Look at the RaDonda Vaught case or the Michelle Heughins case; terrifying to be looking at jail time for a med error.
Many nurses are watching these cases more closely and deciding that since staffing isn't getting any better and they won't be protected, it's not worth the risk.
She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects. Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation. This went beyond a mistake to negligence.
“In response to a story like this one, there are two kinds of nurses,” Garner said. “You have the nurses who assume they would never make a mistake like that, and usually it’s because they don’t realize they could. And the second kind are the ones who know this could happen, any day, no matter how careful they are. This could be me. I could be RaDonda.”
https://khn.org/news/article/radonda-vaught-nurse-error-medi...
HN readers can look at this case filing:
https://www.documentcloud.org/documents/6785652-RaDonda-Vaug...
> Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation.
The linked PDF includes images of medicine in question. There's a single warning on top that reads "WARNING: PARALYZING AGENT" and a red cap. I don't see any warnings on the side. The vial appears to be tiny, smaller than my thumb.
But yes, she made a series of mistakes, listed on the last two pages of the PDF.
I am not a nurse, but I can easily imagine how someone could make the errors she did in an overworked and high-stress environment. It's a cascading series of errors that starts with overriding the medicine cabinet when she can't find the medicine she's looking for. But according to her defense, overriding the cabinet had become almost standard operating procedure at Vanderbilt at that timeframe. Once she starts down this path, she's operating on automatic and almost blind to what she's doing.
I agree she was negligent. I don't think she should go to prison for it. In the bigger picture, this is causing more nurses to quit, likely leading to more medical errors and deaths, not fewer.
There are so, so many differences between the two meds, I don't see how confusing them would be possible short of gross negligence (for context, I am a paramedic, and often administer medications (including both of the meds involved here) in a high stress environment).
Vecuronium (the paralyzing drug) is a powder in the vial and you need to first inject saline it into the vial, shake it up, and then draw out the "reconstituted" med. This is very unusual (there are only a handful of medications in common use that require this, and Midazolam, the intended med, is _definitely_ not one of them). The reconstitution process means she would have had to look at the top of the vial several times, and warning on the tops of vials are, again, very uncommon. Also uncommon is the red cap on the vial.
I have made errors before while caring for patients, and I will likely make them again. I am very aware of the fact that we all can make mistakes, but the number of mistakes that needed to be made here far exceeds the standard of what is reasonable, and is well into the territory of "gross negligence", in my opinion.
but we literally have a law for "negligent homicide"?
edit: minor grammar fix
The hospital has far too many incentives to play fast and loose and then leave the nurses in the lurch with a system stacked against them. The hospital has far too many incentives to skimp on training and safety. etc.
Should this nurse also have her license looked into? Yeah, it looks like it. And is it up to the hospital to fire her or not? Yes.
However, barring actual proof of premeditation, all charges and fines should land on the hospital--not the nurse.
With staff shortages nurses dont have the time for that.
Hire 2x more nurses - so there is 2x more time for each patient.
No, very different from every other med in the drawer. The red cap on the vial is very unusual (reserved for very dangerous meds like this), and the bold printed warning on the top (that you have to look at at least twice while while preparing to administer this medication) is also something used very rarely.
Edit: I should say that doesn’t mean I think it makes any sense the hospital isn’t liable and jail time for the nurse seems odd
Welcome to being an engineer, if that's what you want to call yourself. The engineer who approves a bridge design can be held liable if it collapses due to a design fault.
Another aspect is that certain HIPAA allowances for data usage require a lawyer's expertise, not an engineer's. For example, can a health insurer use patient data to train a model w/o first obtaining patient consent? If the model will be used for "healthcare operations" (i.e., adjudicating claims), you might argue that the answer is yes. If the same model will be used for suggesting treatment options to doctors, you might argue that the answer is no. If you answer wrongly, you are hit with a statutory fine.
It's like having a fine for painting the bridge the wrong color because there is a law that bridges must be green, but you used lime. Not because you're worried about the bridge collapsing, but because the law says so.
Generally, civil engineers don't need to worry about fines or jail as long as things stay up.
Basically, contracts can control the liability in most cases, but HIPPA prevents that by explicitly defining liability under the statute.
Here's some info on the engineer portion.
https://www.nspe.org/resources/professional-liability/liabil...
*HIPAA
* Vaught stated her department was not understaffed, nor was she tired. The incident also occurred in 2017, so pre-pandemic
* Vaught went to dispense Versed (generic name midazolam) by the brand name, instead of the generic name as they're trained to do. This led to her selecting vercuronium bromide instead
* Vaught stated she had dispensed midazolam several times before, which would have had to have been by the generic name
* Vaught ignored several warnings from the dispensing machine stating the patient was not prescribed vercuronium bromide
* Vaught ignored the red cap on the vial dispensed that stated it was a paralytic agent
* Vaught ignored that vercuronium bromide needed to be reconstituted with sterile water (unlike midazolam, which comes as a liquid). She stated she thought it was odd that she didn't have to reconstitute it before when dispensing the correct medicine
* Vaught did not scan in the medication before or after giving it to the patient, which would have likely prompted another warning about it not being prescribed
* Vaught could not recall exactly how much she gave to the patient
* Vaught immediately left the room after injection, and did not wait to observe the patient for any side-effects
All of this information is available in the DA discovery documents (https://www.documentcloud.org/documents/6785652-RaDonda-Vaug...) and the CMS report (https://www.documentcloud.org/documents/5346023-CMS-Report.h...).
The opinions on the case I've observed have been nurses who aren't aware of this and saying she should not have been convicted, and the nurses who are aware who think the conviction is fair ...ish. The latter is at least unanimous she should have her license revoked.
Most agree that Vanderbilt should be held responsible for negligence as well. My wife's hospital for instance does not stock _any_ paralytics within machines, to prevent it being accidentally dispensed without involving the pharmacy. There's also evidence that Vanderbilt tried to cover the incident up.
I've made a point of stressing to any RN I've talked about it with the importance of having a lawyer with you when talking with investigators. Vaught straight up incriminated herself multiple times during her initial interview.
