Dallas, Texas (June 13, 2022) - Recently, the nation was riveted by the highly publicized criminal trial of former Registered Nurse, RaDonda Vaught, who was convicted of reckless homicide and impaired adult abuse after a 2017 medication error killed her 75-year-old patient, Charlene Murphey. Although medication errors occasionally result in patient injury or death, those committing such errors are typically disciplined by state licensing boards or tried for negligence in medical malpractice cases in civil courts. To be criminally charged for a medication error is nearly unheard of, which explains why, in a show of solidarity, nurses from across the United States traveled to Tennessee to observe the courtroom proceedings in the Vaught matter. Nurses nationwide have also supported Ms. Vaught on social media. In fact, Ms. Vaught's GoFundMe raised over $100,000 for her legal defense.
Still, nurses throughout the country are concerned about the Vaught case. Although Ms. Vaught was not sentenced to jail time in this particular matter, nurses nevertheless fear that the case could serve as precedent for convicting nurses of homicide in instances where they make medication errors, notwithstanding that homicide usually requires intent. Nurses also are concerned about Vaught's general implications for the future of nursing. That is, if nurses may face criminal charges for medication errors, then they may avoid reporting errors or leave the profession altogether.
What Happened?
On March 25, 2022, Ms. Vaught was convicted of reckless homicide and impaired adult abuse following a medication error that resulted in the death of Ms. Murphey. At the time of her death, Ms. Murphey was being treated for a stroke at a prestigious medical center. Before her discharge, she was to have one last MRI. Because Ms. Murphey was claustrophobic, Ms. Vaught received a physician's order to administer Versed, a mild antianxiety medication. However, Ms. Vaught overrode the system and administered the wrong medication – vecuronium – a powerful paralytic agent. Instead of going home as planned, the error left Ms. Murphey brain dead. Ms. Vaught admitted her mistake in real time and was terminated by her hospital employer. On May 13, 2022, Ms. Vaught was sentenced to three years of supervised probation and given no jail time. The crimes of which she was convicted carried a combined potential jail sentence of up to eight years.
The Reality of Nursing
Nurses from around the country rallied in support of Ms. Vaught because they understood the difficulties of patient care and the sobering reality of how commonplace errors are in the field. Indeed, medical errors are the number three leading cause of death in the United States, with medication errors being the most common. On average, a U.S. hospital patient is subjected to at least one medication error per day, leading to more than 7,000 inpatient deaths every year. Moreover, nurses are the backbone of the medical system, and the quality of care they provide is one of the primary factors determining medical service performance. According to a study in the Journal of Nursing Scholarship, nurses in hospitals are the last line of defense and the individuals most likely to commit or prevent medication errors. Not surprisingly, frontline nursing has never been an easy profession, and burnout as well as emotional exhaustion have only increased during the COVID-19 pandemic.
Guidance For Providers
While it is not yet known what impact the Vaught case will have on nurses and patient care, the best approach is to utilize longstanding safety interventions:
Follow the Five Rights of Medication Safety: Right Patient, Right Medication, Right Dose, Right Time, and Right Route - To avoid errors, nurses need to take their time with medications. Mistakes most often occur when nurses are acting quickly in emergent situations. In Ms. Vaught's case, the situation was not emergent. The right medication, dose, patient, time, and route was ordered. The primary condition for which Ms. Murphey was being treated – a bleed – had been stabilized. The MRI was expected to be her last scan prior to discharge. This was not a situation where there was an immediate emergency and no doctor was in sight, forcing the nurse to decide whether to practice medicine without a license. Instead, the Versed that Ms. Vaught needed to administer was not for an emergency procedure, but rather to calm Ms. Murphey's claustrophobia.
Don't Ignore the Safety Mechanisms – Research suggests that nurses who employ workarounds, as Ms. Vaught did in overriding the scanning system due to technical problems, do so in part to save time or because they may not appreciate the safety benefits of the system. While Ms. Vaught testified that overrides were a part of daily life in her work, the prosecution contended that she deliberately overlooked the notice that read, "WARNING: PARALYZING AGENT," on the top of the medication bottle before injecting Ms. Murphey with the vecuronium. Additionally, while Versed is drawn straight from a vial of liquid, vecuronium is a powder that needs to be reconstituted prior to administration. In other words, Ms. Vaught had to take the extra step of mixing the powder with water before administering it - a step that should have caused her to pause and consider the Five Rights.
Don't Rely on GoFundMe – All frontline providers should obtain insurance or ensure that they have coverage through their employer. Generally, physicians are required to procure insurance. Nurses should avail themselves of the same protection. Although an insurance policy may not have provided coverage for Ms. Vaught's criminal trial, the legal fees she incurred in defending her nursing license likely would likely have been covered, depending on her policy. Furthermore, nurses (or any other professionals) who are facing potential discipline related to their professional license, should retain counsel. These individuals are more likely to secure a better outcome with an attorney by their side.
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