Nurse conviction a setback for patient safety

It won't encourage new people to enter the short-staffed field, either

Hard cases set bad precedents, never more so than this week’s negligent homicide conviction of a former Vanderbilt nurse who killed a patient in 2017 by administering the wrong medicine.

The case has sent shock waves through the nation’s nursing corps, which is already reeling from COVID stress, burnout and a growing number of violent attacks by people blaming anyone wearing scrubs for pandemic restrictions. Officials at health care institutions, which face a severe nurse shortage due to the escalating number of early retirements, fear the headline-grabbing case will only make it more difficult to find credentialed nurses willing to fill their open slots.

“A lot of people who thought about going into health care are having second thoughts,” American Nurses Association president Ernest Grant said at an American College of Healthcare Executives forum on Tuesday. “People in health care who are thinking of getting out have even more reason to move in that direction.”

Health care safety advocates are also alarmed by the case, fearing it will put a damper on physicians’ and nurses’ willingness to report medical errors. Since the year 2000 when the Institute of Medicine published its seminal To Err Is Human report, it has been widely recognized that internal reporting of errors is key to finding and correcting the processes that lead to most inadvertent deaths inside hospitals.

An “organization must have a just culture, one that encourages and rewards reporting and focuses not on individual blame and punishment but rather on improving systems and processes,” advises the Institute for Healthcare Improvement, which over the past three decades has led the charge for improving safety inside hospitals.

Janie Harvey Garner, the founder of Show Me Your Stethoscope, a Facebook nursing group with more than 600,000 members, fears the conviction will make nurses reluctant to disclose errors, which will undermine voluntary reporting programs aimed at improving quality. “Health care just changed forever,” she told Kaiser Health News after the verdict. “You can no longer trust people to tell the truth because they will be incriminating themselves.”

The case

Radonda Vaught, 37, who had her nurses license revoked after the incident, now faces up to six years in prison for neglect and negligent homicide. During her trial, the Nashville District Attorney convinced the jury she violated basic nursing standards in preparing Charlene Murphey, an impaired 75-year-old, for a routine MRI scan. She had expressed fears of entering the machine and requested sedation.

Vaught grabbed a paralyzing drug instead of the sedative from the medicine cabinet, overlooking the fact one was a liquid and the other a powder. She also ignored the warning label and failed to monitor the patient. “The immutable fact of this case is that Charlene Murphey is dead because RaDonda Vaught could not bother to pay attention to what she was doing,” assistant DA Chad Jackson told the jury.

Vaught’s attorney tried to argue that problems with Vanderbilt University Medical Center’s medication cabinets contributed to the errors. The hospital’s medication safety officer testified that the hospital had some technical problems with medication cabinets in 2017, but that they were resolved weeks before Vaught administered the wrong drug to Murphey, KHN reported.

A rare case

Criminal cases against medical personnel for errors are extremely rare. During the Tennessee Board of Nursing hearing in 2021 that led to her license revocation, Vaught admitted she had been distracted and failed to double-check her actions. “I know the reason this patient is no longer here is because of me,” Vaught told the nursing board. “There won’t ever be a day that goes by that I don’t think about what I did.” In the year since, she has repeatedly appeared before television news cameras to publicly apologize to Murphey’s family.

During the trial, dozens of nurses dressed in scrubs showed up in court to express support for Vaught.

The pandemic has required most nurses to long hours under high stress conditions. Patient safety advocates fret the national movement to reduce hospital errors has suffered a sharp setback as harried nurses in short-staffed institutions deal with what at times has been an overwhelming caseload.

The extent to which medical error increases mortality, a problem long before the pandemic, remains controversial. The 2000 IOM report estimated that as many as 98,000 people died a year from medical errors inside hospitals. A 2016 Johns Hopkins study nearly tripled that estimate to 250,000, which would make it the third leading cause of death in the U.S.

Subsequent research suggested the actual total is far lower, about 22,000 deaths a year, according to a 2020 study in the Journal of General Internal Medicine. But the author of that study, Benjamin Rodwin, an assistant professor of internal medicine at Yale, suggested his lower number might have been due to the reporting and correction systems hospitals put in place in the wake of the original IOM report.

Now it’s not just the pandemic that poses a threat to that progress. “Criminalizing medical errors is completely contrary to the suggestions in the IOM report,” Rick Pollack, CEO of the American Hospital Association, said Tuesday. “We need to encourage people to report errors so we can improve.”