RaDonda Vaught’s verdict raises alarm in the medical community

Fear of imprisonment may be the last thing that makes medical professionals wonder if they might not be better off in a different field.

Former Vanderbilt University Medical Center nurse Radonda Vaught was sentenced to three years in prison but received probation on Friday for a miscarriage that resulted in the death of a patient. In March, a jury found Vought guilty of negligent homicide and abuse of a disabled person when she accidentally injected the wrong drug to 75-year-old Charlene Murphy in 2017. On Friday, a judge in Nashville, Tennessee, handed down a verdict for these heinous crimes. .

Legal experts don’t expect Vought’s case to spark new prosecutions for erroneous medical professionals, but a colleague’s nearly sent to jail shocked workers, including those who gathered outside a Nashville courthouse to protest .

“Nurses should not be in jail for doing their jobs. Two years ago we were heroes, and now we are facing jail,” Bobbi Martin, nurse and president of the Global Nurses Network, said at the rally. . “We need support from the public to make sure they know that what we do is dangerous every day and that the hospitals we work in put us in that situation.”

The criminal convictions of nurses like Voth mark a departure from the typical disciplinary path through state licensing boards.

“This is placing an additional burden on our already depleted clinical team,” said Janet Tomcavage, executive vice president and chief nurse at Geisinger.

While the case will encourage communication that will hopefully improve patient safety, punishing employees will not solve systemic problems, industry leaders and workers have said. Health care workers, already suffering from a stressful work environment and staffing shortages exacerbated by the COVID-19 pandemic, say they are afraid to do their jobs.

“This will scare the nurses even more,” said Tanya Leshko, an attorney for Buchanan Ingersoll & Rooney. “The way to make patients safer is to improve systems. What they did here, for whatever reason, is a very punitive approach to a single incident.”

Nurses need to do more with less and not feel supported by their employers, says Maria Nunez, an intensive care nurse at St. Francis Medical Center in Lynnwood, Calif., and a member of the California Amalgamated Nursing Association/Union of Medical Professionals. Medical workers.

“They only care about productivity, patient movement, and what is most cost-effective for them,” Nunes said. “Things just got worse.”

According to Nunes, many of her peers have given up nursing due to burnout or fear of making a mistake. According to her, she decided to take a vacation to rethink her career after 20 years in this field.

Troubleshooting the root of the problem
The healthcare industry has historically struggled to create transparent and open jobs. The pandemic is exacerbating these long-standing problems as caregivers work longer hours in harsh working conditions.

Vought’s felonious indictment does nothing to solve systemic problems, said Dr. Markus Schabacker, president and CEO of ECRI, a patient safety organization.

“We do not believe that public punishment of a person will help one patient. I think it will be just the opposite,” Shubaker said. “This will lead to people trying to hide their potential mistakes or close misses.”

According to Shubaker, the healthcare sector should follow the example of aviation and nuclear energy. These businesses have created layoff systems and cultures where employees feel empowered to speak up, he says. This includes using technology to guard against inevitable human error, and analyzing errors and possible misses for improvement, he says.

Staffing levels and worker mental health top ECRI’s list of the top 10 patient safety issues this year. “When you don’t have enough staff, you will be multitasking, you will be working with a higher risk profile,” Schubaker said.

The Geisinger Company of Danville, Pennsylvania, after Vought’s conviction, convened a panel to answer nurses’ questions. According to Tomcavage, many have asked if Geisinger will support their backs in situations like this.

The staff met with leaders from Geisinger’s department: a nurse, a doctor, a medical practitioner, the legal department, the human resources department, and public relations specialists. They reviewed Vought’s case, described Geisinger’s handling of previous incidents, and explained the healthcare system’s protocols and communications strategy, Tomcavage said. The company also delivered memos on these matters, she said, managers discussed workers’ concerns during rounds, and her lawyers attended nurses’ meetings.

“We have fail-safe processes in place that prevent nurses from being placed in these locations,” Tomcavage said.

Geisinger uses artificial intelligence to process more EHR inputs and minimize manual errors. The health system has blocked medicine carts in the radiology department. Two people must sign when medications are used off-label.

To make it easier for nurses, Geisinger uses unlicensed logistics coordinators to deliver medicines, restock linens and equip patient rooms. Geisinger hopes that more of its senior employees will stay if they ask them to participate in virtual, team telehealth care models, Tomcavage said.

“The nurses told me, ‘As long as you continue to support staff when mistakes are made, and you have a thoughtful and careful approach to changing care processes to support the team, I think we will have the same level of accountability,'” Tomcavage. said.

New way forward

Denise Duncan, president of the California United Nurses Association/Healthcare Workers Union, said the union has received many calls and text messages from nurses concerned about Vought’s case. According to Duncan, a registered nurse, in recent years, more and more workers have been disciplined for medical errors.

“We are seeing more hostile attempts from different employers,” Duncan said. For years, workers have championed what is known as a fair culture, in which medical facilities and employees work together to identify systemic failures. The concept, although not a term, was popularized in the 1999 Institute of Medicine report “To Error is Human”, which identified system change as the key to improving patient safety.

Last year, the Health Workers Union Alliance struck a deal with Oakland, Calif.-based Kaiser Permanente to include Just Culture in their contracts, said Charmaine Morales, vice president of the California Amalgamated Nurses/Health Workers Union, which is one of 21 unions members of the alliance.

Union members and Kaiser Permanente managers have formed a national committee that will meet for the first time on May 18 to begin developing a vision for a fair culture that every business can use as a guide. Morales says the ultimate goal is for new Kaiser Permanente employees to learn about Just Culture on their first day on the job. The group plans to meet monthly and develop a strategy by the end of the year, she said.

Unique case

It’s unlikely that this case will trigger similar criminal charges every time someone makes a medical mistake, said Carol Michele, partner at Weinberg Wheeler Hudgins Gunn & Dial. But that doesn’t mean the guardians won’t think about it, she said.

“There is increased visibility and risk of medical error. Now you face criminal prosecution in addition to losing your license,” Michel said. “Add that to the hard work as a healthcare provider, especially now that we’re going through a pandemic and a shortage of nurses in the country.”

While copycat cases are unlikely, nursing groups could lobby state legislators to establish safeguards that protect healthcare workers from criminal charges, unless they acted maliciously, recklessly or negligently, Michel said.

State licensing boards usually stepped in and determined whether nurses should be punished. If the board punishes the guardians, they can appeal.

“The prosecutor says that the state hand did not respond properly, so we have plenty to choose from,” Leshko said. “They randomly picked the worst one in the toolbox.”

Vanderbilt University Medical Center has removed paralyzing agents from its first aid kits, including vecuronium, a drug Vought mistakenly administered to Murphy. The system required all managers, medical staff leaders, nurses, respiratory therapists, and paramedics to complete an education course on its drug policy in accordance with its remedial plan. The hospital declined to comment.

“If you can’t track down the root cause of mistakes and can’t fix the systems that allow you to make them, then people won’t be honest and open,” Leshko said. “In terms of fixing a system bug and building a better system, it doesn’t help much.”

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