The RaDonda Vaught Case: Implications for Healthcare Providers

The healthcare world was shaken in March 2022 when nurse RaDonda Vaught was found guilty of manslaughter due to a medication error. The case garnered national attention for medical professionals across the country and caused many to rethink their decision to be a medical practitioner. A brief discussion of the case and its implications is below.

Background

RaDonda Vaught, a Tennessee nurse working at a prominent Nashville-based hospital, was criminally indicted on abuse and homicide charges after she gave a patient the wrong medication, which led to the patient’s death. The case centered around a 2017 medication error involving an elderly patient, 75 years old, whose condition was improving. The patient was to be given a sedative, Versed, for a final scan before discharge. Instead of Versed, the patient was given vecuronium, a paralytic medication. The medication left the patient brain-dead. The hospital did not report the medication error to state or federal officials or to the Joint Commission, a hospital accrediting agency that recommends but does not require reporting. (The facts surrounding the incident are largely unknown by anyone outside of those involved, but the Tennessean newspaper in 2020 published a detailed timeline of the events surrounding the incident, investigation, and trial.)

A few months after the incident, in early 2018, the hospital fired Vaught and settled the case with the family. Several months later, in October 2018, an anonymous tip to state and federal health officials regarding the unreported medication error triggered a surprise inspection at the hospital by the Centers for Medicare and Medicaid Services (CMS). CMS released its findings in late November 2018, and the hospital responded with a plan of correction.

Three months later, on February 4, 2019, Vaught was arrested on a criminal indictment for reckless homicide and impaired adult abuse as a result of the incident. The district attorney in Nashville did not indict the hospital despite the ability to bring criminal charges against a corporate entity.

Throughout the course of the investigation and trial, it became apparent that Vaught overrode a medication cabinet’s safeguards. The investigation also revealed that cabinet overrides were a part of the everyday practice for the hospital’s nursing staff because of a problem with the hospital’s communication among the electronic health record, the medication cabinets, and the hospital pharmacy, which caused delays in accessing medications. The hospital’s short-term work-around was to override the safeguard. According to Vaught, a simple bag of fluid could not be obtained without using the override function.

Vaught admitted her error to investigators and to the Tennessee licensing board, which reopened its investigation of the medication incident after initially deciding not to pursue disciplinary action against Vaught. Vaught always maintained responsibility for the medication error.

On March 25, 2022, the jury found Vaught guilty of criminally negligent homicide and abuse of an impaired adult, and she faced up to eight years in prison. She was sentenced on May 13, 2022, to three years of supervised probation. During the sentencing, the judge noted that the case had shifted from the victim to Vaught and expressed sympathy for the patient’s family’s loss. She also noted that Vaught did not intend to break the law and that the mistake could never be repeated again as Vaught would never work in nursing again.

Implications for the Healthcare Profession

The Vaught case brought out national support for nursing and healthcare professionals but most importantly brought concern about the impact of honest reporting of mistakes on the future of healthcare litigation (both civil and criminal). Multiple national nursing organizations, including the American Nurses Association, the Academy of Medical-Surgical Nurses, and the Tennessee Nurses Association, made statements regarding the distressing potential to create a trend of the criminalization of human error in health care and the possibility of creating a practice of covering up medical errors for fear of criminal prosecution.

The potential for charges like these to turn providers against hospital employers and vice versa—which can do nothing but harm medical care—is troubling. One of Vaught’s main defenses was the hospital’s creation of an environment requiring constant overrides of medication cabinet warnings, resulting in a lax response when presented with a warning that should have been heeded. Furthermore, in light of the hospital’s actions, critics questioned why the prosecution did not bring charges against the hospital if its goal truly was to stop similar behavior. Clearly, fear of future criminal prosecution can only breed a culture of animosity between hospitals and their healthcare employees.

Most importantly, this case shows the potential dangers and pitfalls in advising clients regarding similar errors and the possibility of a slippery slope for the criminalization of all medical malpractice resulting in the death of a patient. Some of the many questions that arise for medical malpractice litigators are as follows:

1. Will a civil settlement by a provider for a malpractice claim be used against that provider in a criminal proceeding?
2. Will all malpractice claims resulting in a death result in automatic referral for criminal charges in some jurisdictions?
3. Will healthcare providers start looking at a state’s or city’s laws regarding criminal prosecution of malpractice before determining where to practice, and will that create a shortage of providers in certain areas?

While we do not have immediate answers to these questions, they are surely on the minds of many healthcare providers across the country and surely will impact future health care—unless healthcare providers and litigators can begin to work with each other and their city and state officials to address what can be done to foster an environment of honesty without fear of criminal prosecution.