Recent Court Decision Results in Chilling Effect on Reporting of Medical Mistakes

  • -

By Vanessa Orr

When a mistake is made in a healthcare setting, doctors and nurses are encouraged to report it immediately as a way to mitigate the problem and to ensure that it doesn’t happen again. Unfortunately, a recent court case is showing that sharing this information might not always be in healthcare providers’ best interests.

In 2017, Vanderbilt University Medical Center nurse RaDonda Vaught mistakenly injected patient Charlene Murphey with the wrong drug. Murphey went into a coma and later died, and Vaught was charged with criminally negligent homicide.

“Vaught was using Vanderbilt’s drug dispensing system to get Versed for the patient, a sedative that is used when patients get an MRI,” said Tom Murphy, producer, National Health Care Practice Danna-Gracey, a Division of Risk Strategies. “When the dispensing system didn’t work, she overrode it and instead received Vercuronium, a paralytic that caused Ms. Murphey to stop breathing.  “These systems often don’t work and they are overridden all the time,” he added. “But after review, prosecutors decided to charge her because she was grossly negligent, saying that she missed a number of red flags that she should have caught prior to injecting the patient.”

Vaught was convicted in 2022, which sent a chilling effect through the healthcare community.

“This conviction brought a huge outcry from the American Nursing Association (ANA) and nurses around the country and the world,” said Murphy. “Mistakes are made in healthcare all the time, and in this case the mistake wasn’t caught and the patient died. The ANA believes this sets a dangerous precedent, as honest reporting of mistakes can now get criminalized.

“Medical providers believe that this verdict could create a negative impact that could last for years,” he added. “If providers can be criminalized for reporting mistakes, the less likely it is that they will report them.”

In this particular case, the district attorney says that the charges were brought against Vaught because she missed a number of opportunities to catch her mistake. “He argued that it’s a case about patient safety—specific to this one nurse’s actions—and she should not be practicing medicine because she allowed this to happen,” said Murphy.

Part of the outcry in this case is that Vanderbilt University Medical System was not brought up on criminal charges, despite the fact that its dispensing system was malfunctioning. Vanderbilt settled with the family early in the process, yet took no responsibility to defend Vaught from her charges.

“This is why we tell our clients to check their malpractice insurance to make sure that they have enough insurance and that it is with a good company,” said Murphy. “We all know how expensive a legal defense can be, especially in a criminal case.”

While most policies exclude coverage for intentional criminal acts, professional liability policies will provide a defense for policyholders charged with malpractice or criminal malpractice as long as the act was not intentional.

“While her insurance company should defend her through that trial and pay legal fees, Vanderbilt is not commenting on anything; they basically  threw her under the bus,” said Murphy, noting that Vaught has been raising funds via a GoFundMe page. “This is why we advise healthcare professionals, including doctors, nurses, PAs, and nurse practitioners, to have their own insurance instead of being covered by a hospital.

“The shareholders or C-suite of the hospital is going to do what is in the best interests of the hospital and not the provider,” he added. “In this case, they settled with the family right away, when the right thing to do was to defend Vaught throughout the trial.”

He added that no matter how much time Vaught, who will be sentenced in May, receives, the case will have a chilling effect on healthcare professionals for years to come.

“The bottom line is that we’re already experiencing staffing shortages, which the pandemic hasn’t helped, and now this is telling nurses working long hours saving lives that they could be criminally charged for making a mistake,” he said. “It’s a real issue.”

For more information, contact Tom Murphy  at 800-966-2120.