36 ms·

Agree with all of this, and just to add one thing: liability. Look at the RaDonda Vaught case or the Michelle Heughins case; terrifying to be looking at jail t

Agree with all of this, and just to add one thing: liability. 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.

giantg2 4y ago
I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system. That seems a bit scary. I agree that regulation persuades people not to do things out of fear of breaking the law. We see this in it's intentional form with regulation of other things such as abortion, guns, etc. Put so many laws in place that risk of accidentally breaking one and receiving an extensive punishment isn't worth it.
- throwawayboise 4y ago
  > I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system. 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.
  - initplus 4y ago
    Lot's of better paid gigs with better working conditions where you aren't personally legally liable if you write a bug. I don't especially care about what job title some board thinks I'm allowed to use.
    - giantg2 4y ago
      Yep. I believe that's really the core of the article - overhead like regulation and liability on top of working conditions have people looking to other professions.
  - giantg2 4y ago
    Generally the firm's insurance will cover an engineer since they are a "professional". Software "engineers" generally have not been individually liable for bugs. Usually the software user agreements don't allow for this sort of thing. 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/liability-employed-engineers https://www.nspe.org/resources/professional-liability/liabil...
  - labcomputer 4y ago
    One difference is that HIPAA has a bunch of statutory penalties for "technical violations" that might or might not harm anyone. For example, if a call center staff discloses patient information to, say, the child or parent of a patient, that comes with an automatic fine and (potentially) jail time. 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.
- Sohcahtoa82 4y ago
  > HIPPA *HIPAA
Shuang1 4y ago
That case goes far beyond med error and I don't understand why people keep bringing it up as an example. 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.
- cyberlurker 4y ago
  Right, when I first read the summary it didn’t adequately cover how careless the nurse was. It wasn’t just a small mistake. 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
- sithlord 4y ago
  Literally every medication has warnings slapped all over it. My partner worked at Vanderbilt (on a different floor) around this time, and one constant complaint I heard (prior to the incident) was how there was hardly any controls around anything there.
  - ikiris 4y ago
    Yeah, there's no doubt that this is a shitshow from how Vandy is described (and nursing in general especially with these automated pharm boxes), but that should be additional consequences, not this nurse avoiding hers.
  - JshWright 4y ago
    Every medication does not have a bright red cap with a bold warning printed on the top (that you have to look at at least twice while reconstituting and then drawing up the med). The warnings on a vial of Vecuronium go well beyond the typical "This medication may case XYZ side effect", and for very good reason.
- rvba 4y ago
  > She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects With staff shortages nurses dont have the time for that. Hire 2x more nurses - so there is 2x more time for each patient.
sfteus 4y ago
Married to an RN and absolutely sympathetic to the staffing/pay plight they're currently facing. I'm unfortunately not very familiar with the case of Michelle Heughins, but I've heard a lot of the RaDonda Vaught case. The high points of the case as I understand them: * 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-Vaught-DA-Discovery https://www.documentcloud.org/documents/6785652-RaDonda-Vaug...) and the CMS report (https://www.documentcloud.org/documents/5346023-CMS-Report.html#document/p6 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.
- michael1999 4y ago

giantg2 4y ago

I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system. That seems a bit scary. I agree that regulation persuades people not to do things out of fear of breaking the law. We see this in it's intentional form with regulation of other things such as abortion, guns, etc. Put so many laws in place that risk of accidentally breaking one and receiving an extensive punishment isn't worth it.

throwawayboise 4y ago
> I believe you can even be personally liable for HIPPA security violations as a user or dev of a healthcare system. 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.
- initplus 4y ago
  Lot's of better paid gigs with better working conditions where you aren't personally legally liable if you write a bug. I don't especially care about what job title some board thinks I'm allowed to use.
  - giantg2 4y ago
    Yep. I believe that's really the core of the article - overhead like regulation and liability on top of working conditions have people looking to other professions.
- giantg2 4y ago
  Generally the firm's insurance will cover an engineer since they are a "professional". Software "engineers" generally have not been individually liable for bugs. Usually the software user agreements don't allow for this sort of thing. 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/liability-employed-engineers https://www.nspe.org/resources/professional-liability/liabil...
- labcomputer 4y ago
  One difference is that HIPAA has a bunch of statutory penalties for "technical violations" that might or might not harm anyone. For example, if a call center staff discloses patient information to, say, the child or parent of a patient, that comes with an automatic fine and (potentially) jail time. 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.
Sohcahtoa82 4y ago
> HIPPA *HIPAA

Shuang1 4y ago

That case goes far beyond med error and I don't understand why people keep bringing it up as an example. 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.

cyberlurker 4y ago
Right, when I first read the summary it didn’t adequately cover how careless the nurse was. It wasn’t just a small mistake. 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
sithlord 4y ago
Literally every medication has warnings slapped all over it. My partner worked at Vanderbilt (on a different floor) around this time, and one constant complaint I heard (prior to the incident) was how there was hardly any controls around anything there.
- ikiris 4y ago
  Yeah, there's no doubt that this is a shitshow from how Vandy is described (and nursing in general especially with these automated pharm boxes), but that should be additional consequences, not this nurse avoiding hers.
- JshWright 4y ago
  Every medication does not have a bright red cap with a bold warning printed on the top (that you have to look at at least twice while reconstituting and then drawing up the med). The warnings on a vial of Vecuronium go well beyond the typical "This medication may case XYZ side effect", and for very good reason.
rvba 4y ago
> She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects With staff shortages nurses dont have the time for that. Hire 2x more nurses - so there is 2x more time for each patient.

sfteus 4y ago

Married to an RN and absolutely sympathetic to the staffing/pay plight they're currently facing. I'm unfortunately not very familiar with the case of Michelle Heughins, but I've heard a lot of the RaDonda Vaught case. The high points of the case as I understand them: * 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-Vaught-DA-Discovery https://www.documentcloud.org/documents/6785652-RaDonda-Vaug...) and the CMS report (https://www.documentcloud.org/documents/5346023-CMS-Report.html#document/p6 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.

michael1999 4y ago