Radonda Vaught: exploring the implications of healthcare practice under criminal accountability

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Radonda Vaught’s conviction can entail a major shift in the nature of current healthcare protocols followed today.

Jasmin Parrado, Staff Writer

When reviewing the official criminal conviction of 38-year-old ex-Vanderbilt nurse Radonda Vaught for a medical error that resulted in the death of a patient, I sat back in my chair, and the first thing I thought was: how did it get this far?

How did the consequences of a reported medical error extend to those paralleling the severity of assault, robbery, and murder? Healthcare workers across the country are enraged. Worried. Disturbed.

March 25th, 2022 marked a day that would spark fear in the hearts of all nurses. Vaught was found guilty of negligent homicide and gross negligence in wake of accidentally administering a paralyzing agent to Charlene Murphey instead of a sedative prior to a scan in 2017.

While her attorney defended the absence of criminal intent in the act, prosecutors argued that Vaught did not take proper measures that could have potentially prevented the outcome of her medical error, such as surveying her patient’s status or more closely inspecting the labels on the administered medication entailing possible symptoms, instructions, and dosage amounts.

The obvious admission to this failure in procedure is undeniable; but the factor of legalities surrounding Vaught’s error is an alarming issue to date. When this case became a matter of criminal indictment, the severity of Vaught’s problem worsened tenfold.

In healthcare, it is, by a majority of hospital and workplace requirements, suggested practice for nurses to self-report medical errors they have enacted throughout their shift; this alleviates potential questions of active disengagement from the priority of patient safety and nursing integrity, which would further indicate wrongful intent of the nurse if it were to be suspected. Vaught had reported her medical error to Vanderbilt University Medical Center within hours of the realization that she had made it; though, all to a tragic end, as 75-year-old Murphey had passed away by then.

But, of course, the legal discourse over the nature of Vaught’s mistake just scratches the surface of something much deeper for medical workers. Vaught was not just held to the board of nursing; she was held at the mercy of criminal court—and that means a lot on its own terms.

Upon discussing the matter with medical workers and gaining insight on how Vaught’s case intervenes with usual nursing and healthcare protocol, I realized that there is major importance in definition. What makes a wrongful act an error? What makes it criminal? Malpractice versus malice? Negligence?

Such terms are not interchangeable and must be interpreted correctly in order for Vaught’s case to be met with a more credible outlook. To further understand the frustration behind the issue, let us first establish what differentiates certain terms of error or failure in definitive nursing practice:

Malpractice: Refers to medical errors or failures performed despite a healthcare professional’s supposed proficiency in special medical knowledge that should have been applied in such circumstances surrounding the error.

Negligence: The failure to apply proper foresight or anticipation according to the potential risks and consequences of a circumstance or action.

Notice that in both definitions, the factor of active application of harmful practices or intentions is not existent within the realm of wrongdoing by way of medical error. Let us now review what defines, by a legal basis, a case of gross negligence:

Gross Negligence: Intentional misconduct which entails consciously disregarding extremely harmful or lethal consequences that can result from committing it.

Gross negligence is often considered as misconduct of criminal intent, as such a level of recklessness and disregard for those impacted by the crime must require some active dismissal of those concerns.

Criminal intent is a heavy label; deliberate wrongdoing shifts the entire perspective of what a human being has done. Consider Harold Shipman, the doctor that serially murdered his patients by administering fatal doses of medications; he went so far as to demand the signing of numerous cremation forms for his victims to hide the evidence. His actions were willful and premeditated; his wrongdoings were wanton, so his intentions were criminal. This is where the case of a professional’s involvement in the outcome of wrongdoings or failures surpasses the judgement of their board and extends to matters of legal integrity within society. The suspect in question has not only proven that their work is not safe or substantial for optimal occupational practice, but furthermore, that by way of their applied judgment and active choices, they are a danger to the society they live in.

Now apply these definitions to Vaught’s case. Recall that she was found guilty of negligent homicide and gross negligence.

Vaught had, in realization of her mistake, immediately taken steps to report her error to Vanderbilt University Medical Center; she did not seek to deny any prospective consequence or punishment by the Board of Nursing, and no evidence of deliberate concealment of this mistake was tied to her. It is logically evident, as concluded by general public and healthcare solidarity, that Vaught’s error, though certainly entailing malpractice, did not originate from criminal intent. She did not actively choose to give Murphey Vecuronium instead of Versed.

What had truly transpired to such extremities for this case to be considered on the legal level is unfathomable, but a major contributor to the escalation of this issue came undeniably from a factor of failure within the hospital to provide the same integrity as the nurse in question regarding the nature of the patient’s death. Peter Strianse, the attorney for Vaught, pointed out how the hospital’s medication cabinet system had experienced technical malfunctions preceding Vaught’s mistake. However, Vanderbilt University Medical Center argued against Strianse’s suggestion of its partial accountability for the severity of Vaught’s error, claiming that such technical malfunctions had been resolved before then. On this note, many believe that the hospital, by directing all responsibility towards Vaught, essentially scapegoated her.

When matters of legal consequences came into mind, Vanderbilt backed out to avoid the same outcome. This brings us to a problem of something vital to this discussion: self-preservation.

Moral and Ethical Concerns

To some extent of professional procedures and teachings of right against wrong, we face a substantial dilemma that will now come to arise as a daily internal conflict for the majority of healthcare professionals. This is due to the sole yet powerful fact that, in reality, medical errors are made on a day-to-day basis within the workplace. In an article published in 2017 by James G. Anderson and Kathleen Abrahamson, a comprehensive data report estimated that the annual collective amount of medical errors reported by 25 participating hospitals in Pennsylvania was 17,000; and that goes to exclude potentially unreported errors and uncollected data from the remainder of the hospital system. Furthermore, error rates are reportedly much higher in the United States than other countries of technologically and medically innovative caliber, such as Canada, Germany, New Zealand, Australia, and the United Kingdom.

It is safe to suggest that, in the scope of healthcare practice, medical errors are not alien to the profession. Though errors are usually heavily punished and taught against, there is a developed due process that has been established over years of medical institutions to alleviate and possibly prevent repetition of those same errors. The system makes it so that, by self-reporting, medical workers can allow for higher management to take notice of potential issues within their hospital system. In addition, regulatory bodies, such as the board of nursing or board of medicine, are comprised of highly knowledgeable individuals in the specified medical profession that will be able to more properly evaluate the circumstances surrounding severe errors, since they understand the practices and tendencies that the job in question entails.

Now, imagine that a case designed to be judged by its assigned board is suddenly directed to the judgment of a regulatory body dealing with social misconduct and error; the pure misalignment of the case and appointed jurisdiction results in a higher probability of misrepresentation for the case, since the jurisdiction may only understand specifics of sociolegal aspects as opposed to those related to healthcare procedures and legalities. Is it right for an authority (presumably encompassing less proficiency in healthcare) to pursue a case they may not be able to interpret on equal parts? The imbalance of knowledge against authority lands healthcare professionals in a predicament of their rights as a civilian being held at the mercy of a legal body that does not possess the same mastery; the implications are intense, as the environment a defendant is thrown into can present incredibly unfair conditions for them.

Revisiting the aforementioned commonality of medical errors, it is clear to see why they are so often a matter of resolution in reference to healthcare instead; reporting them, though still to a detriment, aids hospital systems across the country in improving the quality of healthcare. Why accompany this traditional process with an inherent requirement to receive the verdict of someone whose expertise potentially expands only to legal issues in civilian context?

For this reason, there is fear for regression of healthcare practice into a much vaguer and more dangerous field under which to be accommodated. An unspoken question of who to prioritize, due to the consequences, dismisses the implementation of professional thought development and true critical thinking, as well as patient advocacy. What would you do as a healthcare professional if you were faced with the chance of going to prison with every error you report?

It might be easy, as someone who doesn’t work in healthcare, to blindly assume that a healthcare worker would always rightfully choose their patient’s safety or professional integrity over themselves. But this case cannot resolve on the superficiality of what people believe they deserve as patients. Healthcare workers are people too; they too are members of a society, with laws, principles, and conflicts from which they are not exempt. It is always easy to say that you would do what is “right,” but words and concepts are merely matters of our own mental retreat; an internal projection of our ideal selves, in an ideal circumstance, in an ideal society.

What if you had a child? A family to come home to, to provide for? How would you weigh between reporting an error you’ve made on your patient, lethal or nonlethal, for the good of the order, and choosing not to report in order to preserve the life you currently lead? Radonda Vaught’s case forces healthcare workers to look within themselves; an intense moral feat that must be met within a matter of minutes; seconds, truly. But the undeniable force of human nature exists within us all, extending to the most complex ethical dilemmas that bring about this moral feat.

However often one engrains the aspect of selflessness into an individual, that individual will still opt to do what is best for their livelihood, whether that be their family or the rest of their life’s worth. Now that such security of maintaining this livelihood is threatened, an obvious backfiring result will arise from the matter. It is not like the threat of prison will stop medical mistakes from ever happening again; we are all human and subject to errors of mass proportions. However, the one constant factor to our nature happens to be our understandable tendency for self-preservation. Now that healthcare workers know of this threat, it is likely that self-preservation will prevail above all, and patient safety is likely to be at higher risk more often. If we are referring to medical society’s contribution to progress, innovative approaches to healthcare will stall at the disjunction between sufficient reporting of errors and systemic improvements in response to those errors, since there will be very little to properly evaluate and resolve.

This is a likely aspect, especially within the nursing profession, as a majority of nursing occupations are held by individuals whose life circumstances propose a need for preservation of some component; a stellar example comes in a 2018 report in which the U.S. Census Bureau identified 1.1 million working mothers as registered nurses. The assumed priority of a mother’s secrecy against the procedures of their work would, in this example, exist for the sake of their ability to care for their child.

At the end of the day, Vaught’s subjection to the justice system spurs questions of what will happen to the world of medical practice. Many often wonder: what transformations will arise from this precedent? How much worse will the nursing shortage be? How will this affect statistics outlining patient safety, as well as nurse-to-patient ratios? What is the true authority or validity of a professional board when an error will be evaluated on the legal level anyway?

I, upon the many conversations I’ve had with medical professionals, now find that it goes even deeper: what does Vaught’s case most emphasize about human nature? Will we, as patients, really be able to establish the same virtue of trust within our healthcare system? Was that ever really a security we should have adopted to begin with, since human nature has always prevailed above all, and really has only been dormant in the presence of an efficient professional system that doesn’t urge it so? Is it right for laws of government to attempt even nearly to encompass the ever-changing realm of medical practice, and furthermore, science?

Radonda Vaught is an unfortunate victim to a confrontation between two different worlds; but as we move forward in the tension and inauspicious prospects of this disturbing precedent, it seems that an efficient approach we can utilize to reverse it in time happens to parallel to a process that has now been at stake: we must gather and learn, and we should seek to prevent by way of expanding our education and resources. Such is the inevitable way of the world, and though the room for error without consequences narrows largely, there is bound to be a sort of compensation or development that will aid healthcare practice in progressing to its previous efficiency.

How will it be done? I do not know. But at the end of the day, despite all punishments, laws, and warring principles, I do know and reaffirm this: our shortcomings, our errors—our mistakes, more than anything else, happen to bear the sweetest fruits of progress.

 

 

I extend my thanks to medical professionals Balbina Nasiff and Ysulin Parrado for wonderfully contributing to my analysis of this case.