Nurse found guilty. Future legal precedent?

[OptionOffense]

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.

My point exactly.

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[OptionOffense]

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 am as well but if she never saw the medication ever before, she likely didnt re constitute it properly either. It comes in 10 mg. If you put it in 5 cc syringe and give 1cc thats 2 mg. Likely she wouldnt use a 5cc or a 10cc syringe to administer 2mg of versed. She would use a 3 cc syringe. So she likely reconstituted 10 mg in a 3cc volume and gave 1 cc which would give you more than 3 mg. That is a clinically significant dose in a critically ill 70 year old. Either way, she bypassed many stops that would have told her "something aint right."

 

[wholeheartedly]

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.

The vial lid being red and clearly saying paralytic agent on top, and multiple other points saying paralytic agent are huge for me too.

Also, I don’t know about you, but any time I’ve had to override a safety system in the hospital I’m usually uber paranoid about it and check myself even more. Also have a colleague double check if possible (and she had an orientee with her, so someone perfectly capable of double checking)

Which brings in my next issue, she was training someone. When I’m training someone I’m always on my best behavior following/demonstrating proper safety protocols.

This is also informative, long but the investigation descriptions, not the tags are interesting. starts pg 6 and page 20 and others.

DocumentCloud

www.documentcloud.org

 

[wholeheartedly]

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.

It’s not really a good legal standard but for me it’s the 70 mph vs 100 mph plus texting plus eating criteria. If it’s an honest mistake anyone could make and in line with common med errors then it’s bad and still legally negligent but I wouldn’t take issue with it not being prosecuted. But I don’t see many other people making this set of mistakes and blowing off this many checks and protocols, so that’s the line for me.

Malpractice is civil. criminal is criminal. they aren’t mutually exclusive.

 

[vector2]

I'm still not sure I agree with the charges being as strong as negligent homicide, but with regard to the question of whether a reasonable person could make this error in the heat of the moment (I've never used an Acudose system before):

 

[nimbus]

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

“I am aware and do not need to be reminded again.”

“Benefits outweigh risk.”

 

[coffeebythelake]

“I am aware and do not need to be reminded again.”

“Benefits outweigh risk.”

"Clinician reviewed"

These alerts are about the hospital system trying to cover their ass because they "told you so" with the pop-up. And if you make a mistake they will hang you out to dry. Hospital execs think they are improving the system with these dumb alerts. In actuality they are making things worse.

 

[nimbus]

I'm still not sure I agree with the charges being as strong as negligent homicide, but with regard to the question of whether a reasonable person could make this error in the heat of the moment (I've never used an Acudose system before):


View attachment 352399
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All I can think is that she did not have a good grasp of the English language and did not understand what “paralyzing agent” actually means.

 

[hiyaman]

Many mixed thoughts here. On one hand I'm shocked that she did not see paralytic or paralyzing agent written on both the medication cabinet and on the vial itself. Plus the fact that she had to reconstitute should've prompted for her to look at the label to see how to reconstitute if she wasn't familiar with the drug. And the fact she left the patient alone instead of staying too monitor is very eye raising.

But I've also had my own near misses and errors and had colleagues who have medication errors and I would say none of us should warrant criminal charges. I don't think she should've been indicted or convicted.

Vanderbilt has a share of the blame. They should really reconsider allowing administration of any IV sedatives In a radiology suite for pet or MRI as the biggest issue for these areas are lack of personnel who can monitor the patient.

 

[Dr. Rude]

All I can think is that she did not have a good grasp of the English language and did not understand what “paralyzing agent” actually means.

Did the Equivalent of clicking the silence button multiple times without actually looking at the alarm more likely.

 

[Mman]

They should really reconsider allowing administration of any IV sedatives In a radiology suite for pet or MRI as the biggest issue for these areas are lack of personnel who can monitor the patient.

I am certainly not volunteering to anesthetize every single slightly claustrophobic person that needs an MRI

 

[Zekchar]

Everyone is making the slippery slope argument here. I disagree and wholeheartedly agree with the criminal charges. I also agree that Vandy should have liability in this and that an outside investigation regarding reporting failures and coverups needs to be done.

At the end of a day though, a patient horrifically lost their life due to gross negligence. At some point there has to be accountability. You cannot simply make infinite mistakes, claim Just Cause, and have immunity to all consequences. The system is not supposed to punish the individual within reason, but it is also not designed to absolve individuals of all blame either.

On a side note, there are parallels here between Just Cause and Qualified Immunity. You cannot claim to oppose qualified immunity for police officers while simultaneously arguing that this nurse should not have been persecuted under Just Cause preconditions. Either we collectively hold individuals responsible for egregious acts or we dont.

 

[Proudfather94]

I am certainly not volunteering to anesthetize every single slightly claustrophobic person that needs an MRI

Couldn't they have just given her an oral medication or a little bit of IM Ativan to knock the edge off if she was that anxious and wasn't alert enough to take the meds orally?

 

[Mman]

Couldn't they have just given her an oral medication or a little bit of IM Ativan to knock the edge off if she was that anxious and wasn't alert enough to take the meds orally?

IM Ativan? She could have given IM succinylcholine for all we know. The correct med as ordered was probably perfectly safe for the patient. The problem was an incorrect med was given, not that an incorrect med was ordered.

 

[deleted875186]

I think we all agree we don’t agree with negligible homicide, but probably because we are all bias, we have made med errors before, and we think it’s a slippery slope.

The errors the nurse made fit the definition for negligible homicide, it’s unfortunate you can’t change the law.

 

[wholeheartedly]

It should be noted that the determination of “negligent homicide“ was a downgrade from the original charge of “reckless homicide” i think we tend to get uncomfortable because homicide is a loaded word often associated with murder and even though we know that isn’t this context. but as noted above, this is the same charge you’d get if you were doing something like falling alseep at the wheel and killed someone or texting a driving.

also, for those talking about state board action, the nursing board initially determined no action was warranted and she was free to carry on. that’s hugely problematic here. i mean not even a hey, you need to take some courses on medication error prevention. it wasn’t until charges were made that they decide to re-evaluate and revoke her license.

finally, what Vandy did covering this up was shady AF and they needed/need more than CMS slapping immediate jeopardy tags on them and letting them fix it.

 

[deleted875186]

again, the most unbelievable part of this case is the nursing board initially closing the case without any disciplinary action. Only after the anonymous tip and reopening the case did they take action.

 

[deleted875186]

It should be noted that the determination of “negligent homicide“ was a downgrade from the original charge of “reckless homicide” i think we tend to get uncomfortable because homicide is a loaded word often associated with murder and even though we know that isn’t this context. but as noted above, this is the same charge you’d get if you were doing something like falling alseep at the wheel and killed someone or texting a driving.

also, for those talking about state board action, the nursing board initially determined no action was warranted. that’s hugely problematic here. it wasn’t until charges were made that they decide to re-evaluate and revoke her license.

finally, what Vandy did covering this up was shady AF and they needed/need more than CMS slapping immediate jeopardy tags on them and letting them fix it.

Agreed. Vandy lied on the death certificate, did not report the case to the medical examiner, fired the nurse, and settled with the family, incredibly shady, I’m not a lawyer but something there feels illegal.

 

[OptionOffense]

I am certainly not volunteering to anesthetize every single slightly claustrophobic person that needs an MRI

If they pay you, you will. I certainly will.

 

[OptionOffense]

Agreed. Vandy lied on the death certificate, did not report the case to the medical examiner, fired the nurse, and settled with the family, incredibly shady, I’m not a lawyer but something there feels illegal.

the only way to get back at Vandy is to keep this **** in the news and keep talking about it. Spread the news!!!

 

[Mman]

If they pay you, you will. I certainly will.

don't have enough staffing to accomplish the sheer volume it would require

 

[deleted875186]

As mentioned above, a PO Valium is fairly fast acting and should be sufficient for most adults. They don’t make PO vecuronium.

 

[ERRES2288]

The only thing I can think is she was so unfamiliar with the terms "versed, midazolam, vecuronium, paralyzing" and had no experience with any of them that she did not even know what the alerts were telling her. I see no other way that you could override so many alerts and reconstitute a medicine that is not correct. I wonder if the the question was ever asked of her "do you know what the term paralyzing means?"

 

[IMGASMD]

All I can think is that she did not have a good grasp of the English language and did not understand what “paralyzing agent” actually means.

I actually thought about that…. Maybe she can’t read good….

Makes her illiterate, not a killer.

I can totally see myself just ignore all warnings on the Pyxis or EMR.

What’s a little unsettling is, if all those five warnings are for the same patient on the same machine for the same medication.

And the “red flags” with the fact that she’s not tired nor overworked…..

Sad case

 

[Planktonmd]

If that nurse has never given Midazolam before and she does not know what "paralyzing agent" means all these red flags would mean nothing to her. That wouldn't be criminal negligence, it is simple lack of training and education that her employer should be liable for.
Anyone who can have access to these medications should know what they are and what they can do. It is the job of the pharmacy, nursing leadership, and the hospital to make sure these employees are trained and educated.

 

[chessknt]

Everyone is making the slippery slope argument here. I disagree and wholeheartedly agree with the criminal charges. I also agree that Vandy should have liability in this and that an outside investigation regarding reporting failures and coverups needs to be done.

At the end of a day though, a patient horrifically lost their life due to gross negligence. At some point there has to be accountability. You cannot simply make infinite mistakes, claim Just Cause, and have immunity to all consequences. The system is not supposed to punish the individual within reason, but it is also not designed to absolve individuals of all blame either.

On a side note, there are parallels here between Just Cause and Qualified Immunity. You cannot claim to oppose qualified immunity for police officers while simultaneously arguing that this nurse should not have been persecuted under Just Cause preconditions. Either we collectively hold individuals responsible for egregious acts or we dont.

She lost her job and her career so there was (eventually) accountability.

Some specialties practice in much higher risk areas where loss of life happens. Mistakes in these areas leading to loss of life that might otherwise have been avoidable have previously been considered malpractice risk however now we are opening the door for a particularly angry or powerful family to convince a DA to pursue criminal charges. If you are in private practice your criminal defense will not be covered by malpractice and there is an excellent chance you will also lose your job while the case is ongoing. This particular case took 5 years to resolve. Our legal system is designed in such a way that you have to face a rigged system with infinite resources to defend yourself while out of work and facing a highly charged media narrative that will likely not be entirely true.

You think that is just? What if you end up being declared innocent? Is the loss above worth whatever benefit you think society is getting by putting a medical professional through this process? There is a case going on now against a CCM doc for providing comfort care to patients who had no chance of survival. Even if he wins his case his life is still ruined.

 

[deleted875186]

I actually thought about that…. Maybe she can’t read good….

Makes her illiterate, not a killer.

I can totally see myself just ignore all warnings on the Pyxis or EMR.

What’s a little unsettling is, if all those five warnings are for the same patient on the same machine for the same medication.

And the “red flags” with the fact that she’s not tired nor overworked…..

Sad case

This would be a interesting defense.

I have often thought about this when I take our roc or vec, the Pyxis deliberately uses lay terms like “PARALYZING AGENT”, it doesn’t say “neuromuscular blocker”. Really hard ti argue a lay person doesn’t understand this alert.

 

[bronx43]

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.

Couldn't agree enough.
Medicine has gotten to a point where we're all looking at this steaming pile of garbage and asking "when can I GTFO?" Something like this only moves the finish line a bit closer. As a rheumatologist, I can totally see myself being "negligent" in continuing someone's biologic, while not double/triple checking to make sure there's a TB test in the EMR after the patient promised that they got it at an outside lab just a year ago.

I have no interest in debates about whether this was a "morally right" decision. The only thing I care about is if my ass can go to prison for a medical error, then the price of my services just went up. When the monetary reward measured in purchasing power (the only thing this rotting house of cards can offer us at this point) reaches a certain low threshold, then I'm peacing out.
There's a price to EVERYTHING. Is the public ready to pay up?

 

[Zekchar]

She lost her job and her career so there was (eventually) accountability.

Some specialties practice in much higher risk areas where loss of life happens. Mistakes in these areas leading to loss of life that might otherwise have been avoidable have previously been considered malpractice risk however now we are opening the door for a particularly angry or powerful family to convince a DA to pursue criminal charges. If you are in private practice your criminal defense will not be covered by malpractice and there is an excellent chance you will also lose your job while the case is ongoing. This particular case took 5 years to resolve. Our legal system is designed in such a way that you have to face a rigged system with infinite resources to defend yourself while out of work and facing a highly charged media narrative that will likely not be entirely true.

You think that is just? What if you end up being declared innocent? Is the loss above worth whatever benefit you think society is getting by putting a medical professional through this process? There is a case going on now against a CCM doc for providing comfort care to patients who had no chance of survival. Even if he wins his case his life is still ruined.

Well said. If your wife/husband/son/daughter were going for a MRI and had this happen to them, you would feel differently.

If this forces mandatory ratios, great. If this causes a sick-out / strike due to unsafe electronic systems, great.

At some point though, the individual bears responsibility at the individual level. This nurse bore that responsibility and received (in my opinion) the correct verdict. Remember that she wasn't convicted of premeditated murder, but rather negligent homicide. The definition of her actions fits.

 

[bronx43]

Well said. If your wife/husband/son/daughter were going for a MRI and had this happen to them, you would feel differently.

Sorry, but this simply isn't a good argument. Invoking individual emotional response to a hypothetical doesn't mean it's necessarily for the greater good.

The US official policy is to not negotiate with terrorists, and for good reason. Do I agree that this is in the interest of the greater good? Yes.
How about if my family were hostages? Then, I would want the US to pony up every penny in the Treasury, every ounce of gold in Fort Knox, and every foreign asset held by the US government. I can give two s**ts about unintended consequences and changes to future behavior leading to potentially worse outcomes.

There are many examples but you get the gist.

 

[coffeebythelake]

the only way to get back at Vandy is to keep this **** in the news and keep talking about it. Spread the news!!!

This should be a huge scandal foe Vandy and their hospital executives should be charged with crimes as well for thr cover-up.

 

[OptionOffense]

The only thing I care about is if my ass can go to prison for a medical error, then the price of my services just went up.

Dont be a complete dumb-a ss and you wont. On the other hand, everytime I order zofran for someone who had a general anesthetic it tells me there is a interaction between zofran and propofol (Using propofol together with ondansetron can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening) and I have to find the reason why I am ignoring it to continue about my day. Same thing with someone who says they were allergic to codeine and all of a sudden an alert pops up for anytime you try to order narcotic.

 

[chessknt]

Well said. If your wife/husband/son/daughter were going for a MRI and had this happen to them, you would feel differently.

If this forces mandatory ratios, great. If this causes a sick-out / strike due to unsafe electronic systems, great.

At some point though, the individual bears responsibility at the individual level. This nurse bore that responsibility and received (in my opinion) the correct verdict. Remember that she wasn't convicted of premeditated murder, but rather negligent homicide. The definition of her actions fits.

The criminal case doesn't result in any changes to a system though, only individual punishment. Prosecuting individual providers who have no leadership role is the least effective way to enforce a change for the greater good in a hospital.

Supporting this verdict is tacit acceptance that any mistake you make in the future that results in harm will be subject (beyond peer review, medical licensing review, and civil malpractice risk) to a biased and poorly defined lay process of assessment by a politically motivated individual. If this person decides the story is juicy enough then your life is now ruined.

 

[OptionOffense]

This should be a huge scandal foe Vandy and their hospital executives should be charged with crimes as well for thr cover-up.

If the nurse wasnt a "know it all" like many nurses i know, this probably would not have happened. This much is crystal clear: requiring more education to be able to handle a drug as seemingly innocuous as versed would yield an alive patient in this case. Vandy is ground zero for all this nursy independent bull****. That much should be uncovered.

 

[chessknt]

Dont be a complete dumb-a ss and you wont. On the other hand, everytime I order zofran for someone who had a general anesthetic it tells me there is a interaction between zofran and propofol (Using propofol together with ondansetron can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening) and I have to find the reason why I am ignoring it to continue about my day. Same thing with someone who says they were allergic to codeine and all of a sudden an alert pops up for anytime you try to order narcotic.

And if that person gets tdp and dies? Might not even be malpractice but why didn't you use aprepitant or a non qt prolonging agent doctor? That is potentially criminal negligence now.

 

[wholeheartedly]

The only thing I can think is she was so unfamiliar with the terms "versed, midazolam, vecuronium, paralyzing" and had no experience with any of them that she did not even know what the alerts were telling her. I see no other way that you could override so many alerts and reconstitute a medicine that is not correct. I wonder if the the question was ever asked of her "do you know what the term paralyzing means?"

I read somewhere she had given versed several times before, not vec. she was also working in the neuro icu so i hope she wouldve had a decent skill set ability to read

 

[bronx43]

Dont be a complete dumb-a ss and you wont. On the other hand, everytime I order zofran for someone who had a general anesthetic it tells me there is a interaction between zofran and propofol (Using propofol together with ondansetron can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening) and I have to find the reason why I am ignoring it to continue about my day. Same thing with someone who says they were allergic to codeine and all of a sudden an alert pops up for anytime you try to order narcotic.

Great advice. I will be sure to follow it to a T.


Btw, do you mind giving us a table of every "dumb-a ss" and non-"dumb-a ss" medical decision so I can post it on the wall of my office?
Oh, and please include every known and unknown variable and confounding factor mixed in every possible permutation. Kthx.

 

[OptionOffense]

Great advice. I will be sure to follow it to a T.


Btw, do you mind giving us a table of every "dumb-a ss" and non-"dumb-a ss" medical decision so I can post it on the wall of my office?
Oh, and please include every known and unknown variable and confounding factor mixed in every possible permutation. Kthx.

Easy: If you come across something you are unfamiliar instead of being a dumb a ss and winging it, call someone and ask ( a pharmacist, a colleague etc.. isnt that what we were taught in residecny?) or just dont do it.

 

[bronx43]

Easy: If you come across something you are unfamiliar instead of being a dumb a ss and winging it, call someone and ask ( a pharmacist, a colleague etc.. isnt that what we were taught in residecny?) or just dont do it.

Oh, I see. So every mistake is one of unfamiliarity. Got it.


Wait, can you define familiarity?

 

[OptionOffense]

Oh, I see. So every mistake is one of unfamiliarity. Got it.

The one in question was clearly. Do you doubt that?

 

[bronx43]

The one in question was clearly. Do you doubt that?

I'm not talking about the one in question. I'm talking about medical errors in general.

Are you saying that this court decision has zero implications for any case that isn't EXACTLY the way this error was made?

 

[OptionOffense]

I'm not talking about the one in question. I'm talking about medical errors in general.

Are you saying that this court decision has zero implications for any case that isn't EXACTLY the way this error was made?

You asked me for a table of every dumb a ss and non dumb ass medical decision and I told you how you can avoid being in the same exact position as the one in question . Dont do unfamiliar things unless you have consulted someone who is familiar. Done. That will keep you out of jail for the most part.

 

[bronx43]

You asked me for a table of every dumb a ss and non dumb ass medical decision and I told you how you can avoid being in the same exact position as the one in question . Dont do unfamiliar things unless you have consulted someone who is familiar. Done. That will keep you out of jail for the most part.

Define familiar.
How about if it's something I thought was familiar but actually isn't? Do I go to jail then?
Have you ever made a mistake in your life?

 

[ERRES2288]

Oh course she was negligent but don’t you have to be negligent to have committed malpractice ? So is every case of negligence that results in death going to result in a homicide charge?

Is there some number of errors that need to be made to have a charge? It’s a slippery slope

 

[Señor S]

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 a big factor; there has already been a good amount of blowback against this verdict and I think the nursing groups are behind that. So I think that might dissuade other prosecutors from pursuing these types of cases...against nurses. Doctors are a more appealing target for a number of reasons (less positive sentiment and more resentment from the general public etc). And unlike nurses doctors in 2022 have almost no solidarity with each other; if anything we look for opportunities to turn against each other and **** each other over.

This is a really scary time to work in healthcare.

 

[OptionOffense]

This is a big factor; there has already been a good amount of blowback against this verdict and I think the nursing groups are behind that. So I think that might dissuade other prosecutors from pursuing these types of cases...against nurses. Doctors are a more appealing target for a number of reasons (less positive sentiment and more resentment from the general public etc). And unlike nurses doctors in 2022 have almost no solidarity with each other; if anything we look for opportunities to turn against each other and **** each other over.

This is a really scary time to work in healthcare.

Nurses are so powerful that they can bully District Attorneys prosecuting criminal activity? Maybe, if that is true that in and of itself is scary.

 

[Señor S]

Nurses are so powerful that they can bully District Attorneys prosecuting criminal activity? Maybe, if that is true that in and of itself is scary.

DAs are political creatures and can be "bullied" into prosecuting or not prosecuting almost anything, in the sense that a sufficient public outcry one way or the other can easily sway their decisions. That's what prosecutors are, ultimately: politicians who put people in jail. And nurses are very powerful: there are a lot of them (numerically) and they act in a cohesive fashion and look out for each other. The nursing board didn't even discipline her the first time they reviewed her case.

 

[ToliBro]

I can only speak from the nursing perspective, particularly about anesthesia matters (I'll defer to the much more knowledgeable docs in here for those)... but I can't say I ever gave Versed to anyone outside the ICU or ER in any of the 10+ hospitals I've worked in. Of those times, only to intubated ICU patients as a prn or continuous drip, and to anyone else with a physician present giving verbal orders as part of a procedure. It seems like a strange choice of med for a claustrophobic person in a scanner. Versed has usually been on the moderate sedation list, which is usually a separate training program for ICU/ER/procedural areas only ("credentialed for moderate sedation"), and monitoring for drugs on said list has always been a part of training. The pt was on the neuro stepdown unit, too, and at a bare minimum anyone I send from ICU or Stepdown is on continuous telemetry + pulse ox if not on room air. ICU patients get 1:1 RN when off the unit at all times. Sending someone to a scan who's in stepdown going off the unit without even a pulse ox is utterly bizarre, particularly since they're going to be off the unit for about 2 hours for PET due to tracer time.

Reading the CMS report is rather hair raising. The nurse apparently looked at the bottle to figure out how to reconstitute it (!) but didn't read what medication it was? I've been busy and rushed before but that is rather alarming. The number of alerts on top of an administration of a drug she likely didn't know anything about and the horrific manner of death probably does factor into why she was charged; it looks pretty bad to an outside observer.

At any rate, this is Vandy throwing the person at the sharp end of the stick under the bus to save themselves. Funny how none of the clipboard wielders or suits are sitting in the dock.

Nurses are so powerful that they can bully District Attorneys prosecuting criminal activity? Maybe, if that is true that in and of itself is scary.

I try to avoid spending much time in the nursing social media/professional organization sphere, I like my IQ where it is, but there's definitely a nursing-wide belief that physicians are more protected by society than nurses are and that nurses stab each other in the back while physicians protect their own. IMO it's the other way around, particularly in civil actions-- nurses usually don't have malpractice insurance or assets worth suing over usually unless you get a rich person crusading for your head.

 

[OptionOffense]

. It seems like a strange choice of med for a claustrophobic person in a scanner.

See, this is what I am talking about. You do not have the education nor training to be saying stuff like this or making that decision. You do not. So stop. Versed is not a strange choice. It is the absolutely correct choice for the purpose it was intended for.
Statements like yours are why this woman is dead.

 

[chessknt]

See, this is what I am talking about. You do not have the education nor training to be saying stuff like this or making that decision. You do not. So stop. Versed is not a strange choice. It is the absolutely correct choice for the purpose it was intended for.
Statements like yours are why this woman is dead.

What? I agree with her, I never prescribe versed for elderly patients in unmonitored settings, too rapid and too much potential for badness. I actually prescribe things for patients on an outpatient and inpatient basis including anxiety meds for scanning and it is always Ativan. I'm not saying versed wouldn't work but why would you use that over a slower acting medication that is far more standard? Do you treat outpatients or floor patients who you aren't personally monitoring?