RaDonda Vaught homicide case

Last updated
Tennessee v. Vaught
DateDecember 27, 2017 (2017-12-27)
VenueDavidson County Criminal Court
Location Nashville, Tennessee
TypeDeath
OutcomeConviction
ConvictedRaDonda L. Vaught
VerdictGuilty
SentenceProbation

State of Tennessee v. RaDonda L. Vaught was an American legal trial in which former Vanderbilt University Medical Center nurse RaDonda Vaught was convicted of criminally negligent homicide and impaired adult abuse after she mistakenly administered the wrong medication that killed a patient in 2017. [1] She was sentenced to three years' probation.

Contents

The case has been highly controversial. Vaught's trial, which was held in Nashville, Tennessee, in March 2022, garnered national attention and sparked debate over when it should be appropriate to prosecute health care professionals for medical errors that result in harm to patients. [2]

Nurses and other medical practitioners closely monitored the trial, and many expressed concern, alarm, and outrage following the verdict. [2] [3] [4] Some experts and professional organizations warned that the case was likely to negatively affect the quality of American health care by discouraging health care workers from reporting their mistakes. [2] Similarly, the case was seen as undermining the practice of just culture, a policy that has been widely adopted by the medical field over the past two decades in order to improve patient safety. Just culture views genuine errors as system failures and doesn't penalize workers who report making them. [5] [6]

Concerns have also been raised that Vaught's prosecution would cause some nurses to leave the field and some prospective nurses not to enter it in the first place at a time when there is already a nursing shortage. [2] [4] [7]

Incident and aftermath

RaDonda Vaught began work as a nurse at Vanderbilt University Medical Center in December 2015. [8]

On December 24, 2017, 75-year-old Charlene Murphey was admitted to the hospital for a subdural hematoma. [8] Two days later, Vaught, a registered nurse, was instructed to administer Versed (midazolam, a sedating drug) to Murphey, but instead administered vecuronium (a paralyzing drug). [9] [10]

Vaught had tried to withdraw Versed from an automated dispensing cabinet which is designed to communicate with the medical record software. The two electronic systems did not communicate and subsequently the ordered medication did not appear on the list of medications ordered. This was a common occurrence, as the hospital was switching from a different software company and she used an override which allowed her access to a larger array of medications. [9] Murphey was to be given Versed prior to an MRI scan but was inadvertently given vecuronium. Murphey, who went into cardiac arrest following the administration of the medication, was placed on life support which was withdrawn the next day as a result of permanent brain death. [8] [11]

Vaught immediately admitted the error and was fired from the hospital after an internal investigation in January 2018. [8] She was arrested and charged in Murphey's death in 2019. [9]

Revocation of nursing license

After the initial incident the TN BON reviewed Vaught's case and deemed it an accident requiring no further action. However, In September 2019, the Tennessee Department of Health's Board of Nursing reversed their decision, charging Vaught with three infractions: unprofessional conduct, abandoning or neglecting a patient who required care, and failing to maintain an accurate patient record.

In July 2021, the nursing board revoked Vaught's license and fined her $3,000. During her testimony, she took responsibility for the error, but also described procedural issues at the hospital. "Overriding was something we did as a part of our practice every day. You couldn't get a bag of fluids for a patient without using an override function." [8] [12]

The Institute for Safe Medication Practices called the board decision "disturbing and unjust." It alleged that the decision reflected "significant outcome bias," "inability to differentiate between human error, at-risk behavior, and reckless behavior," "lack of a thorough investigation," and other shortcomings. [12]

Criminal trial

After being delayed for more than a year due to the COVID-19 pandemic, Vaught's trial began on March 21, 2022. [8] [12]

Prosecutors portrayed the use of the override function as evidence of recklessness, even though many experts have testified that overrides are daily events at many hospitals, and Vaught stated that Vanderbilt's 2017 upgrade of its computer systems had caused such delays that nurses were instructed to use overrides to get medication that they needed. [9] [3]

A Tennessee Bureau of Investigation agent testified that the medical center had a "heavy burden of responsibility" for the deadly medication error, but that the Bureau of Investigation only pursued criminal charges and penalties against the nurse, not the hospital. [9]

After Murphey's death, the hospital did not report the error to federal or state regulators (as required by law) and reported to the county medical examiner that Murphey died of natural causes with no mention of the vecuronium. [9] The hospital also negotiated an out-of-court settlement with Murphey's family which prevents them from disclosing details of her death. [9]

On March 25, 2022, the jury convicted Vaught of gross neglect of an impaired adult and negligent homicide, which carries a maximum sentence of eight years in prison. She was acquitted of the more serious charge of reckless homicide. [1] [2] On May 13, 2022, Judge Jennifer Smith ruled that Vaught would not have to spend time in prison, sentencing her instead to three years' probation. [13]

Public reaction

After the trial, a Change.org petition requesting clemency for Vaught quickly garnered over 200,000 signatures. [2] [14]

In response to the public backlash, the prosecutor's office issued a statement in which it defended its decision to prosecute Vaught: "The jury's conviction of Radonda Vaught was not an indictment against the nursing profession or the medical community. This case was, and always has been about the gross neglect by Radonda Vaught that caused the death of Charlene Murphey." [15]

Nursing unions and other concerned organizations issued statements warning that Vaught's prosecution could set a precedent for criminalizing honest medical errors and lead to compromised patient care due to medical workers failing to report their errors out of fear of severe punishment. [2]

Janie Harvey Garner of Show Me Your Stethoscope, a nurse advocacy group, said that Vaught's case undermined the practice of just culture, which seeks to improve health care by not penalizing health care workers who are transparent about mistakes and near mistakes. [5] The "just culture" philosophy has been adopted by hospitals since a 1999 study by the National Academy of Medicine found that 98,000 people may have been dying due to medical errors annually. [5]

Robin Begley of the American Hospital Association said the case was likely to have a "chilling effect on the culture of safety in health care." [15]

The American Nurses Association, the American Association of Critical-Care Nurses, and the National Medical Association all expressed concern that Vaught's prosecution set a "dangerous precedent." [2]

The American Nurses Association stated: [16] [1]

"We are deeply distressed by this verdict and the harmful ramifications of criminalizing the honest reporting of mistakes.

Health care delivery is highly complex. It is inevitable that mistakes will happen, and systems will fail. It is completely unrealistic to think otherwise. The criminalization of medical errors is unnerving, and this verdict sets into motion a dangerous precedent. There are more effective and just mechanisms to examine errors, establish system improvements and take corrective action. The non-intentional acts of Individual nurses like RaDonda Vaught should not be criminalized to ensure patient safety.

The nursing profession is already extremely short-staffed, strained and facing immense pressure – an unfortunate multi-year trend that was further exacerbated by the effects of the pandemic. This ruling will have a long-lasting negative impact on the profession."

The American Bar Association issued a statement saying that, "A robust culture of safety relies on self-reporting and transparency to drive process improvement, and criminalizing errors instead foments blame and creates fear." [17]

Related Research Articles

<span class="mw-page-title-main">Registered nurse</span> Nurse who has graduated from a nursing program

A registered nurse (RN) is a nurse who has graduated or successfully passed a nursing program from a recognized nursing school and met the requirements outlined by a country, state, province or similar government-authorized licensing body to obtain a nursing license. An RN's scope of practice is determined by legislation, and is regulated by a professional body or council.

A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailments.

<span class="mw-page-title-main">Vecuronium bromide</span> Muscle relaxant

Vecuronium bromide, sold under the brand name Norcuron among others, is a medication used as part of general anesthesia to provide skeletal muscle relaxation during surgery or mechanical ventilation. It is also used to help with endotracheal intubation; however, agents such as suxamethonium (succinylcholine) or rocuronium are generally preferred if this needs to be done quickly. It is given by injection into a vein. Effects are greatest at about 4 minutes and last for up to an hour.

The Vanderbilt University Medical Center (VUMC) is a medical provider with multiple hospitals in Nashville, Tennessee, as well as clinics and facilities throughout Middle Tennessee. VUMC is an independent non-profit organization, but maintains academic affiliations with Vanderbilt University. As of 2023, the health system had more than 3 million patient visits a year, a workforce of 40,000, and 1,741 licensed hospital beds.

Computerized physician order entry (CPOE), sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients under his or her care.

<span class="mw-page-title-main">Nurse practitioner</span> Mid-level medical provider

A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications and formulate treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion.

Home health is a nursing specialty in which nurses provide multidimensional home care to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. Home health nurses create care plans to achieve goals based on the client's diagnosis. These plans can include preventive, therapeutic, and rehabilitative actions. Home health nurses also supervise certified nursing assistants. The professional nursing organization for home health nurses is the Home Healthcare Nurses Association (HHNA). Home health care is intended for clients that are well enough to be discharged home, but still require skilled nursing personnel to assess, initiate and oversee nursing interventions.

Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.

A patient safety organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection, analysis, reporting, education, funding, and advocacy. A PSO differs from a Federally designed Patient Safety Organization (PSO), which provides health care providers in the U.S. privilege and confidentiality protections for efforts to improve patient safety and the quality of patient care delivery

Primary nursing is a system of nursing care delivery that emphasizes continuity of care and responsibility acceptance by having one registered nurse (RN), often teamed with a licensed practical nurse (LPN) and/or nursing assistant (NA), who together provide complete care for a group of patients throughout their stay in a hospital unit or department. While the patient is on the nurses' unit, the primary nurse accepts responsibility for administering some and coordinating all aspects of the patient's nursing care, with the support of other members of the nursing staff. This results in the nurse having greater insight into the patient's condition, both medical and emotional.

<span class="mw-page-title-main">Emergency nursing</span> Professional nursing specialty

Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients who require prompt medical attention to avoid long-term disability or death. In addition to addressing "true emergencies," emergency nurses increasingly care for people who are unwilling or unable to get primary medical care elsewhere and come to emergency departments for help. In fact, only a small percentage of emergency department (ED) patients have emergency conditions such as a stroke, heart attack or major trauma. Emergency nurses also tend to patients with acute alcohol and/or drug intoxication, psychiatric and behavioral problems and those who have been raped.

In the United States, a psychiatric-mental health nurse practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders or substance abuse problems. They are licensed to provide emergency psychiatric services, psychosocial and physical assessments of their patients, treatment plans, and manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on psychiatric diagnosis, including the differential diagnosis of medical disorders with psychiatric symptoms, and on medication treatment for psychiatric disorders.

<span class="mw-page-title-main">Flight nurse</span> Specialist in rescue/evacuation patient care

A flight nurse is a registered nurse specializing in the field of providing comprehensive pre-hospital, emergency critical care, and hospital care to a vast scope of patients. The care of these patients is generally provided during aeromedical evacuation or rescue operations aboard helicopters, propeller aircraft, or jet aircraft. On board a rescue aircraft, is a flight nurse, accompanied by flight medics and respiratory practitioners, as well as the option of a flight physician for comprehensive emergency and critical transport teams. The inclusion of a flight physician is more common in pediatric and neonatal transport teams. A critical care flight nurse must be able to deal with all age groups with broad critical emergencies. With no physicians on site, the nurses scope of practice is expanded. The critical care experience is transferred over to a flight nurse with impacting factors such as altitude and changes in pressure, gravitational forces, and weather. Some patients may experience exacerbations because of factors related to the cabin environment, including hypoxia, limited mobility, gas expansion, and the risk of injury related to turbulence. Resources for definitive care are limited. Aeromedical evacuation crews coordinate with other organizations to plan for the safe and timely care and evacuation of patients. Crews must be prepared for patients with trauma and mental health illnesses.

<span class="mw-page-title-main">Nursing</span> Health care profession

Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence". Nurses practice in many specialties with varying levels of certification and responsibility. Nurses comprise the largest component of most healthcare environments. Shortages of qualified nurses are found in many countries.

<span class="mw-page-title-main">Healthcare in Belgium</span>

Healthcare in Belgium is composed of three parts. Firstly, there is a primarily publicly funded healthcare and social security service run by the federal government, which organises and regulates healthcare; independent private/public practitioners, university/semi-private hospitals and care institutions. There are a few private hospitals. Secondly is the insurance coverage provided for patients. Finally, industry coverage; which covers the production and distribution of healthcare products for research and development. The primary aspect of this research is done in universities and hospitals.

Clinical point of care (POC) is the point in time when clinicians deliver healthcare products and services to patients at the time of care.

<span class="mw-page-title-main">Winkler County nurse whistleblower case</span> Legal proceedings against two Texas nurses for reporting a doctor to the state medical board

The Winkler County nurse whistleblower case was a series of legal proceedings in West Texas concerning the retaliation against two nurses who submitted an anonymous state medical board complaint against a physician in 2009. The case attracted national attention for its implications on whistleblowing by nurses.

<span class="mw-page-title-main">Nurse midwife</span> Health professional

A nurse midwife is both a nurse and a midwife, having completed nursing and midwifery education leading to practice as a nurse midwife and sometimes credentialed in the specialty. Nurse midwives provide care of women across the lifespan, including during pregnancy and the postpartum period, and well woman care and birth control.

<span class="mw-page-title-main">Correctional nursing</span> Nursing for prisoners

Correctional nursing or forensic nursing is nursing as it relates to prisoners. Nurses are required in prisons, jails, and detention centers; their job is to provide physical and mental healthcare for detainees and inmates. In these correctional settings, nurses are the primary healthcare providers. These nurses also work with crime victims and assist in expert witness testimonies, and are involved in a variety of legal cases, including paternity disputes and workplace injuries.

The impact of the COVID-19 pandemic on hospitals became severe for some hospital systems of the United States in the spring of 2020, a few months after the COVID-19 pandemic began. Some had started to run out of beds, along with having shortages of nurses and doctors. By November 2020, with 13 million cases so far, hospitals throughout the country had been overwhelmed with record numbers of COVID-19 patients. Nursing students had to fill in on an emergency basis, and field hospitals were set up to handle the overflow.

References

  1. 1 2 3 "Former nurse found guilty in accidental injection death of 75-year-old patient". npr.org. Retrieved April 1, 2022.
  2. 1 2 3 4 5 6 7 8 Kelman, Brett; Norman, Hannah (2022-04-05). "Why nurses are raging and quitting after the RaDonda Vaught verdict". NPR.
  3. 1 2 Kelman, Brett (2022-03-22). "As a nurse faces prison for a deadly error, her colleagues worry: Could I be next?". NPR . Murphey's care alone required at least 20 cabinet overrides in just three days, Vaught said. "Overriding was something we did as part of our practice every day," Vaught said. "You couldn't get a bag of fluids for a patient without using an override function." Overrides are common outside of Vanderbilt, too, according to experts following Vaught's case. Michael Cohen, president emeritus of the Institute for Safe Medication Practices, and Lorie Brown, past president of the American Association of Nurse Attorneys, each said it is common for nurses to use an override to obtain medication in a hospital. But Cohen and Brown stressed that even with an override, it should not have been so easy to access vecuronium.
  4. 1 2 Landman, Keren (2022-05-02). "A nurse made a fatal error. Why was she charged with a crime?". Vox.
  5. 1 2 3 "'Who is going to replace them?' Nurse's guilty verdict in patient death raises concern in industry". USA Today. 2022-03-30.
  6. ↑ "Another Round of the Blame Game: A Paralyzing Criminal Indictment that Recklessly "Overrides" Just Culture". Institute for Safe Medical Practices. 2019-02-14.
  7. ↑ Bean, Mackenzie (2022-05-06). "Nurses make exit plans after RaDonda Vaught's conviction". Becker's Hospital Review.
  8. 1 2 3 4 5 6 Kelman, Brett (2022-03-27). "The RaDonda Vaught trial has ended. This timeline will help with the confusing case". Nashville Tennessean.
  9. 1 2 3 4 5 6 7 "In nurse's trial, witness says hospital bears 'heavy' responsibility for patient death". NPR . Retrieved April 1, 2022.
  10. ↑ Hammonds, Rebekah (2022-03-27). "TBI report on nurse killing patient: 'Vaught admitted she f----- up". NewsChannel5 Nashville. Retrieved 2022-05-06.
  11. ↑ Watt, Windy. "RaDonda Vaught's Criminal Prosecution and Its Implications for Medical Errors". GoodRx. Retrieved 2022-09-02.
  12. 1 2 3 "TN Board of Nursing's Unjust Decision to Revoke Nurse's License: Travesty on Top of Tragedy!". Institute for Safe Medication Practices. 2021-08-12. Retrieved 2022-05-06.
  13. ↑ "Tennessee nurse convicted in lethal drug error sentenced to three years probation". NPR . Retrieved May 14, 2022.
  14. ↑ Bean, Mackenzie (2022-04-12). "Tennessee governor won't consider clemency for RaDonda Vaught". Becker Health News.
  15. 1 2 Pawlowski, A. (2022-05-03). "Should a nurse's medical error be considered a crime?".
  16. ↑ "Statement in Response to the Conviction of Nurse RaDonda Vaught". American Nurses Association . 2022-03-25.
  17. ↑ "Criminal Conviction of Nurse for Fatal Medication Error Diminishes Patient Safety". American Bar Association. 2022-04-22.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.