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!

[toomuchbaloney]

MacNinni123 said:

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

 

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?

Deliberate? Do you mean like deliberately ignoring the warnings on the medication label?  Deliberately NOT questioning why she needed to reconstitute the med she had never had to reconstitute before? Deliberately giving a what she thought was a sedative so quickly and then deliberately walking away without assessing her patient for effect?  

I mean, any other health professional would likely have noticed that something wasn't right before they even completed the injection... how fast do you push IV Versed?

[subee, MSN, CRNA]

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.

The prosecution in this case, then, just neglected their duties?  I am NOT in disfavor of RV receiving a criminal charge because I believe I hair split well enough to convince most people what she did was beyond simple error.  However, I am only pointing out that I believe the prosecutor didn't go forward because of the complexities of this case compared to other medical errors cases that haven't risen to the level of interest for criminal prosecutors.  I'll just leave it as...................Tennessee.

[subee, MSN, CRNA]

toomuchbaloney said:

 

Deliberate? Do you mean like deliberately ignoring the warnings on the medication label?  Deliberately NOT questioning why she needed to reconstitute the med she had never had to reconstitute before? Deliberately giving a what she thought was a sedative so quickly and then deliberately walking away without assessing her patient for effect?  

I mean, any other health professional would likely have noticed that something wasn't right before they even completed the injection... how fast do you push IV Versed?

Personally, I think she was high out of her mind.  This is often the scenario when an addict is entering the end stages of their disease.  No one here has a definitive answer whether she was drug tested or not.  BTW, when one is expert at giving Versed, we give it very quickly.  I don't (didn't) want patients to be sleepy when they entered the room; I just didn't want them to be distressed.  I'm still trying to figure out why ANYONE would order IV Versed when it comes in liquid and tablet form.  

[toomuchbaloney]

subee said:

Personally, I think she was high out of her mind.  This is often the scenario when an addict is entering the end stages of their disease.  No one here has a definitive answer whether she was drug tested or not.  BTW, when one is expert at giving Versed, we give it very quickly.  I don't (didn't) want patients to be sleepy when they entered the room; I just didn't want them to be distressed.  I'm still trying to figure out why ANYONE would order IV Versed when it comes in liquid and tablet form.  

Maybe it's because my early career was in the NICU and PICU but I would never inject midazolam IV push rapidly and walk away.  A sedative dose ordered for a potentially naive patient under my care would have been injected slowly so I could assess if they even needed the entire dose to achieve the desired outcome.  Patient centered care.  

[MacNinni123]

mtmkjr said:

Not necessary to break into the crash cart unless coding 

I agree...my point exactly. Otherwise there IS time to follow the safety rule.

[0.9%NormalSarah, BSN, RN]

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.  

No. I have overridden vecuronium so far 3 times in my career and it was urgent and necessary every time to prevent a patient from breathing in a very dangerous pattern so as to compromise his or her own airway. The patients already had advanced airways and it still scared the crap out of me. I pulled it, triple checked what I was doing, and administered, which helped save my patients' lives. Just because you haven't found yourself in dire need of a medication like this in a pinch doesn't mean it doesn't happen and that we should remove this responsibility from prudent nurses. Also most of the time RSI kits with paralytics in them are kept in the fridge and must be overridden. 

And before anyone goes on about needing to sedate the patient first, they were all heavily sedated. Their lungs were just so far gone and noncompliant with the vent that they couldn't even function without the use of paralytic. 

MacNinni123 said:

I agree...my point exactly. Otherwise there IS time to follow the safety rule.

A code is not the only emergency a patient may face. There are other reasons to override medication needed urgently. See my above comment.

[Wuzzie]

^ This!!

If you haven't been there you really don't know  

 

[klone, MSN, RN]

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.  

Vecuronium is needed in RSI, the very emergent situation that allows for it to be overridden. 

[klone, MSN, RN]

MacNinni123 said:

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

There are emergent situations that require meds that are not code meds, thus it's appropriate that these meds be available in the Pyxis but not the crash cart. 

[emergenceRN17, ASN, BSN, RN]

klone said:

Vecuronium is needed in RSI, the very emergent situation that allows for it to be overridden. 

I'm realizing this now. I apologize, 

[subee, MSN, CRNA]

toomuchbaloney said:

Maybe it's because my early career was in the NICU and PICU but I would never inject midazolam IV push rapidly and walk away.  A sedative dose ordered for a potentially naive patient under my care would have been injected slowly so I could assess if they even needed the entire dose to achieve the desired outcome.  Patient centered care.  

We're not walking away at this point; we are pushing the stretcher into the room.  However, doing time outs put a kink in the works when someone decided that it had to be done in the room; not in the holding area.  But we noticed that unmedicated patients would often agree to anything because of their stress level when they see all those instruments!  

[aynRN513]

I stand by my statement that I do not believe nurses should be prosecuted for making medication errors. If an error is not made with malice and forethought, but a true error, then let the governing/licensing boards discipline the offender. Here is my issue with your response, you felt the need to offend and belittle by stating those who believe differently than you are "immature and self-serving".