Nurse found guilty. Future legal precedent?

[Dr. Rude]

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?

Please, you have a patient in the scanner, anxious. Versed 1mg with a PRN dose for a second milligram is not unreasonable.

---

Members don't see this ad.

 

[OptionOffense]

What? I agree with her, I. 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?

Now we are arguing over which benzo should have been prescribed . Dude, go home!

 

[IMGASMD]

Same result.
It would have been
Ativan vs Atracurium.

Now let’s go back to the regular programming.

 

[chessknt]

Please, you have a patient in the scanner, anxious. Versed 1mg with a PRN dose for a second milligram is not unreasonable.

But the patient wasn't in the scanner and wasn't going to be monitored. Versed and Ativan aren't identical.

Clearly not the heart of the issue but this is an unusual order for a floor patient as someone who has a lot of experience with floor patients. That unfamiliarity contributed in a small part to the outcome.

 

[OptionOffense]

But the patient wasn't in the scanner and wasn't going to be monitored. Versed and Ativan aren't identical.

Clearly not the heart of the issue but this is an unusual order for a floor patient as someone who has a lot of experience with floor patients. That unfamiliarity contributed in a small part to the outcome.

Versed and Ativan are not identical. Whats your point? You would not forego monitoring with ativan would you? If you are intimating that the nurse would not have ever picked up the Vecuronium if Ativan was ordered perhaps you are right but with ifs "we can put paris in a bottle" famous french proverb. avec des si on mettrait Paris en bouteille - Wiktionary

The order was legitimate. Don't blame the order, blame the lack of education on the nurses part for giving a deadly medication that she had never seen before because of her attitude as a "know it all."

 

[chessknt]

Versed and Ativan are not identical. Whats your point? You would not forego monitoring with ativan would you? If you are intimating that the nurse would not have ever picked up the Vecuronium if Ativan was ordered perhaps you are right but with ifs "we can put paris in a bottle"

The order was legitimate. Don't blame the order, blame the lack of education on the nurses part for giving a deadly medication that she had never seen before because of her attitude as a "know it all."

So when I have a 25 year old with anxiety who needs an MRI and calls the clinic I should tell her to go pick up a vial of midazolam from CVS and require a nurse to get pulled from somewhere to monitor her?

Of course not, she gets a one time dose of po Ativan and needs to have a driver. She takes it when she checks in and I don't call the on call anesthesiologist to hook ekg leads up to her....

I get it--this isn't the problem in this case but you were the one that viciously struck out at the other poster as some sort of uneducated nurse who couldn't understand the excellent medical reasoning behind this order when in reality it was an unusual choice for the situation though not wrong.

 

[OptionOffense]

So when I have a 25 year old with anxiety who needs an MRI and calls the clinic I should tell her to go pick up a vial of midazolam from CVS and require a nurse to get pulled from somewhere to monitor her?

Of course not, she gets a one time dose of po Ativan and needs to have a driver. She takes it when she checks in and I don't call the on call anesthesiologist to hook ekg leads up to her....

I get it--this isn't the problem in this case but you were the one that viciously struck out at the other poster as some sort of uneducated nurse who couldn't understand the excellent medical reasoning behind this order when in reality it was an unusual choice for the situation though not wrong.

Am i missing something? The patient was NOT an outpatient. Had been an inpatient for some time. Midazolam comes P.O. as well.
I did not viciously strike at anyone. I pointed out that the order was NOT strange which s/he said was.

 

[coffeebythelake]

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.

Ugh... 🙄

 

[ToliBro]

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.

Saying "hey, this is weird" is now equivalent to homicide?

I'm not an anesthesiologist or physician. Y'all definitely know better than I do about meds. All I can share is that from a nursing perspective that floor/stepdown nurses almost never use midazolam and in many of the places I have worked nurses will be told not to touch it unless they're ER, ICU, or procedural staff. I see a black box warning for midazolam that says "use only in hospital/ambulatory care setting w/continuous resp/cardiac fxn monitoring, resuscitative drugs, appropriate ventilation/intubation equipment, and personnel trained/skilled in airway management." But the patient was not monitored at all in the scanner. I didn't find anything in the CMS report indicating that monitoring was ordered but not done; as a result, I can only say that I find it strange that a medication that says in my reference "monitor patient" so closely that it's worth black box status is ordered on someone who isn't being monitored. Equally odd that someone in a stepdown status isn't being at least remotely monitored.

It is definitely the responsibility of the person who is physically giving the medicine to be familiar with it. Not being familiar with a medication is not some sort of absolution; nor is it the ordering physician's fault. But it is not a medicine that floor staff are familiar with, and thus they may not realize "hey, I give this all the time, it's never in powder form, maybe I should look at it more closely." Lorazepam or occasionally alprazolam are what I received orders for when I worked stepdown and that would have been a medication whose forms the nurse would have been intimately familiar with. It's one more small chink in the armor of patient safety that contributed to the error without malice on the part of the ordering physician or the person administering it.

 

[deleted875186]

The choice of benzo is irrelevant. The choice of midazolam was fine, although some hospitals do limit it to ventilated patients, and probably would not have been my choice, but still irrelevant.

The lack of monitoring when a dose of sedation with the intent to calm down an inpatient for a scan is certainly unusual as well, and is part of the negligence in the case.

 

[coffeebythelake]

The choice of benzo is irrelevant. The choice of midazolam was fine, although some hospitals do limit it to ventilated patients, and probably would not have been my choice, but still irrelevant.

The lack of monitoring when a dose of sedation with the intent to calm down an inpatient for a scan is certainly unusual as well, and is part of the negligence in the case.

While I agree with this, I think it is also important to recognize that benzodiazepines by itself very rarely cause respiratory depression.

 

[Status Sciaticus]

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.

How do you know it was the zofran that caused the TDP? Perhaps the patient was going to get the TDP anyways?

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

Well the bar is now set as making 6 consecutive errors and then killing a patient. Pretty sure its hard to swiss cheese yourself into that, especially if you take a minute to look at what you are doing and read what you are putting inside your patient.

 

[chessknt]

How do you know it was the zofran that caused the TDP? Perhaps the patient was going to get the TDP anyways?

We don't know. Guess you can find out in court over a period of 5 years with no income while facing a murder charge unless you think the line should be drawn there. What if the patient is a senator? Maybe the line gets moved.

 

[USCTrojan11]

While I agree in this case she was criminally negligent leading to a death - I am very worried about the precedent it sets. Imagine a jury having very limited sympathy for an anesthesiologist who lost an airway and the prosecutor saying "Dr - why did you not have the neck prepped and draped with ENT surgeon in the room like you said in your oral boards? Is that not standard of care? Would that not have easily prevented this outcome?"

 

[bronx43]

Well the bar is now set as making 6 consecutive errors and then killing a patient. Pretty sure its hard to swiss cheese yourself into that, especially if you take a minute to look at what you are doing and read what you are putting inside your patient.

The bar isn’t set anywhere… it’s set by whatever emotions are being pushed by the prosecutors and how sympathetic the victim is to a group of non-medical jurors.

You actually think the next set of jurors will say “oh, I see that only 5 medical errors were committed and not 6. Therefore not guilty!”

 

[deleted875186]

The bar isn’t set anywhere… it’s set by whatever emotions are being pushed by the prosecutors and how sympathetic the victim is to a group of non-medical jurors.

You actually think the next set of jurors will say “oh, I see that only 5 medical errors were committed and not 6. Therefore not guilty!”

Agreed, there is no precedent that we are overturning here. Doctors have been tried for criminal offenses many times before.

 

[chessknt]

Agreed, there is no precedent that we are overturning here. Doctors have been tried for criminal offenses many times before.

For insurance fraud and sexual abuse for sure but for homicide in what is essentially an egregious medmal negligence case? Who? The only ones I am aware of is the Husel case which seems like a total ****show and the plastic surgeon that killed that young woman getting breast implants by delivering an anesthetic and not monitoring her and THEN not contacting EMS for hours. Are there many other examples?

 

[nimbus]

For insurance fraud and sexual abuse for sure but for homicide in what is essentially an egregious medmal negligence case? Who?

Chris Dunstch (Dr. Death) is serving a life sentence for aggravated assault.

Geoffrey Kim is charged with manslaughter.

Conrad Murray was convicted of manslaughter.

 

[wholeheartedly]

For insurance fraud and sexual abuse for sure but for homicide in what is essentially an egregious medmal negligence case? Who? The only ones I am aware of is the Husel case which seems like a total ****show and the plastic surgeon that killed that young woman getting breast implants by delivering an anesthetic and not monitoring her and THEN not contacting EMS for hours. Are there many other examples?

I keep seeing the med mal thing brought up. med mal is civil to help pts and their families. criminal negligence is to hold someone ciminally accountable. they don’t really have much to do with each other.

 

[Onefellswoop87]

For insurance fraud and sexual abuse for sure but for homicide in what is essentially an egregious medmal negligence case? Who? The only ones I am aware of is the Husel case which seems like a total ****show and the plastic surgeon that killed that young woman getting breast implants by delivering an anesthetic and not monitoring her and THEN not contacting EMS for hours. Are there many other examples?

So gave an inappropriate drug (Vec, not talking about bento choice), didn’t monitor the patient, and then didn’t call code blue/rapid response for the paralyzed patient in the MRI. Thanks for drawing a perfect parallel to this case with the plastic surgeon.

 

[Southpaw]

I’m not sure why anyone here would become paranoid about getting criminally charged after killing a patient based on this case. The only thing I took home from the case was that 1) the BON is useless (but I already knew that) 2) don’t skip a laundry list of safety warnings (including wording directly on the vial…) to give a med that isn’t ordered and yet to be confirmed w pharmacy 3) don’t skip out of correct safety monitoring for your patient (even if she’d given versed the patient needed to be monitored).

This case required a lot of errors for it to end up where it did, and since it ended with a dead patient that nurse owns the responsibility. Is Vandy also guilty? Absolutely.

Someone give some reasonable examples of how badly you could screw up and expect to be criminally charged after killing your patient, given the results of this case? The examples I’ve read here aren’t great ones. I came to work today not worried anymore than I was last week.

If you really want to change something here, change the law for negligent homicide. The case seemed to meet the definition.

 

[Onefellswoop87]

I have a hard time blaming the system for the event. The nurse stated in discovery she wasn’t over tired or over worked. She had prior icu experience. She had time to go to more than one medication delivery system and check the medication orders. It was a series of mistakes and errors that fall on one person’s shoulders. Different from other med-mal events where bad outcomes are after multiple layers of Swiss cheese models. That’s also why I also have a hard time saying or agreeing that this will set a precedent.
Except the only precedent is don’t ignore multiple safety warnings, don’t give meds you aren’t supposed to or aren’t familiar with, and do monitor your patients.
I do blame Vandy and the board of nursing for all their shady handling of it after the fact.

 

[Proudfather94]

I think if they made it to where the jury had to comprise of currently practicing nurses and physicians for these kinds of cases that would really help. Being convicted by 12 members of the medical field would mean you probably deserve to go to prison.

I don't think most members of the general public are able to understand the situation enough to make a call like they did in this trial.

 

[Dr. Rude]

I have a hard time blaming the system for the event. The nurse stated in discovery she wasn’t over tired or over worked. She had prior icu experience. She had time to go to more than one medication delivery system and check the medication orders. It was a series of mistakes and errors that fall on one person’s shoulders. Different from other med-mal events where bad outcomes are after multiple layers of Swiss cheese models. That’s also why I also have a hard time saying or agreeing that this will set a precedent.
Except the only precedent is don’t ignore multiple safety warnings, don’t give meds you aren’t supposed to or aren’t familiar with, and do monitor your patients.
I do blame Vandy and the board of nursing for all their shady handling of it after the fact.

Except, in order to get the work done we routinely override (which becomes frequently don't read) multiple warnings, silence alarms, etc. just to get through our day. It becomes automatic. Many of us do it without thinking or paying attention. The systemic failure is filling our days with all of these advisories and warnings, that we have to click through so somebody's ass is covered.

 

[Onefellswoop87]

Except, in order to get the work done we routinely override (which becomes frequently don't read) multiple warnings, silence alarms, etc. just to get through our day. It becomes automatic. Many of us do it without thinking or paying attention. The systemic failure is filling our days with all of these advisories and warnings, that we have to click through so somebody's ass is covered.

I get that perspective. I do. I’ve clicked through my fair share of warnings. And alarm fatigue is real. And meaningless alarms are meaningless.

But paralytic warnings on the medication dispenser and the bottle are not the same, in my eyes, as the patient I just saw who has an “allergy” to fentanyl because it caused respiratory depression on him. The warnings I’ll get that I have to click through to order meds for him in the PACU aren’t equivalent to what occurred in this case.

Sure, the systems are frustrating and the warnings sometimes make me want to pull out the little hair I have left. But you said the biggest problem, “Maybe of us do it without thinking or paying attention.” That’s an individual issue, not a system problem.

 

[Onefellswoop87]

I think if they made it to where the jury had to comprise of currently practicing nurses and physicians for these kinds of cases that would really help. Being convicted by 12 members of the medical field would mean you probably deserve to go to prison.

I don't think most members of the general public are able to understand the situation enough to make a call like they did in this trial.

That’s a real highbrow opinion. I’d think anyone who works in a sector with government regulation or OSHA oversight and warnings (so almost every industry?) could see what she did as egregious and negligent.

 

[IMGASMD]

“What they're saying: District Attorney Glenn Funk rebuffed that criticism in prepared remarks following the verdict, arguing the case was not an indictment against nurses or the medical profession.

"This case was, and always has been, about the gross neglect by RaDonda Vaught that caused the death of Charlene Murphey," Funk said. "This was not a 'singular' or 'momentary' mistake."


The other side: The American Nurses Association (ANA) said through a spokesperson's statement that it is "deeply distressed" by the verdict and argued it is "completely unrealistic" to think mistakes won't occur during health care delivery.

"The criminalization of medical errors is unnerving, and this verdict sets into motion a dangerous precedent," the ANA said. "There are more effective and just mechanisms to examine errors, establish system improvements and take corrective action."”

Source: Axios

 

[Status Sciaticus]

We don't know. Guess you can find out in court over a period of 5 years with no income while facing a murder charge unless you think the line should be drawn there. What if the patient is a senator? Maybe the line gets moved.

Countersue the government? Theyre pretty easy to sue and win against. Also if you cant find a place of work that will not hire you due to a medication error, IDK what to tell you. People get hired after killing people left and right (see Dr. Duntsch).
I wouldn t block an athlete, and I wouldnt anesthetize anyone with political power. Simply pass the case onto somebody else, or properly consent the patient on the risks of the anesthetic up to and including death, as remote as that risk may be. Also dont give that patient vecuronium without mechanical ventilation.

The bar isn’t set anywhere… it’s set by whatever emotions are being pushed by the prosecutors and how sympathetic the victim is to a group of non-medical jurors.

You actually think the next set of jurors will say “oh, I see that only 5 medical errors were committed and not 6. Therefore not guilty!”

The bar comment was sarcastic... I didnt really mean that the legal bar is at 6 errors. But I can understand that sarcasm doesnt translate well across text. You are correct that the bar is essentially set on a case by case basis. Ideally it shouldnt matter unless you **** up as bad as this nurse did.

 

[deleted875186]

Except, in order to get the work done we routinely override (which becomes frequently don't read) multiple warnings, silence alarms, etc. just to get through our day. It becomes automatic. Many of us do it without thinking or paying attention. The systemic failure is filling our days with all of these advisories and warnings, that we have to click through so somebody's ass is covered.

At the same time, we click through these because we are sure of the medications we give, I know true allergy to a synthetic opioid is incredibly rare, and I know my patients history. In my mind, keep the high alert warning on paralytics, put in in propofol, ketamine, etomidate, and synthetic opioids too, anyone checking them out of the pixis should be very careful unless it’s an anesthesiologist and they use the medicine every day. I don’t mind clicking through “high alert” warnings, I’m going to double check the vial and concentration before I push it anyway.

 

[Señor S]

Countersue the government? Theyre pretty easy to sue and win against. Also if you cant find a place of work that will not hire you due to a medication error, IDK what to tell you. People get hired after killing people left and right (see Dr. Duntsch).
I wouldn t block an athlete, and I wouldnt anesthetize anyone with political power. Simply pass the case onto somebody else, or properly consent the patient on the risks of the anesthetic up to and including death, as remote as that risk may be. Also dont give that patient vecuronium without mechanical ventilation.

It's easy to sue (let alone win against) the government? You'd just hand a VIP case off to a colleague? What if your colleagues feel the same as you? Baffling post.

 

[Señor S]

I’m not sure why anyone here would become paranoid about getting criminally charged after killing a patient based on this case. The only thing I took home from the case was that 1) the BON is useless (but I already knew that) 2) don’t skip a laundry list of safety warnings (including wording directly on the vial…) to give a med that isn’t ordered and yet to be confirmed w pharmacy 3) don’t skip out of correct safety monitoring for your patient (even if she’d given versed the patient needed to be monitored).

That's a really glib interpretation. I could come up with a million scenarios where people could be seriously harmed by things I didn't double check, contraindications I ignored and stuff I didn't follow up on. Which of these makes me a criminal? Do I trust a jury to make that distinction, especially if they're exposed to dozens of lawyer-driven "investigative journalism" stories in the press that make me out to be a monster? Do I trust the prosecutor, since the decision to prosecute usually leads to conviction as a matter of course?

Or to put it another way: if this is the threshold to get sent to prison (worst possible outcome), what is the threshold to lose your medical license? Get sanctioned by the board? Lose your job? It must be a much lower bar, enough that we've all made mistakes that could justify at least some of those outcomes. And there are plenty of online-degreed "providers" ready to take any non-proceduralist's place, and plenty of evil corporations who will throw hapless peons (such as ourselves) to the wolves at the first sign of trouble.

I hope this doesn't set a precedent...but I fear it's just the beginning. If you trust the government not to take this too far then you have much more faith in them than I do.

 

[secretasianman]

If a physician did the equivalent of this, i bet there would be charges and massive public outcry. We are already held to a higher standard so don’t think this hasn’t already been the case. But with more and more poorly trained midlevels in medicine today, who else is the public going to turn to when awfully bad mistakes like this happen and the hospital system and the nursing board aren’t doing enough?

 

[Status Sciaticus]

It's easy to sue (let alone win against) the government? You'd just hand a VIP case off to a colleague? What if your colleagues feel the same as you? Baffling post.

1. Yep. Take a look at how often the NYPD gets sued for stupid stuff and how frequently it settles. Take a look at your own local PD/county hospital/etc...
2. Yep, if they want it, they can do it. If they dont want to, they dont have to. Its within my right to refuse to block an athlete, operate on an actor, intubate a singer, etc.... I bet the anesthesiologists who provided the anesthesia for Trevor Noah feels the same. Bet the person who dropped Tyrod Taylors lung feels the same. I also did say I would over-consent the patient on all parts of the anesthetic to cover myself if all else fails. But you do you.

 

[Nuriko]

Chris Dunstch (Dr. Death) is serving a life sentence for aggravated assault.

Geoffrey Kim is charged with manslaughter.

Conrad Murray was convicted of manslaughter.

Let's be real here:

Dunstch- maimed/killed MULTIPLE people and continued to repeat his actions without seeking any sort of help or remediation in spite of the fact that he was obviously causing harm

Kim- waited several HOURS to take a patient who had just coded before sending her to a hospital (I don't blame him for not being able to resuscitate. That falls on the unsupervised CRNA, a whole other issue).

Murray- administered PROPOFOL in a man's HOUSE, while UNMONITORED, and WALKED AWAY

The common thread here is that all these people, simply put, DID NOT GIVE A DAMN. They had the knowledge and mental capacity to recognize that their actions would cause harm and walked into them anyway. This is the furthest thing from good will, altruism, good intent, or anything else that would separate malpractice from criminal charges.

I can see arguments for much of what Radonda Vaught did. Overriding hard stops (6 though... really?), unfamiliarity with a medication, not reconstituting properly, being 'overworked' (although multiple sources said she wasn't)... but there is one thing that cannot be forgiven. You DO NOT administer IVP sedation to a patient who is unmonitored, and you CERTAINLY do not walk away after administering said medication. Even if she truly thought she was giving Versed, this would be unacceptable. Even a student would know that this would put someone in unreasonable danger. This is likely the tipping point that led to her guilty verdict.

You can certainly blame the healthcare system, Vanderbilt, etc for poor staffing ratios, improper training with medication administration, covering up the investigation, overstimulation from override warnings, and other factors that may have contributed. You cannot blame them for her indifference.

 

[Señor S]

1. Yep. Take a look at how often the NYPD gets sued for stupid stuff and how frequently it settles. Take a look at your own local PD/county hospital/etc...

Uh...

Sovereign immunity - Wikipedia

en.wikipedia.org

Absolute immunity - Wikipedia

en.wikipedia.org

Judicial immunity - Wikipedia

en.wikipedia.org

But good luck with that lawsuit against the prosecutor. Let us know how it works out for you.

 

[Southpaw]

That's a really glib interpretation. I could come up with a million scenarios where people could be seriously harmed by things I didn't double check, contraindications I ignored and stuff I didn't follow up on. Which of these makes me a criminal? Do I trust a jury to make that distinction, especially if they're exposed to dozens of lawyer-driven "investigative journalism" stories in the press that make me out to be a monster? Do I trust the prosecutor, since the decision to prosecute usually leads to conviction as a matter of course?

Or to put it another way: if this is the threshold to get sent to prison (worst possible outcome), what is the threshold to lose your medical license? Get sanctioned by the board? Lose your job? It must be a much lower bar, enough that we've all made mistakes that could justify at least some of those outcomes. And there are plenty of online-degreed "providers" ready to take any non-proceduralist's place, and plenty of evil corporations who will throw hapless peons (such as ourselves) to the wolves at the first sign of trouble.

I hope this doesn't set a precedent...but I fear it's just the beginning. If you trust the government not to take this too far then you have much more faith in them than I do.

Well, go ahead and give me some decent examples then. Just a couple for the sake of discussion. I understand people don't like the way this feels. And in my anesthesiology career I've been around plenty of medication errors. But I'd have to think long and hard, and even then I probably couldn't come up with something so egregious as what Ms. Vaught did. And I'm sure she feels awful, but this case meets the definition of negligent homicide. Asking a DA to look the other way or not do their job because she's a nurse or works in a hospital isn't the way this world works.

There's a lot to take in here. The Board of Nursing, after such a massive screwup didn't sanction her at all. Nada, zilch, nothing. Not for 4 years until a state's attorney recommended they revoke her license and the writing was on the wall. So how in the world is the Board of Nursing going to advocate for patient safety? Well, they're not.

Again, if you really want to do something then work on changing the law for negligent homicide. As it turns out, ignoring a gazillon safety warnings with the intent of giving a relatively innocuous dose of a medication (which still required monitoring!) but instead walking away after leaving a paralyzed patient unmonitored to suffocate to death does in fact meet the bar for negligent homicide. And I personally think a physician would have to try really really hard to do something so egregious that they wind up in the same spot as Ms. Vaught.

 

[jwk]

If a physician did the equivalent of this, i bet there would be charges and massive public outcry. We are already held to a higher standard so don’t think this hasn’t already been the case. But with more and more poorly trained midlevels in medicine today, who else is the public going to turn to when awfully bad mistakes like this happen and the hospital system and the nursing board aren’t doing enough?

Unrecognized esophageal intubations still happen every year. I don't ever recall anyone ever going to jail because of it. I mean really - it's absolutely 100% preventable, easily diagnosed, easily corrected - but it happens with some frequency. Isn't that an egregious mistake?

 

[pgg]

Just an idle thought -

Maybe we shouldn't allow pharmaceutical companies to make up names for drugs for marketing purposes? It's obviously very unsafe.

Wouldn't patients be safer if there was ONE name for every drug? If every drug in a class only had names with common or similar suffixes?

How ridiculous and dangerous is it that there are multiple names for the same drug?


Don't use trade names. Ever. There's no need. It adds risk. If no one ever said "Valium" or "Ativan" or "Versed" ... but instead used the generic names with extremely similarly spelled/pronounced suffixes, this entire class of drug swap errors wouldn't exist.

 

[Nuriko]

Unrecognized esophageal intubations still happen every year. I don't ever recall anyone ever going to jail because of it. I mean really - it's absolutely 100% preventable, easily diagnosed, easily corrected - but it happens with some frequency. Isn't that an egregious mistake?

It is not the mistake that is significant, but how it is handled. We all do our due diligence to make sure the tube is placed correctly. I don't think anyone has an excuse these days, since the invention of the capnograph, but we still listen for breaths, look for condensation, chest rise, etc.

If someone blindly shoved in a tube and promptly walked out without doing any of the proper safety checks, I would argue that criminal charges would be appropriate.

 

[nimbus]

Let's be real here:

Dunstch- maimed/killed MULTIPLE people and continued to repeat his actions without seeking any sort of help or remediation in spite of the fact that he was obviously causing harm

Kim- waited several HOURS to take a patient who had just coded before sending her to a hospital (I don't blame him for not being able to resuscitate. That falls on the unsupervised CRNA, a whole other issue).

Murray- administered PROPOFOL in a man's HOUSE, while UNMONITORED, and WALKED AWAY

The common thread here is that all these people, simply put, DID NOT GIVE A DAMN. They had the knowledge and mental capacity to recognize that their actions would cause harm and walked into them anyway. This is the furthest thing from good will, altruism, good intent, or anything else that would separate malpractice from criminal charges.

I can see arguments for much of what Radonda Vaught did. Overriding hard stops (6 though... really?), unfamiliarity with a medication, not reconstituting properly, being 'overworked' (although multiple sources said she wasn't)... but there is one thing that cannot be forgiven. You DO NOT administer IVP sedation to a patient who is unmonitored, and you CERTAINLY do not walk away after administering said medication. Even if she truly thought she was giving Versed, this would be unacceptable. Even a student would know that this would put someone in unreasonable danger. This is likely the tipping point that led to her guilty verdict.

You can certainly blame the healthcare system, Vanderbilt, etc for poor staffing ratios, improper training with medication administration, covering up the investigation, overstimulation from override warnings, and other factors that may have contributed. You cannot blame them for her indifference.

So Vaught did the same thing as Murray but Murray didn’t override any hard stops?

 

[Southpaw]

Unrecognized esophageal intubations still happen every year. I don't ever recall anyone ever going to jail because of it. I mean really - it's absolutely 100% preventable, easily diagnosed, easily corrected - but it happens with some frequency. Isn't that an egregious mistake?

Yes it is. And if you goosed someone after inducing, unmonitored, and walked out of the OR after doing so leaving the patient to die, then IMO you should face charges AND never touch another patient.

 

[Nuriko]

So Vaught did the same thing as Murray but Murray didn’t override any hard stops?

Effectively. I have no idea how he got the propofol, or whether hard stops like this existed in 2009. Regardless, I do think she showed the same disregard for safety that he did.

 

[nimbus]

Effectively. I have no idea how he got the propofol, or whether hard stops like this existed in 2009. Regardless, I do think she showed the same disregard for safety that he did.

Even Michael Jackson probably didn’t have any Pyxis machines at his house.

 

[IMGASMD]

Even Michael Jackson probably didn’t have any Pyxis machines at his house.

Who does he call/beg to refill his Pyxis? Or to fix his “discrepancies” ?

 

[CubsDynasty]

Who does he call/beg to refill his Pyxis? Or to fix his “discrepancies” ?

He'd probably just Beat It

 

[Status Sciaticus]

Uh...

Sovereign immunity - Wikipedia

en.wikipedia.org

Absolute immunity - Wikipedia

en.wikipedia.org

Judicial immunity - Wikipedia

en.wikipedia.org

But good luck with that lawsuit against the prosecutor. Let us know how it works out for you.

Thanks for the wikipedia links.
Here is one from the NYC Bar

Personal Injury Attorney - Personal Injury Law Firm - Find An Attorney

Learn about personal injury attorneys and personal injury law firms through NYC Bar Legal Referral Service. Find a personal injury attorney in New York.

www.nycbar.org

Here's a couple regarding the Federal Tort Claims Act:

Federal Tort Claims Act | house.gov

www.house.gov

Frequent Questions About Federal Tort Claims Act (FTCA) Claims Processing | US EPA

Frequent questions about Standard Form 95, claim form for damage, injury or death.

www.epa.gov

Suing for loss on income is covered in all three links.

Unrecognized esophageal intubations still happen every year. I don't ever recall anyone ever going to jail because of it. I mean really - it's absolutely 100% preventable, easily diagnosed, easily corrected - but it happens with some frequency. Isn't that an egregious mistake?

Its an accepted risk of attempting endotracheal intubation. You dont recall anyone going to jail because of it because no one is stupid enough to intubate, and walk away without confirming placement and monitoring the patient, both key distinctions in the case being discussed.

 

[Señor S]

Thanks for the wikipedia links.
Here is one from the NYC Bar

Personal Injury Attorney - Personal Injury Law Firm - Find An Attorney

Learn about personal injury attorneys and personal injury law firms through NYC Bar Legal Referral Service. Find a personal injury attorney in New York.

www.nycbar.org

Here's a couple regarding the Federal Tort Claims Act:

Federal Tort Claims Act | house.gov

www.house.gov

Frequent Questions About Federal Tort Claims Act (FTCA) Claims Processing | US EPA

Frequent questions about Standard Form 95, claim form for damage, injury or death.

www.epa.gov

Suing for loss on income is covered in all three links.

Its an accepted risk of attempting endotracheal intubation. You dont recall anyone going to jail because of it because no one is stupid enough to intubate, and walk away without confirming placement and monitoring the patient, both key distinctions in the case being discussed.

Suing the city of New York because you tripped on an uneven sidewalk is something that's allowed for as a matter of law; that's the whole principle of sovereign immunity, that the government cannot be sued unless they consent to it. Personal injury lawyers lobby NYC politicians to legalize these types of lawsuits so the PI guys can make more money. It's a racket.

Here's a non-Wikipedia article

Why Holding Prosecutors Accountable Is So Difficult - Innocence Project

innocenceproject.org

This is the problem with these debates: so many people believe that the system will work in their favor and that they'll get justice with a capital 'J' because that's what their high school civics teacher taught them.

 

[Status Sciaticus]

Suing the city of New York because you tripped on an uneven sidewalk is something that's allowed for as a matter of law; that's the whole principle of sovereign immunity, that the government cannot be sued unless they consent to it. Personal injury lawyers lobby NYC politicians to legalize these types of lawsuits so the PI guys can make more money. It's a racket.

Here's a non-Wikipedia article

Why Holding Prosecutors Accountable Is So Difficult - Innocence Project

innocenceproject.org

This is the problem with these debates: so many people believe that the system will work in their favor and that they'll get justice with a capital 'J' because that's what their high school civics teacher taught them.

The exception to the bolded phrase is the FTCA, which I linked above. Using the FTCA, "[t]he United States [is] liable ... in the same manner and to the same extent as a private individual under like circumstances, but [is not] liable for interest prior to judgment or for punitive damages." 28 U.S.C. § 267

I doubt theres going to be anything fruitful from this back and forth, and I would rather not derail the thread any further, so I will digress on this point.

 

[emergentmd]

She screwed up, should be reprimanded. Lose her license, I think not. Criminal homicide and jail time?

What is the purpose of jail? Rehabilitate vs unsafe to live in society vs voluntary intentional act..... Nope nothing fits here. There is no sound reason for her to be in Prison and clog up the system other than making a name for the DA.

I have seen more intentional malpractice performed by docs who never even receives a slap on the wrist at MEC.

Bottom line is she is used as a pawn to further someone's agenda or career.

 

[kidthor]

I have seen more intentional malpractice performed by docs who never even receives a slap on the wrist at MEC.

Bottom line is she is used as a pawn to further someone's agenda or career.

Exactly - I’ve seen MUCH worse, often flagrant and intentional disregard for safety, and it’s never punished.

If you’re bringing money in or part of the old boys club things get a hand wavey explanation and a cover up, if you’re anything else you’re sacrificed.