it is the right med. Remember the 5 rights? I do NOT believe healthcare workers should be prosecuted for med errors, but I believe we should be held accountable for our actions by our licensing & governing boards.

[emergenceRN17, ASN, BSN, RN]

mtmkjr said:

Sometimes the safety of the patient depends on a nurse being able to access an emergency med 

Except this did not warrant access to an emergency med. This situation was not even close. A med like vecuronium should not have the ability to be overridden.  

[toomuchbaloney]

subee said:

Right now I have mixed feelings about charging a heathcare practitioner with a criminal action unless it can be proven that it was done with deliberation.  I think a case of negligent homocide would be the correct charge in this particular case but I also understand that it could lead juries to convict nurses of a crime less for errors less chilling than this one.  I understand why plenty of people would believe that losing your livelihood and your reputation is not be a commensurate consequence for negligent homocide, but then, what is?

Yet we don't have any history of charging nurses for errors less chilling than this one.  This particular incident was not a simple error, it was gross neglect and willful refusal to follow basic and prudent safety protocols.  It amounted to criminal negligence. 

aynRN513 said:

I have a couple points re: RaDonda Vaught. First, I find it hard to believe that there is no policy or SOC for administering sedatives. If there is not, then that is a separate issue. Second, Ms Vaught was either extremely careless or extremely (for lack of a better word) ignorant when she administered the Vecuronium instead of Versed. If she was not familiar with the medication then she should have looked it up or called pharmacy or a co-worker. As I teach new graduates & hires, we (nurses) are the last stop of safety. It does not matter if the MD/APP wrote the order incorrectly & it passed through pharmacy and was filled incorrectly, we are the ones who administer the med so you better make damn sure it is the right med. Remember the 5 rights? I do NOT believe healthcare workers should be prosecuted for med errors, but I believe we should be held accountable for our actions by our licensing & governing boards.

There are laws about killing people even by accident...

[toomuchbaloney]

aynRN513 said:

I have a couple points re: RaDonda Vaught. First, I find it hard to believe that there is no policy or SOC for administering sedatives. If there is not, then that is a separate issue. Second, Ms Vaught was either extremely careless or extremely (for lack of a better word) ignorant when she administered the Vecuronium instead of Versed. If she was not familiar with the medication then she should have looked it up or called pharmacy or a co-worker. As I teach new graduates & hires, we (nurses) are the last stop of safety. It does not matter if the MD/APP wrote the order incorrectly & it passed through pharmacy and was filled incorrectly, we are the ones who administer the med so you better make damn sure it is the right med. Remember the 5 rights? I do NOT believe healthcare workers should be prosecuted for med errors, but I believe we should be held accountable for our actions by our licensing & governing boards.

Except when that extremely careless behavior results in the death of a patient... then the law should apply just like it would apply to the taxi driver who kills a passenger through negligence and failure to follow expected procedures while driving.  

[JKL33]

emergenceRN17 said:

Except this did not warrant access to an emergency med. This situation was not even close. A med like vecuronium should not have the ability to be overridden.  

We all know this was not an emergency.

The rationale behind access to paralytics is that they are often needed on a timeline that is significantly shorter than the usual process of getting a med profiled from start to finish. This urgent access process requires override which includes safety checks that RV chose not to do.

[subee, MSN, CRNA]

toomuchbaloney said:

Yet we don't have any history of charging nurses for errors less chilling than this one.  This particular incident was not a simple error, it was gross neglect and willful refusal to follow basic and prudent safety protocols.  It amounted to criminal negligence. 

There are laws about killing people even by accident...

Yes, I agree.  I'm not aware of the legal difference between criminal negligence as you say above or negligent homocide.  I was trying to think what a prosecutor would do with this case, and where the line is between a mistake and a criminal mistake.  Would it then become criminal negligence to administer the right medication to the wrong patient or to leave a sponge pad in an abdomen in a bloody trauma case?  Also I'm not clear whether the prosecutors made a deal with the BON to drop in the criminal charges in exchange for the revocation of her license.  

[Susie2310]

catdevil27 said:

After this case hit the news the public started seeing nurses in a different light.  You could see it the comments under the plethora of articles that have been published. It's human nature....ie it happened once so it could happen to ME.

 

I think the public possibly do see nurses in a different light now, but I believe the public were considering more than just that they could be killed/harmed in the process of receiving nursing/medical care, although of course, this possibility was brought squarely to their attention.  I think this is too simple a view of a the public's interest in this case.  I also think that, as a result, the public's interest became more focused on how the healthcare system works.

I believe the public was looking closely at the discussions/arguments and the behavior/actions that were taking place both within the nursing/medical professions for and against bringing charges, and were studying the merits of the case.  I'm sure the public was also paying attention to nurses, the medical profession, and others, on social media.  

 

 

[Susie2310]

aynRN513 said:

 I do NOT believe healthcare workers should be prosecuted for med errors, but I believe we should be held accountable for our actions by our licensing & governing boards.

I find this to be an oversimplification.  We are talking about professional nursing care provided by any licensed nurse that qualifies as gross/criminal negligence.  In my view, prosecution that is brought with merit, after careful consideration of the evidence, has the effect of:  1) Removing the individual from their practice with the public and thus protecting the public; 2) Providing a measure of justice to the injured parties; 3) Putting the particular industry involved on notice; 4) Determining whether criminal conduct has taken place and determining what consequences the person charged should face.  It is a formal procedure that has long lasting consequences for the person charged.

I find it immature and self-serving that some people think nurses and other health care workers should practice in a kind of fantasy world where they are only ever held accountable for their negligent actions that cause harm to patients through informal internal processes and state BON action, when the BON in my state, to the best of my knowledge, doesn't discipline a nurse's license for negligence resulting in harm to patients although the injured party still has the right to bring a civil lawsuit.  My understanding is that in my state, the level of injury/harm has to amount to gross negligence or more before the BON takes action against a nurse's license.  As far as I know, every other licensed professional, from the catering industry to the airline industry, to electricians, surveyors, building contractors, ad infinitum, is held accountable legally when their actions breach the standards of their profession with harm resulting to the public.  In my view, it doesn't engender public confidence to protect healthcare workers from the legal consequences of their actions.

[toomuchbaloney]

subee said:

Yes, I agree.  I'm not aware of the legal difference between criminal negligence as you say above or negligent homocide.  I was trying to think what a prosecutor would do with this case, and where the line is between a mistake and a criminal mistake.  Would it then become criminal negligence to administer the right medication to the wrong patient or to leave a sponge pad in an abdomen in a bloody trauma case?  Also I'm not clear whether the prosecutors made a deal with the BON to drop in the criminal charges in exchange for the revocation of her license.  

The circumstances of this event demonstrated not a simple error but rather a criminally negligent disregard for standard and expected professional practice including simply not even bothering to identify the actual drug she was intending to administer.  

I think the prosecutors were willing not to press for jail time because she cannot reoffend with a revocation of her license.  I'm not certain that all of the victim's family agree that lack of jail time is okay. 

Susie2310 said:

I find this to be an oversimplification.  We are talking about professional nursing care provided by any licensed nurse that qualifies as gross/criminal negligence.  In my view, prosecution that is brought with merit, after careful consideration of the evidence, has the effect of:  1) Removing the individual from their practice with the public and thus protecting the public; 2) Providing a measure of justice to the injured parties; 3) Putting the particular industry involved on notice; 4) Determining whether criminal conduct has taken place and determining what consequences the person charged should face.  It is a formal procedure that has long lasting consequences for the person charged.

I find it immature and self-serving that some people think nurses and other health care workers should practice in a kind of fantasy world where they are only ever held accountable for their negligent actions that cause harm to patients through informal internal processes and state BON action, when the BON in my state, to the best of my knowledge, doesn't discipline a nurse's license for negligence resulting in harm to patients although the injured party still has the right to bring a civil lawsuit.  My understanding is that in my state, the level of injury/harm has to amount to gross negligence or more before the BON takes action against a nurse's license.  As far as I know, every other licensed professional, from the catering industry to the airline industry, to electricians, surveyors, building contractors, ad infinitum, is held accountable legally when their actions breach the standards of their profession with harm resulting to the public.  In my view, it doesn't engender public confidence to protect healthcare workers from the legal consequences of their actions.

Extremely well said... thank you. 

[toomuchbaloney]

MacNinni123 said:

The solution is to take all the steps necessary to assure the safety of the patient,

Which RV did not do... in any fashion at any level.  Criminally negligent.