Nurse found guilty. Future legal precedent?

[CHARLESTONMMM]

Ex-nurse RaDonda Vaught found guilty on two charges in death of patient

RaDonda Vaught, a former Vanderbilt nurse, was charged with reckless homicide after making a medication error in 2017 that may have killed a patient.

www.tennessean.com

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[coffeebythelake]

Ex-nurse RaDonda Vaught found guilty on two charges in death of patient

RaDonda Vaught, a former Vanderbilt nurse, was charged with reckless homicide after making a medication error in 2017 that may have killed a patient.

www.tennessean.com

A tragedy and a mistake. Malpractice, sure. But criminal? I think there were systems related issues that contributed to this, the "swiss cheese" model. Nurse Vaught was the last step in a series of failures which includes the institution, the pharmacy, the staffing set up . I do not think she should have been found guilty.

 

[secretasianman]

Whats with the hair though? She’s going to court not to the mall. Anyways, she could still probably sign up for online np school, so she’ll be fine!

From another article: “
Vaught was investigated by the nursing licensing board in the months after Murphey's death and was not recommended to lose her license or be suspended.

But nearly a year after the event, an anonymous tip, a surprise inspection and state and federal investigations led to threatened sanctions for VUMC and a a criminal indictment for Vaught. “

Like wtf @ the nursing board. At least they didn’t say “job well done” this time..

 

[coffeebythelake]

Whats with the hair though? She’s going to court not to the mall. Anyways, she could still probably sign up for online np school, so she’ll be fine!

From another article: “
Vaught was investigated by the nursing licensing board in the months after Murphey's death and was not recommended to lose her license or be suspended.

But nearly a year after the event, an anonymous tip, a surprise inspection and state and federal investigations led to threatened sanctions for VUMC and a a criminal indictment for Vaught. “

Like wtf @ the nursing board. At least they didn’t say “job well done” this time..

The appropriate sequence of investigation should have involved a Root Cause Analysis of all the system failures which led to her picking and misidentifying vecuronium as versed. It is easy to blame her for everything and say "why didn't she read the whole label?"... but we all know that medication errors in hospitals occur fairly frequently but most of the time without such disasterous results. (Refer to the link below for "Look a-like medications" that have led to errors in the past).. What was her mental state at the time? Was she tired? Was she distracted? Was she unfamiliar with the setting? Did she even know the difference between versed and vecuronium? Was there anyone else to check her dosing prior to administration? Why was there vecuronium in an off-site radiology omnicell when it is only ever used by anesthesiologists and the ICU? What kind of vital sign monitoring occurs for patients in the MRI suite? Is there continuous pulse oximetry there? I do think the system and the circumstances conspired to sabotage Nurse Vaught, and she was the last step in a series of failures in the system.

Patient Safety Alert – Look-alike Medications

Patient Safety Alert – Look-alike Medications

www.soap.org

 

[chessknt]

So the jury thought she intentionally gave the medication to harm him? It was a conscious choice to push vec? I can understand being distracted and ignoring the warnings but manslaughter? This is a horrible precedent unless there was evidence for malice elsewhere... Absolutely ridiculous.

 

[ak_ps]

A possible difference in this case vs others where medication mis-administration occurs is that vecuronium (at least how I see it usually) has to be reconstituted, unlike midazolam which you just pull directly out of the vial.

If she reconstituted it then that is an additional step of negligence and brings up the question of 'how many negligent steps can one take until it becomes malicious practice?'

Aside from the classic override issue - pyxis machines also usually add an additional 'warning this is a paralytic' message which one has to acknowledge prior to pulling the drug.

Not saying she deserves the book thrown at her, but still.

 

[nimbus]

Another grave medication error from awhile back. Should this anesthesiologist face criminal charges?

https://www.cdph.ca.gov/Programs/CHCQ/LCP/CDPH%20Document%20Library/Immediate%20Jeopardy/MercyHospital-2567.pdf?TSPD_101_R0=087ed344cfab200087b5b53b1dbf3ea4eaeca29e222391303647e4e657d1e8a0b544706cc6f9ba1f0895b1dbc614300056a1e3245ca6b30b11729b2bc00fb9f5b2f998e34ab51c4cd12ea2e35c9a8fdff5607088926f2a8a005e5f6564a1c0a2

 

[chessknt]

A possible difference in this case vs others where medication mis-administration occurs is that vecuronium (at least how I see it usually) has to be reconstituted, unlike midazolam which you just pull directly out of the vial.

If she reconstituted it then that is an additional step of negligence and brings up the question of 'how many negligent steps can one take until it becomes malicious practice?'

Aside from the classic override issue - pyxis machines also usually add an additional 'warning this is a paralytic' message which one has to acknowledge prior to pulling the drug.

Not saying she deserves the book thrown at her, but still.

She worked on the floor--versed is not given there either so she probably had no familiarity with either drug. Why these would be stocked on the floor at all is a mystery. It would be like an ob nurse getting assigned to the transfusion center for the day then being accused of homicide when she mixed up two different kinds of chemo.

The patient appeared to be acutely agitated for someone to order versed and the nursing ratio was probably 1:4 at best so who knows how many other issues she was dealing with at the same time. Kind of insane they found another RN on the jury to convict her.

 

[martvubo]

She worked on the floor--versed is not given there either so she probably had no familiarity with either drug. Why these would be stocked on the floor at all is a mystery. It would be like an ob nurse getting assigned to the transfusion center for the day then being accused of homicide when she mixed up two different kinds of chemo.

The patient appeared to be acutely agitated for someone to order versed and the nursing ratio was probably 1:4 at best so who knows how many other issues she was dealing with at the same time. Kind of insane they found another RN on the jury to convict her.

The patient requested something for anxiolysis going into MRI so 2mg Versed was ordered as "give 1mg, if no improvement give other mg"; Versed was verified by pharmacy and in the Pyxis system as being associated with a verified order for the patient. Nurse typed v-e, but the pyxis defaulted to searching by generic names so Vecuronium came up and not Midazolam. Nurse tried to pull Vec, pyxis wouldn't let her because 1. that pyxis didn't have any inside and 2. there was no order for vec or pharmacy verifcation for vec. Nurse went to a different unit (neuro ICU) pyxis, typed v-e, vec came up, again gave her warnings that there was no order for vec, no pharmacy verifcation for vec, and vec is a paralytic all of which she overrode.

Might not change how you feel about this, but RE: "why would it be stocked? acutely agitated etc" it wasn't stocked and the victim wasn't agitated so those are the actual facts to interpret when you decide what you think.

 

[coffeebythelake]

RaDonda Vaught made at least 10 mistakes in fatal Vanderbilt medication error, prosecutors say

RaDonda Vaught has been charged with reckless homicide for a fatal medication error the nurse made at Vanderbilt University Medical Center in 2017.

www.tennessean.com

So she claimed to have been distracted when checking out the medication, overrides the pyxis machine, but also that there was some systems related issues with the pyxis machine verification delays with pharmacy and EMR, that generic names only used not the brand name which made searching for medications more difficult, and she probably had no experience giving either versed or vecuronium if having to reconstitute the drug raised red flags. Still a tragedy and still a mistake

 

[The Duck Knows]

I think this case should be a spark to bring up some changes that seem like low-hanging fruit to me. Why haven’t we standardized medication vials? We standardized colors of gas pipelines and tanks, and went a step further with the PISS and DISS systems. Yet we know that incorrect medication administration is the most common medical error.

Personally, I’ve nearly given 10u pitocin instead of metoclopramide. Fortunately I didn’t give it, as the fetus was already showing some signs of distress.

Most vials of paralytics I’ve seen are red and have some writing on the cap, so it probably still wasn’t enough in this case. But having standardized colors for opioids, pressors, paralytics, and drugs needing dilution would be a good start. Would also be nice if every vial had generic and name brand written in an easy to read font.

Stay diligent, friends

 

[coffeebythelake]

I think this case should be a spark to bring up some changes that seem like low-hanging fruit to me. Why haven’t we standardized medication vials? We standardized colors of gas pipelines and tanks, and went a step further with the PISS and DISS systems. Yet we know that incorrect medication administration is the most common medical error.

Personally, I’ve nearly given 10u pitocin instead of metoclopramide. Fortunately I didn’t give it, as the fetus was already showing some signs of distress.

Most vials of paralytics I’ve seen are red and have some writing on the cap, so it probably still wasn’t enough in this case. But having standardized colors for opioids, pressors, paralytics, and drugs needing dilution would be a good start. Would also be nice if every vial had generic and name brand written in an easy to read font.

Stay diligent, friends

furosemide instead of versed
pitocin instead of zofran
we've all heard of these errors before due to look-alike-vials
i am conscientious about checking and double checking my drugs, but just recently i gave 250 mcg of fentanyl instead of 100 mg of 2% lidocaine. I was holding both drugs in my hand, mixed them up and gave 5 cc from the syringe containing the fentanyl. Fortunately this was during GA induction phase for a young healthy patient, and nothing happened from it, but i think it does speak to the pressures we face daily to be fast and efficient in the face of stress and demands from patients, surgeons, hospital admin

 

[Lecithin5]

As I don’t work with residents, and do my own cases, I’m surprised that syringe mixups don’t happen more often (ie attending walks in to induce, and a new resident hands syringes over, with the lido and roc syringes mislabled…..).

 

[OptionOffense]

The appropriate sequence of investigation should have involved a Root Cause Analysis of all the system failures which led to her picking and misidentifying vecuronium as versed. It is easy to blame her for everything and say "why didn't she read the whole label?"... but we all know that medication errors in hospitals occur fairly frequently but most of the time without such disasterous results. (Refer to the link below for "Look a-like medications" that have led to errors in the past).. What was her mental state at the time? Was she tired? Was she distracted? Was she unfamiliar with the setting? Did she even know the difference between versed and vecuronium? Was there anyone else to check her dosing prior to administration? Why was there vecuronium in an off-site radiology omnicell when it is only ever used by anesthesiologists and the ICU? What kind of vital sign monitoring occurs for patients in the MRI suite? Is there continuous pulse oximetry there? I do think the system and the circumstances conspired to sabotage Nurse Vaught, and she was the last step in a series of failures in the system.

Patient Safety Alert – Look-alike Medications

Patient Safety Alert – Look-alike Medications

www.soap.org

It is impossible to dumb down EVERYTHING. At some point we rely on common sense and training. This is why I have to triple lock up everything before I leave the room. Do I really need to do that? Do I really need a 100k pyxis in the OR? When a 50 dollar utility drawer from home depot will do. DO I really need a pyxis to tell me I grabbed vec rather than versed? Even if you mis read that clue, wouldn't the white powder in the vec bottle raise your spidey senses? CMON dude. Id give her 18 months in the lock up to think about it. This is gross.

 

[OptionOffense]

. It would be like an ob nurse getting assigned to the transfusion center for the day then being accused of homicide when she mixed up two different kinds of chemo.

You ask questions. Thats what I do when I am not familiar with something? Hey how do you hook this thing up? DO i need to warm the platelets? Can i just push this drug... I call my partners in the room and ask questions.. or ask the surgeon or whomever knows... She could have paged the on call Anesthesiologist to ask.. When I have the call phone you wouldnt believe the calls i get.

 

[Proudfather94]

Nurses are already refusing to do medication overrides and verbal orders. I bet the CC and EM forms will be talking about this soon

 

[Planktonmd]

This is a sad day for all medical professionals in this country and it will certainly empower state DAs to seek criminal charges in the future in malpractice cases.
A precedence has been set and unfortunately it will have a long lasting effect.

 

[DocMcCoy]

I think this case should be a spark to bring up some changes that seem like low-hanging fruit to me. Why haven’t we standardized medication vials? We standardized colors of gas pipelines and tanks, and went a step further with the PISS and DISS systems. Yet we know that incorrect medication administration is the most common medical error.

Personally, I’ve nearly given 10u pitocin instead of metoclopramide. Fortunately I didn’t give it, as the fetus was already showing some signs of distress.

Most vials of paralytics I’ve seen are red and have some writing on the cap, so it probably still wasn’t enough in this case. But having standardized colors for opioids, pressors, paralytics, and drugs needing dilution would be a good start. Would also be nice if every vial had generic and name brand written in an easy to read font.

Stay diligent, friends

Decadron and 10mg phenyephrine vials can look waaaay too similar. And they sit in adjacent pockets in my carts.

 

[Dr. Rude]

I think this case should be a spark to bring up some changes that seem like low-hanging fruit to me. Why haven’t we standardized medication vials? We standardized colors of gas pipelines and tanks, and went a step further with the PISS and DISS systems. Yet we know that incorrect medication administration is the most common medical error.

Personally, I’ve nearly given 10u pitocin instead of metoclopramide. Fortunately I didn’t give it, as the fetus was already showing some signs of distress.

Most vials of paralytics I’ve seen are red and have some writing on the cap, so it probably still wasn’t enough in this case. But having standardized colors for opioids, pressors, paralytics, and drugs needing dilution would be a good start. Would also be nice if every vial had generic and name brand written in an easy to read font.

Stay diligent, friends

With supply shortages in recent years, medication sourcing has changed a lot. Lots of drugs now have different packaging than they previously did. Sometimes multiple changes of packing in the last few years.

 

[IMGASMD]

Decadron and 10mg phenyephrine vials can look waaaay too similar. And they sit in adjacent pockets in my carts.

I have a picture of neo, zofran, and decadron all with the same blue color cap.
We don’t stock dexmedetomidine in our machines, or I can probably have a picture of all four together.

 

[nimbus]

With supply shortages in recent years, medication sourcing has changed a lot. Lots of drugs now have different packaging than they previously did. Sometimes multiple changes of packing in the last few years.

Years ago I arranged our anesthesia drug tray in a manner that made sense. Induction agents and nmb’s in one area, pressors in another, antiemetics in another, etc. Since then, due to changes in vendors and multiple changes from from vials to prefilled syringes and vice versa, the original layout no longer works, drugs got randomly moved around, and our drug tray is currently a hot mess.

 

[chessknt]

You ask questions. Thats what I do when I am not familiar with something? Hey how do you hook this thing up? DO i need to warm the platelets? Can i just push this drug... I call my partners in the room and ask questions.. or ask the surgeon or whomever knows... She could have paged the on call Anesthesiologist to ask.. When I have the call phone you wouldnt believe the calls i get.

Have you worked as a floor nurse? How often do you interact with them? It is a different standard and they are so busy it can be impossible to find someone senior to ask (not to mention nobody senior at all because they all quit). If transport is there and ct says ready to go and you had no time to get the drug ready beforehand and now are panicking because you can't find it I can see this happening. It is malpractice but not a criminal offense

 

[chessknt]

The patient requested something for anxiolysis going into MRI so 2mg Versed was ordered as "give 1mg, if no improvement give other mg"; Versed was verified by pharmacy and in the Pyxis system as being associated with a verified order for the patient. Nurse typed v-e, but the pyxis defaulted to searching by generic names so Vecuronium came up and not Midazolam. Nurse tried to pull Vec, pyxis wouldn't let her because 1. that pyxis didn't have any inside and 2. there was no order for vec or pharmacy verifcation for vec. Nurse went to a different unit (neuro ICU) pyxis, typed v-e, vec came up, again gave her warnings that there was no order for vec, no pharmacy verifcation for vec, and vec is a paralytic all of which she overrode.

Might not change how you feel about this, but RE: "why would it be stocked? acutely agitated etc" it wasn't stocked and the victim wasn't agitated so those are the actual facts to interpret when you decide what you think.

Clearly multiple problems in there. Clearly quality problems and a lot of holes and she got damn unlucky that nobody was around to check her in either unit and give her a warning. Why the **** would they order versed instead of Ativan for a MRI? Seems like the md didn't know the limits of the nurse or situation either, should they be on trial now too?

I still don't see criminality unless she had exhibited this pattern or intentionally pulling the wrong drugs to give patients. As someone who works in healthcare (unlike the lawyers) I can see how this situation could occur multiple ways without homicide being the motivator.

 

[coffeebythelake]

Clearly multiple problems in there. Clearly quality problems and a lot of holes and she got damn unlucky that nobody was around to check her in either unit and give her a warning. Why the **** would they order versed instead of Ativan for a MRI? Seems like the md didn't know the limits of the nurse or situation either, should they be on trial now too?

I still don't see criminality unless she had exhibited this pattern or intentionally pulling the wrong drugs to give patients. As someone who works in healthcare (unlike the lawyers) I can see how this situation could occur multiple days as without homicide being the motivator.

And Vanderbilt tried to cover it up. There a conspiracy after the fact. Of course no consequences for all the people who tried to brush this under the rug.

The worst part of what happened with Nurse Vaught is that it will make medical professionals think twice about admitting to any sort of wrongdoing. So long to M&M's. So long to trying to learn from mistakes and creating stronger systems to prevent them from happening again.

 

[Status Sciaticus]

Lots of hyperbole and "sky is falling" sentiment here and on other social media. Fact of the matter is that with regards to the nurse, she overrode 6 hard stops and went out of her way to administer a paralytic agent. To those that say that she didnt know what she was administering, its her own fault. Anytime medication is administered, you need to make sure its the right patient and the right medication.
The nurse also left the room without assessing the patient after the medication was administered.

And she didnt admit her mistake or come forward. A second nurse noted that the patient had been given vecuronium rather than versed, at which point the patient had suffered catastrophic brain injury. If you are taking the time to reconstitute a medication that has a red flag warning that is screaming "PARALYTIC AGENT" right on the cap and ignoring doing your job, then yes you should be held accountable.

Not saying that Vanderbilt shouldn't be prosecuted for the coverup. But the nurses action, though unintentional as it may be, is still tantamount to negligent homicide. Intent is not required under the law.

 

[chessknt]

Lots of hyperbole and "sky is falling" sentiment here and on other social media. Fact of the matter is that with regards to the nurse, she overrode 6 hard stops and went out of her way to administer a paralytic agent. To those that say that she didnt know what she was administering, its her own fault. Anytime medication is administered, you need to make sure its the right patient and the right medication.
The nurse also left the room without assessing the patient after the medication was administered.

And she didnt admit her mistake or come forward. A second nurse noted that the patient had been given vecuronium rather than versed, at which point the patient had suffered catastrophic brain injury. If you are taking the time to reconstitute a medication that has a red flag warning that is screaming "PARALYTIC AGENT" right on the cap and ignoring doing your job, then yes you should be held accountable.

Not saying that Vanderbilt shouldn't be prosecuted for the coverup. But the nurses action, though unintentional as it may be, is still tantamount to negligent homicide. Intent is not required under the law.

And wouldn't you say that cases of medical malpractice that lead to death could follow this same logic? Like not giving antibiotics in sepsis or calling a surgeon for nec fasc? Homicide right there.

 

[coffeebythelake]

And wouldn't you say that cases of medical malpractice that lead to death could follow this same logic? Like not giving antibiotics in sepsis or calling a surgeon for nec fasc? Homicide right there.

Or failing to correctly identify a misplaced endotracheal tube...

 

[Mman]

we had a long thread about this case on this forum 4 years ago

 

[kidthor]

Honestly this case could happen anyone in healthcare. There are plenty of systems that set us all up for error or workarounds, and we don't think much of it till something goes wrong. I've personally had several medication errors or near errors that luckily never harmed a patient, but much of that is luck. I've heard of residents having horrible medication errors, some that led to death. We regularly tell nurses it's ok to put in a med under our name for a PACU patient when we can't get to a computer to enter a med (which then may have them put in an override, put in a med dose that you hope was communicated right, and then again hopefully they pull the right med). In these two circumstances you could be on the hook too...

Just think - you have a brand new CA-1 rapid infuse vancomycin because they don't know any better, the patient bottoms out, they give a milligram of epinephrine in panic, and the patient goes to 300/200 and has an MI. Or what about a seemingly appropriately placed central line that ends up in the carotid artery and causes a CVA? What about the intermittent cases where someone injects a spinal medication that ends up being rocuronium because a medication mishap, and the patient goes apnenic into PEA? Or how about that the spinal meds we give that say "not for spinal or epidural injection" on the label!?

Even just yesterday I had to manually enter in two patients into the pixis because of some connectivity problem, noticed three different colored tops for ondansetron - and of course the ondansetron is right next to the full 1mg of epinephrine. And why are there several full bottles of concentrated norepi in any pixis? What about the giant gas lines hanging right in front of my machine, the cords in full trip zone configuration everywhere in the OR, the random empty oxygen tanks, the broken gurneys, the many million dollar davinci robots parked in the hallway making proper patient transport near impossible without squishing everything through.

There are so many errors in medicine because of poor systems. Yes this nurse made a big mistake, perhaps an inexcusable one. But or her to be criminally convicted shocks me. She was set up to fail just like we all are.

Think about my examples above - you could be tried for homicide or battery if your resident made a severe error because your negligent supervision. You could also be tried for homicide or battery if a patient was harmed as a result of any of those systems flaws that caused an error when you had a connection to the patient.

The crazier thing is that plenty of serious bad actors in medicine have no culpability and are never pursued. What about that surgeon at MGH who did simultaneous spine surgeries with bad outcomes, along with a system who punished whistleblowers and conspired to punish them. Those people were directly maiming patients - battery, and the rest conspired to defraud the government and punish whistleblowers - both federal felonies. But do you ever see that sort of behavior punished?

Those people escape blame while the rest of us grunts are all targets. I find it disgusting and disappointing.

 

[Planktonmd]

This type of emotionally motivated verdict is a direct result of the stupid jury system in American justice that allows a "group your peers" to decide your fate!
It is very easy for a prosecutor to appeal to the jurors' emotions and fears in a case like this. All it takes is make them imagine the horrible way this patient died and imagine themselves in her shoes to have them reach a verdict against the poor nurse.

 

[Proudfather94]

This may help the situations with EM docs and pharmacists. If meds need to be ordered to be pushed and verified by pharmacies they will need more docs and pharmacists to make sure this gets done in a timely manner. Not being able to do verbal orders or bypass pharmacy may help with the job shortage.

 

[Status Sciaticus]

And wouldn't you say that cases of medical malpractice that lead to death could follow this same logic? Like not giving antibiotics in sepsis or calling a surgeon for nec fasc? Homicide right there.

If that surgeon had injected a syringe full of bacteria that gave the patient nec fasc, then yes. Did the surgeon willfully neglect 6 best practice guidelines and pop-ups on their EMR that suggested to give antibiotics because "he was distracted that day"? then yes again.

Or failing to correctly identify a misplaced endotracheal tube...

You mean similar to that situation where the CRNA tubed the goose on that 18 year old plastic surgery patient? Yes I think that person should be prosecuted. Being a healthcare professional doesnt give you a get-out-of-jail-free card. If you screw up, you own it. Otherwise you can just go around screwing up, killing patients, and still practicing medicine. ( yes I know that this happens a lot)

 

[martvubo]

What is the connection to verbal orders here? This was a signed order that got verified by pharmacy, and the nurse instead chose to travel to a different unit to pull a drug unrelated to any order on file for the patient. Nobody is claiming she murdered anyone, but it certainly was criminally negligent (IMO meaningfully different from failing to recognize sepsis and give appropriate treatments quickly-- this isn't missing appropriate steps, it is overriding several systems in place telling you the specific thing you want to do will be harmful)

 

[coffeebythelake]

You mean similar to that situation where the CRNA tubed the goose on that 18 year old plastic surgery patient? Yes I think that person should be prosecuted. Being a healthcare professional doesnt give you a get-out-of-jail-free card. If you screw up, you own it. Otherwise you can just go around screwing up, killing patients, and still practicing medicine. ( yes I know that this happens a lot)

First of all, not sure what case you are talking about. You might be confusing the facts about that Emmalyn Ng case. 🙄 And for your information, Rex Meeker is being charged with manslaughter not because he failed to intubate the patient but because he allegedly left the patient unattended and also failed to call for help when things went bad.

Secondly, what do you think the sensitivity and specificity of each confirmatory test is for the placement of an endotracheal tube? I can tell you no method is fool proof. When you are not attached to continuous capnography tracing (seeing 3 regular capnographic waveforms being the most specific in a standard OR environment), as one might be in an airway code situation off site, you use EZcaps and auscultation to confirm. Neither of these methods is that specific. Looking for chest rise or misting of the tube? Definitely not specific. The absolute way to confirm is with CXR, u carry one in your pocket?

People screw up and people make mistakes, but to say that mean that is criminal is absurd. Even when you follow the standard of care and sometimes patients have bad outcomes. The difference between malpractice and criminal behavior should be judged by intent, the egregiousness and extent of deviation from accepted good practices.

 

[chessknt]

What is the connection to verbal orders here? This was a signed order that got verified by pharmacy, and the nurse instead chose to travel to a different unit to pull a drug unrelated to any order on file for the patient. Nobody is claiming she murdered anyone, but it certainly was criminally negligent (IMO meaningfully different from failing to recognize sepsis and give appropriate treatments quickly-- this isn't missing appropriate steps, it is overriding several systems in place telling you the specific thing you want to do will be harmful)

Negligence is a malpractice component which is a civil issue. Bringing medical errors in to criminal court should be extraordinarily rare and obviously egregious like a drunk surgeon cutting someone's head off with a saw. This should terrify medical professionals because of the slippery slope.

Also ignoring popup warnings is not a criminal offense. You don't work much with emrs if you think those warnings do ****. I ignore hundreds of these pop ups a day because the majority are about charge capture trying to get the hospital more money or asanine non existent interactions like cefepime and LR.

 

[coffeebythelake]

Negligence is a malpractice component which is a civil issue. Bringing medical errors in to criminal court should be extraordinarily rare and obviously egregious like a drunk surgeon cutting someone's head off with a saw. This should terrify medical professionals because of the slippery slope.

Also ignoring popup warnings is not a criminal offense. You don't work much with emrs if you think those warnings do ****. I ignore hundreds of these pop ups a day because the majority are about charge capture trying to get the hospital more money or asanine non existent interactions like cefepime and LR.

Alarm fatigue. I imagine the same thing happens w pop up warnings.

 

[Status Sciaticus]

First of all, not sure what case you are talking about. You might be confusing the facts about that Emmalyn Ng case. 🙄 And for your information, Rex Meeker is being charged with manslaughter not because he failed to intubate the patient but because he allegedly left the patient unattended and also failed to call for help when things went bad.

Secondly, what do you think the sensitivity and specificity of each confirmatory test is for the placement of an endotracheal tube? I can tell you no method is fool proof. When you are not attached to continuous capnography tracing (seeing 3 regular capnographic waveforms being the most specific in a standard OR environment), as one might be in an airway code situation off site, you use EZcaps and auscultation to confirm. Neither of these methods is that specific. Looking for chest rise or misting of the tube? Definitely not specific. The absolute way to confirm is with CXR, u carry one in your pocket?

People screw up and people make mistakes, but to say that mean that is criminal is absurd. Even when you follow the standard of care and sometimes patients have bad outcomes. The difference between malpractice and criminal behavior should be judged by intent, the egregiousness and extent of deviation from accepted good practices.

First of call, the nurse also left the patient unattended after administering medication, did not reassess the patient throughout the duration of the event. CMS specifically mentions that patients being administered sedatives require monitoring, which she failed to do.

Secondly, people dont use x-rays outside of the ICU to confirm ETT placement. unless you have a TEF, you shouldn't really be hearing breath sounds as you auscultate. Combine that with capnometry, and you have done your due diligence. What this nurse did is analogous to saying you just stuck the tube in the mouth with your bare hands without looking with the blade to even get a view. There was no due diligence done on her part. In fact she went out of her way to not do her due diligence.

Yes people screw up and make mistakes, just like drunk drivers screw up and make mistakes, just like tired and overworked people driving home post-call make mistakes. But if they end up killing someone, they still are tried with criminal charges. Just because the manner in which one is killed doesnt make the charge any less applicable.

A simple google search will show that criminial behavior, in this case, criminally negligent homicide, does not require intent. You may want it to be judged by intent, but the law doesnt require it to be as such.

Tennessee Involuntary Manslaughter Laws - FindLaw

An overview of the state laws related to involuntary manslaughter, including potential penalties.

www.findlaw.com

 

[wholeheartedly]

This wasnt an honest mistake anyone could make. This was multiple consecutive negligent acts, repeatedly disregarding safety practices and standard nursing medication administration practices (that don’t require a computer system) that resulted in the horrific death of a patient. This wasn’t driving 70 mph in a 65 zone level negligence. This is driving 100 mph in a 65 zone while texting on your phone and eating level negligence. This is exactly the type of situation this charge is intended for.

 

[Proudfather94]

This wasnt an honest mistake anyone could make. This was multiple consecutive negligent acts, repeatedly disregarding safety practices and standard nursing medication administration practices (that don’t require a computer system) that resulted in the horrific death of a patient. This wasn’t driving 70 mph in a 65 zone level negligence. This is driving 100 mph in a 65 zone while texting on your phone and eating level negligence. This is exactly the type of situation this charge is intended for.

I would only agree with that if the systems set in place to prevent it from happening weren't messed up. Vandy is as guilty as she is and the administration there that didn't fix these issues need to be in jail with her.

 

[CHARLESTONMMM]

Do you think there will be other district attorneys who look at this case and criminally charge other cases of medical malpractice? These DAs are usually out for blood and this sets precedent and what comes next could be nasty. However the nursing community can rally the troops and campaign against rogue DAs.

 

[chessknt]

Let's hope nobody thinks the same of any mistakes we ever make going forward. Worst we had to worry about was losing our license, but now we can go to jail too if it is bad enough.

Employed pcp given 15 minute visit slots that prescribes anticoagulation for a blood clot but forgot to read the discharge summary for recent subarachnoid and ignored a popup? Off to jail.
Nephrologist writes the wrong bath order despite the emr flagging the hyperkalemia and causes cardiac arrest. To the slammer.
Rheumatologist forgets to check for tb before starting infliximab despite the drug warning to do so and patient ends up in ICU and dies? Felony time.

So many ways to put providers in jail.... Better hope you don't make any mistakes! Sure this time she had to make 6 mistakes, maybe next time it will only be 4 or 5. As long as someone gets hurt we are all on the hook now.

 

[Status Sciaticus]

Do you think there will be other district attorneys who look at this case and criminally charge other cases of medical malpractice? These DAs are usually out for blood and this sets precedent and what comes next could be nasty. However the nursing community can rally the troops and campaign against rogue DAs.

This is where its important to stress the importance of your PACs and lobbyists. Donate to ASAPAC

 

[Mman]

Alarm fatigue. I imagine the same thing happens w pop up warnings.

I auto close pop up warnings because of pop up fatigue. Alerting me to the potential allergic response to hydromorphone on the patient that has an allergic reaction of "nausea" to hydrocodone is just stupid. Same when I try to order midazolam and have to get warned that the patient reported anxiety with lorazepam.

 

[coffeebythelake]

This is where its important to stress the importance of your PACs and lobbyists. Donate to ASAPAC

I'm genuinely surprised you would say this, after claiming just a few posts prior that a failed intubation and other mistakes deserves criminal charges. And no we weren't talking about egregious things like working while drunk although you make reference to that.

 

[Proudfather94]

Let's hope nobody thinks the same of any mistakes we ever make going forward. Worst we had to worry about was losing our license, but now we can go to jail too if it is bad enough.

Employed pcp given 15 minute visit slots that prescribes anticoagulation for a blood clot but forgot to read the discharge summary for recent subarachnoid and ignored a popup? Off to jail.
Nephrologist writes the wrong bath order despite the emr flagging the hyperkalemia and causes cardiac arrest. To the slammer.
Rheumatologist forgets to check for tb before starting infliximab despite the drug warning to do so and patient ends up in ICU and dies? Felony time.

So many ways to put providers in jail.... Better hope you don't make any mistakes! Sure this time she had to make 6 mistakes, maybe next time it will only be 4 or 5. As long as someone gets hurt we are all on the hook now.

Yeah residents are always perfect and never make mistakes right?

 

[coffeebythelake]

I auto close pop up warnings because of pop up fatigue. Alerting me to the potential allergic response to hydromorphone on the patient that has an allergic reaction of "nausea" to hydrocodone is just stupid. Same when I try to order midazolam and have to get warned that the patient reported anxiety with lorazepam.

"Are you sure you want to so this".. click to continue and select reason... EMR questioning me when I want to order fentanyl for a patient who received Zofran. (Presumably due to the incredibly rare chance of SS, although no reason was ever given just that an interaction exists). This is the b.s. dumb systems we work with. Alarms and checks should exist for high yield high priority situations, but unfortunately it is mostly noise.

 

[wholeheartedly]

I would only agree with that if the systems set in place to prevent it from happening weren't messed up. Vandy is as guilty as she is and the administration there that didn't fix these issues need to be in jail with her.

The technical errors in the system resulting in overrides were fixed weeks before this happened.

2nd read this quoted post below again. this goes way beyond normal types of med errors to the degree that yes this is negligent. Basic med administration burned into nursings brain is right med, right patient, right dose, right time, right route, double triple check. you don’t need a high tech system to catch this.

3 she didn’t monitor the pt after administering the med as appropriate either.

This is like 10 different epic screwups she made.

I hate the system and will gladly blame it for anything and everything in short order, but this nurse was truly, egregiously negligent.

The patient requested something for anxiolysis going into MRI so 2mg Versed was ordered as "give 1mg, if no improvement give other mg"; Versed was verified by pharmacy and in the Pyxis system as being associated with a verified order for the patient. Nurse typed v-e, but the pyxis defaulted to searching by generic names so Vecuronium came up and not Midazolam. Nurse tried to pull Vec, pyxis wouldn't let her because 1. that pyxis didn't have any inside and 2. there was no order for vec or pharmacy verifcation for vec. Nurse went to a different unit (neuro ICU) pyxis, typed v-e, vec came up, again gave her warnings that there was no order for vec, no pharmacy verifcation for vec, and vec is a paralytic all of which she overrode.

Might not change how you feel about this, but RE: "why would it be stocked? acutely agitated etc" it wasn't stocked and the victim wasn't agitated so those are the actual facts to interpret when you decide what you think.

 

[wholeheartedly]

This has good details. Per herself, she wasn’t busy and overwhelmed and they weren’t short staffed. esp pg 50 & 51

DocumentCloud

www.documentcloud.org

 

[Status Sciaticus]

I'm genuinely surprised you would say this, after claiming just a few posts prior that a failed intubation and other mistakes deserves criminal charges. And no we weren't talking about egregious things like working while drunk although you make reference to that.

You and I may disagree on the outcome in this particular case. With that said, there is always potential for physicians to be railroaded or scapegoated/retaliated against. You can still have charges brought against you and have a PAC/lobbying group work on your behalf. Utilizing a PAC is not an admission of guilt or unethical.

I heard of a neurosurgery case from years ago where they ask for the "green dye" (IC green) for aneurysm clipping. They didnt have the dye readily available jn the OR, so reached out to the pharmacy, they sent it down, it was summarily reconstituted and administered to the patient. Problem was it wasn't IC green, it was some skin tagging green dye used by plastic surgery and dermatology. Patient ended up with severe injuries and died. Should the anesthesiologist, the pharmacist, and everyone involved in this case be charged with homicide?

The end-user would be at fault here. Pharmacist sent wrong medication, but that didnt result in patient harm. Anesthesiologists reconstituted the medication (should have read what he/she was reconstituting), and administered it, and therefore is the responsible party. Unless the neurosurgery team was okay with giving the other dye. Replace the dye with pure epinephrine, who then strokes/hemorrhages and dies. Is the anesthesiologist at fault now?

 

[chessknt]

This has good details. Per herself, she wasn’t busy and overwhelmed and they weren’t short staffed. esp pg 50 & 51

DocumentCloud

www.documentcloud.org

Thanks for the link--page 5 she states that she worked in the NICU on a regular basis and had given versed but not vec. With med shortages the reconstitution thing does not seem that odd. I am a little surprised that with just 1mg of vecuronium the patient went in to full respiratory arrest but will openly admit I have never given such a small dose.

I think the lack of monitoring peri-scan as an ICU-trained nurse is probably the most damning thing in the case. She had training on how to monitor patients who were sick and should have known that versed in the elderly can be unpredictable and that the pt should be monitored. I am still not convinced at all that this is a criminal issue--she can't practice nursing anymore after this mistake but she doesn't belong in jail. Once you decide she does how does that get determined in the future? Are we really wanting lay people to decide what is malpractice vs. homicide when they dont understand anything about healthcare? This really does open up the threat of criminal charges in any case of malpractice now because there are no clear rules on what is 'criminal' negligence and what is 'malpractice' negligence.