Nurse Convicted in Criminal Proceedings for Medication Error Has Healthcare Professionals Concerned – Professional Negligence
Wood, Smith, Henning & Berman LLP
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In a chilling decision for medical professionals, a Tennessee jury recently convicted a Vanderbilt University Medical Center nurse of reckless homicide and gross negligence of an intoxicated adult patient. Criminal charges were filed against the nurse after she accidentally administered the wrong medication to a patient who later died. This case has broad implications for health care law and medical professionals across the country.
In October 2015, RaDonda Vaught, a registered nurse, began working at Vanderbilt University Medical Center. On Christmas Eve 2017, Charlene Murphey, then 75, was admitted to Vanderbilt with a brain hemorrhage. Over the next two days, Murphy’s condition improved to the point where she was almost ready to be discharged. As part of the exit plan, Murphey was to undergo a final PET scan.
When Vaught was unable to locate the drug Versed (a sedative) in an automatic drug dispensing cabinet, she used a system override and accidentally fired and administered the drug Vecuronium, a paralyzing drug. Besides pulling the wrong drug, Vaught didn’t read the name of the drug, didn’t notice a red warning on the top of the Vecuronium package, didn’t recognize that Versed is a drug liquid whereas Vecuronium is in powder form; and failed to stay with Murphey to check for any adverse reactions to drug administration. After administration of the Vecuronium, Murphey died.
After the patient’s death, Vaught allegedly admitted to other staff that she had made a mistake administering Murphey’s medication. Two Vanderbilt neurologists reported the death to the county medical examiner, but omitted any mention of the medication error. Neurologists attributed Murphey’s death to brain hemorrhage instead of receiving Vecuronium. The medical examiner found no reason to investigate Murphey’s death at the time, based on information provided to the medical examiner’s office.
Nurse Vaught was later charged and convicted of reckless homicide and abuse of an intoxicated adult.
At trial, Vaught argued that Vanderbilt was at least partially responsible for the medication error. She pointed out that Vanderbilt had not disclosed the truth about Murphey’s death to the appropriate government or public agencies. Vaught presented several pieces of evidence in support of this argument:
- Vanderbilt incorrectly reported the death by failing to mention medication error as a possible cause;
- Vanderbilt fired Vaught after the incident and quietly brokered an out-of-court settlement with Murphey’s family. As part of this settlement, the family signed a nondisclosure agreement that prohibited them from discussing the incident in public;
- Details of Murphey’s death only came to light after an anonymous informant contacted the Centers for Medicare and Medicaid Services and the Tennessee Department of Health. Following the tip, the Tennessee Bureau of Investigation opened a criminal investigation into the matter. A special agent testified during the trial that, “In this case, the review led the Department of Health to believe that Vanderbilt Medical Center bore a heavy burden in this matter. No discipline was imposed because, according to the lawyer for the Ministry of Health, professional misconduct must be gross negligence before they can sanction for it.” In fact, the Tennessee Department of Health did not sanction Vanderbilt Medical Center, but it did revoke Vaught’s nursing license. Vaught acknowledged and admitted his error, but claimed that the error was only made possible by continuing technical problems and faulty procedures at Vanderbilt.
A nurse educator on the Vanderbilt unit where Vaught worked testified that it was ‘common’ for nurses to ‘override’ the automatic medication dispensing cabinet to make it more efficient in procuring medication from of the cabinet.
Medical negligence is now a crime?
Vaught was charged and convicted of both reckless homicide and abuse of an intoxicated adult. The criminal charges have had a chilling effect throughout the medical community which is already facing morale issues and staffing shortages due to the impact of the COVID-19 pandemic.
Although negligence and even gross negligence claims against healthcare professionals are common, it is rare for a healthcare professional to face criminal charges as a result of their actions or omissions. In response to the verdict, the American Nurses Association and the Tennessee Nurses Association released a joint statement noting in part: “Health care delivery is very complex. It is inevitable that errors will occur and systems will fail. It is totally unrealistic to think the criminalization of medical errors is unnerving, and this verdict sets a dangerous precedent. There are more efficient and fairer mechanisms for reviewing errors, establishing system improvements and taking corrective action.
Sentencing of Nurse Vaught is scheduled to take place on May 13, 2023.
Key points to remember:
- While this case is of great concern to medical professionals, the number of safeguards Nurse Vaught circumvented is a significant factor in the outcome of this case. It was not a situation with one error but with several errors;
- Hospitals should take note of this decision given that there was evidence they were aware that nurses were bypassing the electronic medicine cabinet. If hospitals are aware of this pattern of conduct among their nursing staff, hospitals should educate their nursing staff to ensure that they follow proper protocols for drug supply;
- Electronic medication delivery safeguards alone are not enough to always protect patients from human error;
- The disclosure of the error was not entirely open and transparent. The administration of the wrong drug was not disclosed by the medical examiner. In any civil litigation that would arise from this type of event, these factors are extremely poor optics that could lead to the imposition of punitive damages. Transparency about what happened after the error was disclosed is essential for the Hospital to maintain credibility in its statements about taking patient safety seriously.
- Many in the health field have expressed the view that improving systems and corrective action should be encouraged rather than hanging the fear of criminalization and condemnation over nurses’ heads. This precedent may discourage nurses and other staff from reporting misconduct, errors or “near misses”. Over time, this can lead to more deaths by accident and negligence;
- While according to the American Nurses’ Association, medical errors are “inevitable”,
the same are rarely, if ever, prosecuted in criminal court unless an element of intentional behavior is present;
- After the COVID-19 pandemic, most hospitals are struggling with a nursing shortage. The ramifications of this belief may have a further chilling effect on the industry and the willingness of potential nurses to enter the profession; and
- Vaught’s conviction not only set a very concerning precedent for the nursing community, but it also demonstrates that the goodwill medical professionals had extended to them during the COVID-19 pandemic when doctors, nurses and others members of staff have been honored as “heroes” because their commitment to providing public health care in difficult circumstances has already begun to fade. This erosion of the “heroic” nature of these health professionals will also have an impact on civil verdicts and damages.
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