Nurse charged with criminal charges

[clubdeac]

As a nurse faces prison for a deadly error, her colleagues worry: Could I be next?

Former nurse RaDonda Vaught is on trial on charges of reckless homicide. Her case raises consequential questions about how nurses use computerized medication-dispensing cabinets.

www.doximity.com

This story has been all over my news feeds. Everyone’s up in arms acting like this is the first time a healthcare worker has had criminal charges brought against them in a wrongful death case. Nurses are going crazy all over the Internet.

Haven’t several pain docs already been through this due to opioid overdoses? The internet and social media were silent. Just goes to show how much louder and more powerful the nurses and their respective organizations are.

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[BobBarker]

She mixed up the vecuronium powder. So she had a syringe filled with vecuronium with concentration dependent on how she mixed it. She then had to decide how many cc to give or gave all that she had. It is hard to believe someone could be that oblivious.

 

[hyperalgesia]

At my hospital pharmacists have to independently verify every medication order and unlock the pyxis machine for ONLY that medication. A little plastic compartment in a drawer opens. At my hospital, they've gone too far and docs have to do this for every single clinic injection. But for nurses and everyone else, there is a system that is almost idiot proof. No doubt that's where this is going.

 

[Agast]

Pill mill doctors are motivated by greed. This nurse had no MO, she’s just painfully dumb. Apparently you can be so stupid that it’s a crime. I would be curious to know of other examples of “criminal negligence” in order to understand how fitting the sentence is.

 

[Agast]

In nurse's trial, witness says hospital bears 'heavy' responsibility for patient death

Nashville, Tenn., nurse RaDonda Vaught is on trial for reckless homicide for giving the wrong medication to a patient at Vanderbilt University Medical Center.

www.npr.org

“The case against Vaught hinges on her use of an electronic medication cabinet, a computerized device that dispenses drugs and is widely used in hospitals. According to documents filed in the case, Vaught initially tried to withdraw Versed from a cabinet by typing "VE" into its search function without realizing she should have been looking for its generic name, midazolam. When the cabinet did not produce Versed, Vaught triggered an override that unlocked a much larger swath of medications and then searched for "VE" again. This time, the cabinet offered vecuronium.”

Death by being paralyzed while you are awake is pretty horrific…at least opioid OD patients die in their sleep.

 

[gaspasser127]

Nurses are going crazy on the internet over this. If a nurse has an order to give Versed (orange top vial) and instead grabs Vecuronium (red top vial that says PARALYTIC with powder that has to be reconstituted in a 10 mL syringe), reconstitutes the med, presumably scans the medication and the patient wrist band prior to administering per protocol, then overrides the warning saying this medication is not ordered, and then gives the medication killing the patient - yeah. She should go to jail for killing a patient.

This isn’t a case of someone giving a higher than intended dose to a neonate or administering a look-alike medication.

This is negligence and incompetence to the point of murder.

 

[paindoc007]

Eeek. Ya’ll are tough. That wasn’t my first thought when I read this of screw her, she’s so stupid she deserves it. Feel bad for her, and the patient of course. But we all make mistakes. I’m not a fan of the DAs, cops, idiotic jurors, and any criminal/legal system involved at any capacity frankly. We all know surgeons botching a surgery or making a mistake that has led to a bad outcome. Are we criminally liable for it all?

 

[Agast]

Eeek. Ya’ll are tough. That wasn’t my first thought when I read this of screw her, she’s so stupid she deserves it. Feel bad for her, and the patient of course. But we all make mistakes. I’m not a fan of the DAs, cops, idiotic jurors, and any criminal/legal system involved at any capacity frankly. We all know surgeons botching a surgery or making a mistake that has led to a bad outcome. Are we criminally liable for it all?

You’re conflating two ideas. One - she’s definitely stupid. Two - as to whether she deserves it, laws don’t care if you practice in a high stress medical field. No one is above the law. Criminal negligence is essentially involuntary manslaughter. The charge specifically accounts for accidentally killing someone, but the accident was coupled with something you deliberately did that deviates from the norm (in her case, all the steps that led to her selecting the wrong medication including the very obvious PARALYTIC label on the vial itself). In some states drunk driving is considered criminal negligence. IANAL but unfortunately for Ms Vaught she ticked the boxes on the nose for Tennessee law. She will probably see a reduced sentence. Apparently criminally negligent homocide is only worth 1-2 years in prison max, which is not bad considering someone died.

 

[RoloTomassi]

Stupid mistake but more of a "what was I thinking"moment than malicious. Seems harsh compared to what those nurses/nurse aids got in that recent Georgia case. They ignored and laughed at that WW2 vet who was calling for help, waited an hour after he was unresponsive before calling 911, then lied about doing CPR. Got off light compared to the 12 years this nurse is facing.

 

[Ferrismonk]

At first I was sympathetic for this RN, the pyxis will definitely show versed as well as vecuronium if you just type in "VE". I also work in anesthesia and my intra-op pyxis has all those drugs. I routinely will withdraw meds I need and give them with zero oversight.

But then I realized how much different it is for an RN on the floor. They can usually only withdraw medications that have been ordered for a patient, unless there is an emergency. It's under two different tabs. Also, the Vec and Versed bottles look completely different. The Vec vial will say in bright red letters "Paralytic". Vec is also a powder that needs to be reconstituted, versed doesn't. Before a medication is given, you must scan the patient barcode, then the vial, and it'll match to an order. This would also have to have been dismissed. This RN was grossly negligent and deserves loss of license and manslaughter charges.

 

[jsaul]

The crazy thing was at first the nursing board decided not to discipline. But then after all the attention and criminal charges then changed their minds

 

[cowboydoc]

The crazy thing was at first the nursing board decided not to discipline. But then after all the attention and criminal charges then changed their minds

This is most unsurprising to me. Nursing boards are like unions that stand by their members unless it is indefensibly egregious. It's why nurses are doing risky procedures on youtube and probably have no idea the potential risk/harm involved.

 

[clubdeac]

No doubt she was *****ic, almost unbelievably so but it wasn’t intentional or malicious.

I guess my point in the original post was that everyone on the Internet, including my gf thinks this is the first time a healthcare professional has been convicted of criminal charges instead of civil in a wrongful death case which could set a bad precedent. The precedent has already been set and no one freaking cared. Just points to the fact that we as physicians are slowly getting squeezed out primarily bc we’re not loud enough

 

[Agast]

The second charge is where she gets more prison time - neglect of an impaired adult. Who injects enough versed to sedate someone for an MRI and then walks away with them unmonitored? Theoretically even with the correct medication that patient still could have died. I think that’s what sunk her.

 

[lobelsteve]

How many different layers of override and decisions made to get this drug into this patient?

This is not a simple error. It is a series of intentional errors that went ignored.

 

[Ducttape]

yes the issue is that there were criminal charges that she was convicted.

she was not intending to kill and got no benefit from making this mistake. she admitted this mistake.

a main concern is that this ruling will make all healthcare personnel really second guess whether to report an error in the first place. the classic swiss cheese model of medical errors cant be altered if no reporting is done. it may be better to lie than report to try to correct system errors (for example, why was vec even in the pyxis accessed by nurses - this should be a anesthesiologist only drug)

 

[drrosenrosen]

She mixed up the vecuronium powder. So she had a syringe filled with vecuronium with concentration dependent on how she mixed it. She then had to decide how many cc to give or gave all that she had. It is hard to believe someone could be that oblivious.

This. It is not a sound alike medication. It is not an easy error to make. The vials are different size, shape, and color. Midazolam should have been in a 2 or 5cc vial, vec is a 10cc vial, and HAS TO BE RECONSTITUTED. There were so damn many places were she could have caught this mistake before administering the medication.

 

[Agast]

yes the issue is that there were criminal charges that she was convicted.

she was not intending to kill and got no benefit from making this mistake. she admitted this mistake.

a main concern is that this ruling will make all healthcare personnel really second guess whether to report an error in the first place. the classic swiss cheese model of medical errors cant be altered if no reporting is done. it may be better to lie than report to try to correct system errors (for example, why was vec even in the pyxis accessed by nurses - this should be a anesthesiologist only drug)

Is it a systemic error to inject someone with sedation-level Versed and peace out while they’re not on monitors, or is that a judgement error?

 

[drusso]

This is most unsurprising to me. Nursing boards are like unions that stand by their members unless it is indefensibly egregious. It's why nurses are doing risky procedures on youtube and probably have no idea the potential risk/harm involved.

We could have this too as a profession if we wanted it. Instead, we eat our own.

 

[SeniorWrangler]

I'm not a lawyer but just to say, when someone faces "up to 12 years" for a charge, that almost always means they are going to serve many, many fewer years than that if convicted, with time served and time off for good behavior etc etc.
Also, she will be able to bring a lot of testimony about Vanderbilt's malfunctioning EHR and pharmacy system to bear in her trial which may be very helpful. "The real killer here is the multimillion dollar hospital that refused to hire enough nurses or pay for a safe pharmacy system. Nurse Vonda is a victim of the system, just like the poor old lady who died."

 

[Ducttape]

Is it a systemic error to inject someone with sedation-level Versed and peace out while they’re not on monitors, or is that a judgement error?

now...

reporting it and having it looked at might have identified a system error with monitoring the patient. or an error in the dispensation of medications. or an error in the nurses ability to reconstitute or administer that medication.


but criminalizing her behavior will make it less palatable for other nurses in any other situation to report an error, and endanger other patients.

 

[Agast]

now...

reporting it and having it looked at might have identified a system error with monitoring the patient. or an error in the dispensation of medications. or an error in the nurses ability to reconstitute or administer that medication.


but criminalizing her behavior will make it less palatable for other nurses in any other situation to report an error, and endanger other patients.

Honestly, do you really think she reported the error in the first place? She didn't know the difference between Vecuronium and Versed - she had no idea she made an error. Someone probably went through the patient's history and saw that Vecuronium had been checked out under the patient's name.