Tennessee Nurse RaDonda Vaught - Legal Perspectives of Fatal Medication Error

[Lorie Brown RN, MN, JD]

Unless you've been living under a rock. You know all about RaDonda Vaught, the Tennessee Nurse who made a terrible and tragic fatal medication error. I won't go over all the details of the case here since there have already been multiple articles in the news and on allnurses.com. I will share more in the video below. As a nurse attorney, I want to give some legal perspectives about this case.

The Basics

• Charlene Murphy (let's not forget about her) - a patient undergoing a CAT scan
• RaDonda Vaught - nurse with 2 years of experience working as a help-a-nurse
• The Doctor (whose name has not been spread all over the news) ordered Versed
• RaDonda overrode the Pyxis and erroneously retrieved Vecuronium instead of Versed
• RaDonda failed to perform the 5 Rights of Medication Administration
• The fatal dose of Vecuronium administered to Charlene Murphy
• RaDonda still has an active license
• Vanderbilt Medical Center did not tell the family about the medication error until a year later.

Questions

• Did Vanderbilt Medical Center have policies and procedures for the administration of Versed including monitoring?
• Why didn't the family learn the truth of the matter until a year after CMS investigated?
• Should RaDonda be found guilty of Reckless Homicide and receive a prison sentence?
• In the State of Tennessee, what is Reckless Homicide?
• Why did RaDonda plea not guilty?
• What precedent might the outcome of this case set?

The real issue in Radonda's situation is "did this amount to reckless homicide?” I do not agree that it did. Flat out negligence, no question about it. Medical malpractice, no question about it. I have no idea what a jury will decide should RaDonda's case go to trial. What would your vote be if you were sitting on the jury? Guilty or Not Guilty?

If you find yourself of the opinion that "yes", RaDonda should be criminally prosecuted, keep in mind that this could be you!

Please watch the video below and find out the answers to some of the questions posted above. Then, share your comments below.

[TriciaJ, RN]

56 minutes ago, Persephone Paige said:

Doesn't anybody else wonder if she meant to do it?

Sorry if this flips some people out, but I've examined this from all sorts of different angles and it just doesn't make a lot of sense as just an accident.

No, I really don't think she meant to do it. What would be the motive? I think this is someone who managed to become a nurse despite scoring low on the empathy scale and was allowed to skate on loose practice. In a busy work place she might have even been rewarded for being so efficient. She was over-confident and believed the rules were for people who weren't as stellar as her. In addition, she had an orientee to grandstand for.

Of course, this is all conjecture on my part. There have been many previous threads on this forum where someone is mystified by a sloppy coworker who is never called out. The standard response is that they will trip themselves up eventually and hope no one gets killed in the process. I think this is one of those situations and unfortunately, someone did get killed.

[JKL33]

1 hour ago, Persephone Paige said:

Doesn't anybody else wonder if she meant to do it?

Sorry if this flips some people out, but I've examined this from all sorts of different angles and it just doesn't make a lot of sense as just an accident. 

No.

Not flipped out, but that's a theory that actually might be the only thing that makes less sense than what we have been discussing given the facts/testimony in the report.

Maybe you don't qualify for vecuronium, but RV did. Lots of us do, actually. That's why she was able to access it so easily. It is beyond unlikely that with just a few minutes' notice of this "opportunity," she took her tag-along witness and grabbed some vecuronium, then went off to kill someone once she got directions to where she needed to go to do it.

[LilPeanut, MSN, RN, NP]

5 hours ago, juan de la cruz said:

@LilPeanut Those cases you referenced are adult or child abuse cases. That's prevalent and are well known to lead to criminal prosecution. That's never been a gray area for many people. If you can find more medication errors that were criminally prosecuted than the three cases I know of, then that would be great. The National Practitioner Data Bank would probably be a good source of all med errors because cases uploaded there led to a civil suit or a settlement. I was hoping that this thread being focused on legal aspects and led by a Nurse Attorney would focus on med errors.

Nope, the UK cases all involved med errors, but I would argue this wasn't a med error. This was a total failure to employ any aspect of nursing. It's not different, IMO, than any of the other neglectful or wrong things the other people did. I really dislike it being called a med error, because it wasn't.

3 hours ago, Persephone Paige said:

This is going to sound 'way out there,' but it's been on my mind over the last few days as I've read more and more about the case. And the more I've learnt, the less 'way out there' it seems.

Every nurse I know lives in mortal fear of something like this. Why not RV? I'm not an ICU nurse, but I'm a person. I've lived long enough to have had procedures where Versed was given to me. Even if I hadn't, I've supported loved ones through the pre-op process. Real life experience...

I've also watched a ton of medical shows involving crime. When someone mentions the drug Vecuronium, I might have had to look up the specifics, but something about it triggers a memory of something that I don't qualify for.

RV did everything wrong! Really? Everything? Shouldn't time, repetition, experience merit that she at least do one thing right? Except the killing of the patient? That's the only thing she did right.

Doesn't anybody else wonder if she meant to do it?

Sorry if this flips some people out, but I've examined this from all sorts of different angles and it just doesn't make a lot of sense as just an accident.

I've thought about it. Goodness knows the steps would be the same. The only reason I doubt it was purposeful is that she a) did have an orientee with her and b) left such a big paper trail behind her that if she had wanted to kill someone, there would have been much better and less risky ways to do it.

I am far more suspicious about practicing under the influence.

[Persephone Paige, ADN]

1 hour ago, LilPeanut said:

I've thought about it. Goodness knows the steps would be the same. The only reason I doubt it was purposeful is that she a) did have an orientee with her and b) left such a big paper trail behind her that if she had wanted to kill someone, there would have been much better and less risky ways to do it.

I am far more suspicious about practicing under the influence.

Interesting the perspectives... To me, the paper trail is a big part of why she's getting 'away' with it. But, I get where you're coming from. An orientee would be a big distraction, but I think everyone here agrees that there's a point where we would have stopped. Like that 'pause' they do in the OR before they end up cutting the wrong extremity off. And it could be that same concept that caused her to barrel right on through all the check points and on to kill a patient.

Anyway, I'm so hopeful that she will eventually be put out of commission. An employer would have to be stupid to take on that kind of liability, especially now that the details are out there for the world to see.

[Wuzzie]

10 hours ago, Leader25 said:

Where does that put the rest of our angelic nurses,now they will drag everyone for a cavity search and jail time?

I think Juan did a good job of pointing out that the precedent was set in 1998 with the first known criminal charges related to a medication error and associated sub-standard nursing care yet it hasn't resulted in hordes of nurses being dragged before a judge. In fact, in the last 20 years there have been only two if you include the RV case. I honestly don't think it ever will. Maybe an uptick in civil cases but not criminal.

[Crow31]

This is my last time I comment about this case. These kinds of incidents come to find out are not that uncommon and so she isn't as much of an outlier as you might think. So... if you can't understand what that means don't bother reading further. The legal jargon is a waste of breath and time because we don't have a say and will never have a say. Just know that any fatal med errors can (and now with the publicity of this case) will more than likely result in criminal charges. How you feel about that doesn't matter. I have been and more than ever now after reading articles about this case and the comments more frustrated with how people are focused on the wrong things. For me, personally, I'm not surprised something like this happened. And guess what? Because everyone wants to focus on the wrong things, this kind of thing is going to keep happening even as I type.

Here's why I'm not surprised. I have had my suspicions about how nurses were being used ever since I came out of nursing school. For instance, I thought ICU nurses were for the experienced nurses or for the new nurses that were exceptional in school and came with high recommendation from there professors or something. Come to find out that wasn't the case and so was kind of confused by that because I was new to the system. Instead, I come to find that nurses are not treated on a professional level.

Why do I say that? Because nurses are treated all the same. Reguardless of experience, education, we all have the same degree and passed the same the test so we must all be the same right? Well, obviously not. How many people have to die before that is recognized? Who thought a help nurse was a great idea? Who thought that a nurse with no ICU/ER experience or training can hop around unit to unit? The system, just needing a warm body is who. Someone who can practice the fundamentals of nursing correctly. Here's the thing that I find insulting, we aren't just a bunch of task performing robots. This is why I am insulted as a professional. There is critical thinking and knowledge in what we do and needs to be treated as such. If that were the case, a "help nurse" idea wouldn't even exist. For instance, ever heard of a "help doctor" that goes from unit to unit performing tasks and orders for doctors who need help? We all really know that what would had prevented this death is if the nurse or her orientee would had known what verded/vec was. There are a slew of other things that happened of course, but that's the bottom line. I could even argue to say the reason why she was reckless was because she received praise from her coworkers for being fast and accomplishing so many tasks for them. Therefore, further induced her task orientated practice, which included cutting corners, making her the reckless nurse she was. The point is the culture of treating nurses as a bunch of task robots is dangerous and insulting. My only suggestion right now is to make nurses more specialized and maybe a residency? But no one really wants to do that because the flexibility of nursing is part of the reason nursing is appealing to some.

The next part will make me sound like a granny. Listen, I haven't been a nurse for long, but dang has it changed! We can't school these potential nurses into just taking a test! There is so much more to nursing than that. I promise you the school I went to was super tough. They were not playing around. I don't get that vibe anymore. I see students in the corner chit chatting it up or on their phones instead of looking up medications they are going to be quizzed on or the care plans of their patients. I don't hear the instructors quizzing the students or asking how they can do things better. These are not just isolated cases I'm talking about I promise. Then when I ask my fellow co-workers what school they go to and they tell me the school and talk about how great a school it is. They make comment like "Yeah, that school has like a 97% passing the NCLEX"

I'll stop here because I'm sure I'm just wasting my breath, but ya'll the system is broke and been broke. Medicine is high paced and requires competent, confident highly specialized kind nurses. This doesn't prevent all med errors and errors in general because literally our brain can only process so much in so much time before mistakes happen. But these kind of med errors can be prevented and I'm obviously not just talking about the 5 rights. It's a whole culture change, a system change that needs to be addressed. Again, this isn't me for or against her and what she did. If you think that's what this post is about you are missing the point.

[Wuzzie]

1 hour ago, Crow31 said:

Because everyone wants to focus on the wrong things, this kind of thing is going to keep happening even as I type.

That's your opinion which you certainly have a right to but I do not think I am focused on the wrong things in this instance. There was another thread about a med error where the patient coded but did not die. Look at my opinion there. It was somewhat similar but there were so many glaring system errors that the nurse could not possibly shoulder the entire blame for the situation. It needs to be taken on a case by case basis.

[Workitinurfava, BSN, RN]

1 hour ago, Crow31 said:

This is my last time I comment about this case. These kinds of incidents come to find out are not that uncommon and so she isn't as much of an outlier as you might think. So... if you can't understand what that means don't bother reading further. The legal jargon is a waste of breath and time because we don't have a say and will never have a say. Just know that any fatal med errors can (and now with the publicity of this case) will more than likely result in criminal charges. How you feel about that doesn't matter. I have been and more than ever now after reading articles about this case and the comments more frustrated with how people are focused on the wrong things. For me, personally, I'm not surprised something like this happened. And guess what? Because everyone wants to focus on the wrong things, this kind of thing is going to keep happening even as I type.

Here's why I'm not surprised. I have had my suspicions about how nurses were being used ever since I came out of nursing school. For instance, I thought ICU nurses were for the experienced nurses or for the new nurses that were exceptional in school and came with high recommendation from there professors or something. Come to find out that wasn't the case and so was kind of confused by that because I was new to the system. Instead, I come to find that nurses are not treated on a professional level.

Why do I say that? Because nurses are treated all the same. Reguardless of experience, education, we all have the same degree and passed the same the test so we must all be the same right? Well, obviously not. How many people have to die before that is recognized? Who thought a help nurse was a great idea? Who thought that a nurse with no ICU/ER experience or training can hop around unit to unit? The system, just needing a warm body is who. Someone who can practice the fundamentals of nursing correctly. Here's the thing that I find insulting, we aren't just a bunch of task performing robots. This is why I am insulted as a professional. There is critical thinking and knowledge in what we do and needs to be treated as such. If that were the case, a "help nurse" idea wouldn't even exist. For instance, ever heard of a "help doctor" that goes from unit to unit performing tasks and orders for doctors who need help? We all really know that what would had prevented this death is if the nurse or her orientee would had known what verded/vec was. There are a slew of other things that happened of course, but that's the bottom line. I could even argue to say the reason why she was reckless was because she received praise from her coworkers for being fast and accomplishing so many tasks for them. Therefore, further induced her task orientated practice, which included cutting corners, making her the reckless nurse she was. The point is the culture of treating nurses as a bunch of task robots is dangerous and insulting. My only suggestion right now is to make nurses more specialized and maybe a residency? But no one really wants to do that because the flexibility of nursing is part of the reason nursing is appealing to some.

The next part will make me sound like a granny. Listen, I haven't been a nurse for long, but dang has it changed! We can't school these potential nurses into just taking a test! There is so much more to nursing than that. I promise you the school I went to was super tough. They were not playing around. I don't get that vibe anymore. I see students in the corner chit chatting it up or on their phones instead of looking up medications they are going to be quizzed on or the care plans of their patients. I don't hear the instructors quizzing the students or asking how they can do things better. These are not just isolated cases I'm talking about I promise. Then when I ask my fellow co-workers what school they go to and they tell me the school and talk about how great a school it is. They make comment like "Yeah, that school has like a 97% passing the NCLEX"

I'll stop here because I'm sure I'm just wasting my breath, but ya'll the system is broke and been broke. Medicine is high paced and requires competent, confident highly specialized kind nurses. This doesn't prevent all med errors and errors in general because literally our brain can only process so much in so much time before mistakes happen. But these kind of med errors can be prevented and I'm obviously not just talking about the 5 rights. It's a whole culture change, a system change that needs to be addressed. Again, this isn't me for or against her and what she did. If you think that's what this post is about you are missing the point.

I agree with what you are saying. I don't think things will change for the better. Sorry not sorry is the attitude of these hospitals. Things will get worse. The hospitals want nurses to make as much money they can. As a nurse you will have to keep this in mind.

[OyWithThePoodles, RN]

And regardless of how much experience she had... a nurse with one day experience should know the 5 (or 6, how many ever there are now) rights before giving a medicine. It matters not that she had no ICU/ER experience (correct me if I am wrong, but I thought she did have ICU experience), she could've been a nurse for 20 years, and if she hadn't checked the med or monitored the patient, they still would have died. I just don't understand what people aren't getting about that.

ETA: We also see new nurses whining all the time "I want to work in the ICU but they want experience first, how and I supposed to get experience if they won't hire me...wahhh!"

Sorry, the snark is coming out because this nurse was so very reckless, admittedly, and SOMEONE FREAKING DIED. "It could be you one day", well you know what, if I am ever that reckless, and careless and cause a horrific death AND DON'T EVEN REALIZE MY MISTAKE UNTIL IT IS POINTED OUT, then by all means, charge me. I deserve it.

Rant over. Back to my sweet little littles.

[Wuzzie]

1 minute ago, OyWithThePoodles said:

It matters not that she had no ICU/ER experience (correct me if I am wrong, but I thought she did have ICU experience),

She did- two years and was certified although I'm not entirely clear what certification she had. Not a new grad by any means. Come to think of it, a new grad might have performed better.

[Crow31]

OMG, I guess I it's my fault for mentioning her in my post. Oh, well people can't see the big picture of what's happening and that's not my fault. ?‍♀️

[Wuzzie]

1 hour ago, Crow31 said:

I don't hear the instructors quizzing the students or asking how they can do things better.

No you don't because when they do that they get accused of bullying. This is just more of the result of "everyone gets a gold star" mentality. Students can't even be challenged to critically think anymore because their feelings get hurt. Sure, being put in the hot seat was uncomfortable but it prepared us for those times when we really are in the hot seat and our patients' welfare depends on us making good decisions.