NPR on RaDonda Vaught
National Public Radio has run fairly good items about Tennessee nurse RaDonda Vaught, who was recently convicted of a homicide charge in the accidental death of a patient. A March 2022 item described her trial, while an April follow-up had more on nurses’ concerns that the case sets a dangerous precedent, undermining efforts to reduce health care errors and driving nurses from the bedside at a critical time.
May 2022 – National Public Radio has had helpful recent pieces about the conviction of nurse RaDonda Vaught of a homicide charge for an error that may have led to the death of a patient at Vanderbilt University Medical Center in 2017. On March 25, Brett Kalman reported that Vaught had been convicted earlier that day of criminally negligent homicide and neglect of an impaired adult for the death of 75-year-old Charlene Murphey. Vaught now faces years in prison, with her sentencing scheduled for May 13. Many U.S. nurses argue that prosecuting nurses for unintentional mistakes impairs public health by undermining efforts to reduce the high rate of health care errors and driving nurses from the profession, as the piece notes, at a time when the Covid pandemic has placed great stress on the health care system. Reports indicate that Vaught tried to withdraw the prescribed sedative Versed from an automatic drug dispensing machine, in order to calm the patient while she was getting a PET scan. But Vaught mistakenly withdrew the powerful paralytic vecuronium, the result of a word search based on the common first two letters “ve” and the machine’s failure to recognize the trade name Versed—a detail NPR inexplicably failed to include. The prosecution said that Vaught had also ignored many warning signs, and she admitted her error, but her attorney argued that she was being scapegoated for institutional failures. On April 5, NPR had a follow-up piece by Kalman and Hannah Norman. That one focused more on the larger context, highlighting the “fear and outrage” nurses have expressed about the prosecution. It had commentary from nursing scholar Linda Aiken, who said the verdict is likely to discourage reporting of mistakes, reducing safety. And the article included a contrary view from a nurse who claimed that no “competent nurse” could have made the error, as well as statements by the prosecution defending its case. Both pieces could have done much more to describe the systemic issues that seem to have been at least as important as Vaught’s error, including understaffing and poor safety practices related to the task of giving drugs in that clinical setting. The reports were produced by Kaiser Health News. We thank those responsible.
Facing immense pressure
The March NPR story reported that Vaught had been convicted after a three-day trial. It said that although she was acquitted of the more serious charge of reckless homicide, she could still be sentenced to 3-8 years in prison for the neglect charge and 1-2 years for negligent homicide. The piece explained that the patient had been admitted to the hospital for brain injury, but she was improving and was to be scanned by “a large MRI-like machine” in preparation for discharge. Versed was prescribed to calm her during this procedure. Prosecutors argued that Vaught, in addition to ignoring signs that she had mistakenly withdrawn vecuronium, had failed to monitor the patient after giving the drug. (The prosecutors were led by the District Attorney Glenn Funk, who is running for reelection and being criticized for Vaught’s prosecution by his opponent.) At the trial, the prosecutors appeared to indulge in some hyperbole, claiming that Vaught was uncaring and “worse” than a drunk driver who killed a bystander. Vaught’s attorney countered that she had made an honest mistake and was being scapegoated for the hospital’s problems with medication administration, although Vanderbilt said those issues had been resolved before the error. The attorney also argued that it was not clear that the vecuronium actually killed the patient, and there was reportedly testimony to that effect from a Vanderbilt neurologist. Although Vaught did not testify, prosecutors played audio of her admitting to law enforcement that she “probably just killed a patient.” The report also described Vaught’s candid, emotional statements to the state board of nursing that she had been “complacent” and “distracted,” and that she knew the patient was no longer alive because of her, although it’s not clear if those statements were submitted at the trial.
The piece did include some of the wider context. It noted the concern of “nurses and medical professionals” that pursuing health care errors in criminal settings (rather than in civil cases or with licensing boards) could set a dangerous precedent, although such prosecutions are very rare. It quoted Janie Harvey Garner, founder of the Facebook group Show Me Your Stethoscope, who said that because the verdict will discourage the reporting of errors, “health care just changed forever.” The American Nurses Association reportedly issued a statement making similar points about the effect on care, stressing that there are more “effective and just” ways to address errors, and that nursing “is already extremely short-staffed, strained and facing immense pressure — an unfortunate multi-year trend that was further exacerbated by the effects of the pandemic.”
This piece did a good job of presenting basic facts about the trial, in a relatively balanced way, and it had at least a few statements from concerned nurses. It might have included more details about the specific circumstances of the error, beyond Vaught’s actions. These include the difficulties in ensuring safe drug administration in patient-scanning rooms like the one involved here, which often lack mechanisms to scan the drugs; the hospital’s apparent failure to fix its medicine dispensing machines so nurses did not have to constantly use the override feature; the apparent failure to institute no talking zones for nurses giving powerful drugs; the prescribing software’s apparent failure to provide adequate guidance about administering Versed; the apparent failure to place a computer and scanner in the PET scan room where patients are frequently given sedatives and other risky medications; and perhaps above all, the dispensing machine’s failure to recognize medication trade names like Versed, which are used far more commonly than generic names for benzodiazepines and other drugs with long names. Similarly, the piece might have included more on the policy concerns of health professionals, including information about ongoing efforts to reduce health care errors—currently the third leading cause of death in the United States—by promoting “Just Cultures” that emphasize prevention rather than punishment.
Raging and quitting
The more recent piece, “Why nurses are raging and quitting after the RaDonda Vaught verdict,” was primarily about the post-verdict reaction. It focused on the views of direct care nurses, who have expressed outrage on social media – videos with the “#RaDondaVaught” hashtag have had more than 47 million views. Many have argued, the report said, that the verdict will “demoraliz[e] and deplet[e] the ranks of nurses already stretched thin by the pandemic.” Oregon nurse practitioner Emma Moore reportedly felt “overwhelmed and undertrained” coping with a flood of Covid patients at her community health clinic. She quit days after the Vaught verdict, citing it as one reason. She had made medication errors, and she wondered if she could be next for prosecution, “set up to fail” in the Covid era. Florida nurse Ashley Bartholomew pointed to the “impossible situations” that understaffed nurses face, and argued that nurses’ response to the Vaught verdict was “because all of us are acutely aware of how bad the pandemic has exacerbated the existing problems.” The piece said more than 8,000 people had joined a Facebook group planning to protest outside the courthouse during Vaught’s sentencing.
The report also briefly highlighted the reaction of nursing organizations and scholars. In a telling detail, it said that the American Nurses Association and the American Association of Critical-Care Nurses had each termed the conviction a “dangerous precedent.” The piece also quoted the prominent University of Pennsylvania nursing scholar Linda Aiken:
One thing that everybody agrees on is it’s going to have a dampening effect on the reporting of errors or near misses, which then has a detrimental effect on safety. The only way you can really learn about errors in these complicated systems is to have people say, “Oh, I almost gave the wrong drug because …” Well, nobody is going to say that now.
The piece included significant comment from those who support the conviction. Scott Shelp, a “California nurse with a small YouTube channel,” argued in a video that Vaught deserves to go to prison because no “competent nurse” would have made that error. His reaction to concerns about suppressing reporting of errors was that “dishonest” nurses should be “weeded out,” and he also appeared to claim that any act that causes harm is worthy of prison, regardless of intent, a belief that would greatly expand criminal law. The piece also gave ample space to the comments of the prosecutors, who issued a statement that the verdict was “not an indictment against the nursing profession or the medical community,” but about one person “who made 17 egregious actions, and inactions, that killed an elderly woman.”
This article included a good deal of helpful context about how nurses view the verdict, as well as its effects on them and public health, including the expert commentary from Aiken. The comments from the prosecutors and nurse Shelp were also helpful to provide balance – and a sense of the apparent vindictiveness and lack of understanding that led to the verdict. As with the prior piece, though, this one could have included more detail about how the error came about, Vanderbilt’s responsibility, how much the state may have been scapegoating Vaught to protect the powerful university, the extent to which other hospitals place nurses in similar situations, and the efforts of public health professionals to reduce such errors through systemic change.
5/12/22 — We have closed our letter-writing campaign and sent the roughly 50 letters we received to RaDonda’s attorney awaiting the outcome of the sentencing 5/13/22. Thank you to everyone who wrote in support of RaDonda Vaught.
5/13/22 — Judge Jennifer Smith has made her ruling. RaDonda Vaught has received 3 years probation (no jail time), probably the best possible sentence given how far the case was allowed to proceed without being dismissed for its baselessness. There was no intent to harm here. We note the ridiculous attempts by prosecutors to lump RaDonda’s actions in with sexual predators and others who intend to do harm. There is more information about the ruling on NPR’s site here. Thank you to everyone who supported her.