In a fear-inspiring decision for medical professionals, a Tennessee jury recently found a nurse from Vanderbilt University Medical Center guilty of reckless homicide and gross neglect of an impaired 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 wide-ranging implications for health care law and medical professionals across the country.
In October 2015, RaDonda Vaught, a licensed nurse, began work at Vanderbilt University Medical Center. On Christmas Eve 2017, Charlene Murphey, who was then 75 years old, was admitted to Vanderbilt with a brain bleed. Over the next two days, Murphy’s condition improved to the point where she was almost ready for discharge. In connection with the plan for discharge, Murphey was scheduled for a final PET scan.
When Vaught could not locate the medication Versed (a sedative) in an automatic drug dispensing cabinet, she used a system override and accidentally pulled and administered the medication Vecuronium—a paralyzing medication. In addition to pulling the incorrect medication, Vaught failed to read the name of the drug, failed to notice a red warning on the top of Vecuronium packaging, failed to recognize that Versed is a liquid medication while Vecuronium is in powder form; and failed to stay with Murphey to check for any adverse reaction to the administration of the medication. After administration of the Vecuronium, Murphey died.
After the patient’s death, Vaught allegedly admitted to other staff that she had made a mistake in administering Murphey’s medication. Two Vanderbilt neurologists reported the death to the County Medical Examiner but omitted any mention of the medication error. The neurologists attributed Murphey’s death to the brain bleed as opposed to receiving Vecuronium. The Medical Examiner did not find a cause to investigate Murphey’s death at the time given the information reported to the Medical Examiner’s Office.
Nurse Vaught was later charged and convicted of reckless homicide and abuse of an impaired adult.
At trial, Vaught argued that Vanderbilt was at least partially responsible for the medication error. She pointed out that Vanderbilt failed to disclose the truth regarding Murphey’s death to the appropriate governmental or public agencies. Vaught presented several pieces of evidence in support of this argument:
- Vanderbilt improperly reported the death by failing to mention the medication error as a possible cause;
- Vanderbilt fired Vaught after the incident and quietly negotiated an out-of-court settlement with Murphey’s family. As part of that settlement the family signed a non-disclosure agreement which prohibited them from discussing the incident in public;
- The details of Murphey’s death only came to light once an anonymous tipster contacted the Centers for Medicare and Medicaid Services and the Tennessee Department of Health. As a result of the tip, the Tennessee Bureau of Investigation opened a criminal investigation into this 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 carried a heavy burden in this matter. There was no discipline imposed because according to counsel for the Department of Health, a malpractice error has to be gross negligence before they can discipline for it.” In fact, the Tennessee Department of Health did not sanction Vanderbilt Medical Center, but it revoked Vaught’s nursing license. Vaught acknowledged and admitted to her mistake but claimed that the error was only made possible by continuing technical issues and faulty procedures at Vanderbilt.
- A nurse educator at the unit at Vanderbilt where Vaught worked testified that it was “common” for nurses to “override” the automatic drug dispensing cabinet in order to make it more efficient to procure medications from the cabinet.
Medical Negligence is Now a Crime?
Vaught was charged and convicted of both reckless homicide and abuse of an impaired adult. The criminal charges sent a chilling effect throughout the medical community which is already confronting morale issues and staffing shortages due to the impact of the COVID-19 pandemic.
Although negligence and even gross negligence actions against medical professionals are common, it is rare for a medical 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 issued a joint statement noting in part, “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 in unnerving, and this verdict sets in motion a dangerous precedent. There are more effective and just mechanisms to examine errors, establish system improvements and take corrective action.”
Sentencing for Nurse Vaught is scheduled to take place on May 13, 2023.
- While this case is very concerning for health care professionals, the number of safeguards that Nurse Vaught bypassed is a significant factor in the outcome of this case. This was not a situation with one error but with multiple errors;
- Hospitals need to take note of this decision given that there was evidence that it was aware that nurses were overriding the electronic medication cabinet. If hospitals are aware of this pattern of conduct amongst its nursing staff, hospitals need to educate its nursing staff to ensure that it follows the appropriate protocols for procuring medication;
- Electronic safeguards with respect to medication administration are, in and of themselves, not enough to always protect patients from human error;
- The disclosure of the error was not altogether open and transparent. The administration of the incorrect medication 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 relative to what occurred after the disclosure of the mistake is essential for the Hospital to retain credibility with regard to its pronouncements about taking the safety of its patients seriously.
- Many in the healthcare field have voiced the opinion that improved systems and corrective actions should be encouraged rather than hanging the fear of criminalization and conviction over nurses’ heads. This precedent may discourage nurses and other staff from reporting mistakes, errors or “near misses.” Over time, this may lead to more accident and negligent deaths;
- While according to the American Nurses’ Association, medical errors are “inevitable,”
the same are rarely, if ever, prosecuted in criminal court, unless some element of intentional behavior is present;
- After the COVID-19 pandemic, most hospitals are struggling with a nursing shortage. The ramifications of this conviction may have an added chilling effect on the industry and the willingness of potential nurses to enter the profession; and
- Vaught’s conviction not only has established a precedent that is very concerning to the nursing community, but it also demonstrates that good will that health care professional had bestowed upon them during the COVID-19 pandemic when doctors, nurses and other staff were honored as “heroes” for their commitment to delivering public health care under difficult circumstances has already begin to wear off. This erosion of the “heroic” nature of these healthcare professionals will also impact civil verdicts and damage awards.