Nurse's guilty verdict in patient death raises concern in industry



Even before former Nashville nurse RaDonda Vaught was convicted in the death of a patient, medical professionals were concerned about the chilling effect a guilty verdict could have in the industry.

Vaught, 39, was found guilty last week in the 2017 death of Charlene Murphy. Murphy was a patient at Nashville's Vanderbilt University Medical Center when Vaughn inadvertently injected Murphy with a deadly dose of the paralyzing drug vecuronium.

Prosecutors said Vaught consciously disregarded warnings and risks when she pulled the wrong medication from an electronic dispensing cabinet that required her to search for the drug by name, and was therefore culpable in Murphey's death.

What happened in the RaDonda Vaught case
Jurors deliberated for about four hours before convicting Vaught of reckless homicide and impaired adult abuse.

Vaught was stripped of her license by the Tennessee Board of Nursing in July after the board initially chose not to investigate the death.

Murphey's family sat in the gallery all week, as did a collection of nurses and other medical professionals across the aisle gathered in support of Vaught.

The American Nurses Association on Wednesday released a statement of concern the trial could set a worrying precedent and discourage nurses from reporting errors. They worried the trend could ultimately hinder patient safety.

Key development
That verdict — and the fact that Vaught was charged at all — worries patient safety and nursing groups that have worked for years to move hospital culture away from cover-ups, blame and punishment, and toward the honest reporting of mistakes.

The move to a "Just Culture" seeks to improve safety by analyzing human errors and making systemic changes to prevent their recurrence. And that can't happen if providers think they could go to prison, they say.

Just Culture has been widely adopted in hospitals since a 1999 report by the National Academy of Medicine estimated at least 98,000 people may die each year due to medical errors.

But such bad outcomes remain stubbornly common, with too many hospital staffers convinced that owning up to mistakes will expose them to punishment, according to a 2018 study published in the American Journal of Medical Quality.

Why it's important
Vaught was steeped in the idea of Just Culture and says she has "zero regrets" about telling the truth, but her candor was used against her at trial. Assistant District Attorney Brittani Flatt quoted from her interview with a Tennessee Bureau of Investigation agent in closing arguments: "I definitely should have paid more attention. I should have called the pharmacy. I shouldn't have overridden, because it wasn't an emergency."

More than 46,000 death certificates listed complications of medical and surgical care — a category that includes medical errors — among the causes of death in 2020, according to the Centers for Disease Control and Prevention's National Center for Health Statistics.

"Best estimates are 7,000-10,000 fatal medication errors a year. Are we going to lock them up? Who is going to replace them?" said Bruce Lambert, patient safety expert and director of the Center for Communication and Health at Northwestern University.

Quotable
"If you think RaDonda Vaught is criminally negligent, you just don't know how health care works," Lambert said.

Janie Harvey Garner, who founded the nurse advocacy organization Show Me Your Stethoscope. She said that because Vaught owned up to the mistake, Murphey's death "has probably saved lives."

"At my hospital, they've changed their policy and put paralytics into a rapid intubation kit because of this," she said.

What's next
While Murphey's death may serve as a cautionary tale for other nurses, Vaught, now awaits her sentencing. The District Attorney's office confirmed a conviction of reckless homicide can carry 2-4 years of incarceration, the gross neglect charge could stretch from 3-6 years. The judge will determine whether the sentences run concurrently or consecutively, based on statutory guidelines.

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