In a case with implications for medical staff working under pressure, last Friday (25 March), US nurse RaDonda Vaught was convicted of criminally negligent homicide and gross neglect of an impaired adult, writes MedicalBrief.
She faces three to six years behind bars for neglect and one to two years for the negligent homicide.
The conviction of Vaught, who was criminally prosecuted for a fatal drug error in 2017, followed a three-day trial in Nashville, Tennessee. She will be sentenced on 13 May and her sentences will probably run concurrently.
Vaught was acquitted of reckless homicide. Criminally negligent homicide was a lesser charge included under reckless homicide.
Nurses and medical professionals have closely watched the trial, many of them worrying it will set a precedent of criminalising medical mistakes. Medical errors are generally handled by professional licensing boards or civil courts, and criminal prosecutions like Vaught’s case are rare.
Janie Harvey Garner, the founder of Show Me Your Stethoscope, a nursing group on Facebook with more than 600,000 members, says the conviction will have a chilling effect on nurses disclosing their own errors or near errors, which could have a detrimental effect on the quality of patient care.
“Health care just changed forever,” she said after the verdict. “You can no longer trust people to tell the truth because they will be incriminating themselves.”
In the wake of the verdict, the American Nurses Association, which represents 4.3m nurses across the US, issued a statement expressing similar concerns about Vaught’s conviction, saying it sets a “dangerous precedent” of “criminalising the honest reporting of mistakes”, Some medical errors are “inevitable”, the statement said, and there are more “effective and just mechanisms” to address them than criminal prosecution.
“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,” the statement said. “This ruling will have a long-lasting negative impact on the profession.”
Jeremy Faust, MD, MedPage Today's editor-in-chief, said in a blog post that the verdict “may contribute to a culture of silence around medical errors”. “Such silence may make systemic problems less readily identified and rectified. This is the opposite of what we need … We need to destigmatise human errors, acknowledge them, and learn from them.”
Vaught, 38, was arrested in 2019 and charged with reckless homicide and gross neglect of an impaired adult in connection with the killing of Charlene Murphey, who died at Vanderbilt University Medical Center in December 2017. The neglect charge stemmed from allegations that Vaught did not properly monitor Murphey after injecting her with the wrong drug.
Murphey, 75, was admitted to the hospital for a brain injury. At the time of the error, her condition was improving, and she was being prepared for discharge, according to courtroom testimony. She was prescribed a sedative, Versed (midazolam), to calm her before being scanned.
Vaught was tasked to retrieve Versed from a computerised medication cabinet but instead grabbed a powerful paralyser, vecuronium (sold under the name Norcuron, among others). According to an investigation report filed in her court case, the nurse overlooked several warning signs as she withdrew the wrong drug – including that Versed is a liquid but vecuronium is a powder – and then injected Murphey and left her to be scanned. By the time the error was discovered, Murphey was brain-dead.
During the trial, prosecutors painted Vaught as an irresponsible and uncaring nurse who ignored her training and abandoned her patient.
Vaught’s attorney, Peter Strianse, argued that his client made an honest mistake that did not constitute a crime, and had became a “scapegoat” for systemic problems related to medication cabinets at Vanderbilt University Medical Center in 2017.
But while Vanderbilt’s pharmacy medication safety officer testified that the hospital had some technical problems with medication cabinets in 2017, they were apparently resolved weeks before Vaught pulled the wrong drug for Murphey.
In his closing argument, Strianse targeted the reckless homicide charge, saying his client could not have “recklessly” disregarded warning signs if she earnestly believed she had the right drug and saying there was “considerable debate” over whether vecuronium actually killed Murphey.
During the trial, Eli Zimmerman, a Vanderbilt neurologist, testified it was “in the realm of possibility” that Murphey's death was caused entirely by her brain injury.
Additionally, Davidson County Chief Medical Examiner Feng Li testified that although he determined Murphey died from vecuronium, he couldn’t verify how much of the drug she actually received. Li said a small dose may not have been lethal.
During a separate proceeding before the Tennessee Board of Nursing last year, Vaught testified that she allowed herself to become “complacent” and “distracted” while using the medication cabinet and did not double-check which drug she had withdrawn despite multiple opportunities.
See more from MedicalBrief archives:
US nurse on trial for reckless homicide over administration of deadly drug
US Supreme Court to rule on criminal charges against doctors prescribing in good faith
Coming into line with international practice on criminalisation of doctors
Minimum nurse-to-patient ratios cut mortality risk by up to 11% — Australia study