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Janie Harvey Garner, a St. Louis registered nurse: “In response to a story like this one, there are two kinds of nurses,” Garner said. “You have the nurses who

by js2 5y ago

Janie Harvey Garner, a St. Louis registered nurse: “In response to a story like this one, there are two kinds of nurses,” Garner said. “You have the nurses who assume they would never make a mistake like that, and usually it’s because they don’t realize they could. And the second kind are the ones who know this could happen, any day, no matter how careful they are. This could be me. I could be RaDonda.” https://khn.org/news/article/radonda-vaught-nurse-error-medication-dispenser-homicide-trial-tennessee/ https://khn.org/news/article/radonda-vaught-nurse-error-medi... HN readers can look at this case filing: https://www.documentcloud.org/documents/6785652-RaDonda-Vaught-DA-Discovery https://www.documentcloud.org/documents/6785652-RaDonda-Vaug... > 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. The linked PDF includes images of medicine in question. There's a single warning on top that reads "WARNING: PARALYZING AGENT" and a red cap. I don't see any warnings on the side. The vial appears to be tiny, smaller than my thumb. But yes, she made a series of mistakes, listed on the last two pages of the PDF. I am not a nurse, but I can easily imagine how someone could make the errors she did in an overworked and high-stress environment. It's a cascading series of errors that starts with overriding the medicine cabinet when she can't find the medicine she's looking for. But according to her defense, overriding the cabinet had become almost standard operating procedure at Vanderbilt at that timeframe. Once she starts down this path, she's operating on automatic and almost blind to what she's doing. I agree she was negligent. I don't think she should go to prison for it. In the bigger picture, this is causing more nurses to quit, likely leading to more medical errors and deaths, not fewer.

ikiris 5y ago
If nurses quit over criminal liability for killing someone by being that careless, everyone is better off by them not being in the field. Pharmacy has had the same rules for over a hundred years. A great example is even in the movie a wonderful life. edit: minor grammar fix
gruez 5y ago
>I agree she was negligent. I don't think she should go to prison for it. but we literally have a law for "negligent homicide"?
- js2 5y ago
  Yes we do, but we also give DAs discretion over when to enforce it. Given the extenuating circumstances, I don’t think it should have been enforced here. Her employer, by not creating a culture of safety, set her up for failure. I just don't see how in the long term this prosecution reduces medical errors and generally disagree with criminalizing mistakes; even ones such as this.
  - ikiris 5y ago
    Enforcing criminal liability for homicidal negligence is how you force respect of even basic safety requirements that already existed. I'm not arguing that hospitals aren't currently a shitshow, I'm aware I've worked in them. That doesn't excuse this nurse's complete lack of respect for the risks she took.
    - Sakos 5y ago
      As I've said before, if aviation insisted on criminal punishment for pilots, we'd be far worse off. Many accidents are caused by fear of punishment. Culture of safety can only be implemented and enforced top-down. Why punish the nurses when they're not the ones responsible for what kind of culture exists at their institution?
      - krisoft 5y ago
        It is a bit more complicated. We do sometimes punish pilots criminaly. For example one easy way to go to prison is trying to fly a plane under the influence of alcohol. (Here is an example [1]) We do not punish criminaly pilots for other kind of mistakes. For example you are unlikely to go to prison if you miscalculate the required fuel for a flight. I don’t know the details about the nurse. Was it more like the first or more like the second? 1: https://www.bbc.co.uk/news/world-us-canada-39485928.amp https://www.bbc.co.uk/news/world-us-canada-39485928.amp
        Sakos 5y ago
kenjackson 5y ago
If you don't go to jail for this, do you do so for any sort of negligence? What about an Uber driver that runs a red light and kills a pedistrian walking? Or is drunk and kills someone? That worries me a lot more than this story.
- deleted 5y ago
  [deleted]
JshWright 5y ago
> I am not a nurse, but I can easily imagine how someone could make the errors she did in an overworked and high-stress environment. There are so, so many differences between the two meds, I don't see how confusing them would be possible short of gross negligence (for context, I am a paramedic, and often administer medications (including both of the meds involved here) in a high stress environment). Vecuronium (the paralyzing drug) is a powder in the vial and you need to first inject saline it into the vial, shake it up, and then draw out the "reconstituted" med. This is very unusual (there are only a handful of medications in common use that require this, and Midazolam, the intended med, is _definitely_ not one of them). The reconstitution process means she would have had to look at the top of the vial several times, and warning on the tops of vials are, again, very uncommon. Also uncommon is the red cap on the vial. I have made errors before while caring for patients, and I will likely make them again. I am very aware of the fact that we all can make mistakes, but the number of mistakes that needed to be made here far exceeds the standard of what is reasonable, and is well into the territory of "gross negligence", in my opinion.
- js2 5y ago
  I appreciate your perspective as a medic. The PDF I linked enumerates the mistakes she made and the differences between the two medicines, and I have read all that. From non-professional perspective, it seems like it was inattentional blindness. But let me allow for a second that this is a case of gross negligence, despite the fact that CMS investigated Vanderbilt and found many other issues in the workplace: https://www.documentcloud.org/documents/6535181-Vanderbilt-Corrective-Plan.html https://www.documentcloud.org/documents/6535181-Vanderbilt-C... It's not clear to me how criminalizing her mistake helps prevent future medical errors. Do you think criminally prosecuting her was the right decision?
  - JshWright 5y ago
    I am neutral on the idea of criminal prosecution here (for the individual, I absolutely thing there should be accountability for the organization). I am generally opposed to criminal prosecution for medical errors, but it's hard to overstate how outlier this series of mistakes was in terms of the severity of the outcome and the degree of negligence demonstrated. I think the question of "should we put this person in prison for these actions" is equivalent to any other criminal act (which isn't a clear cut answer either, in my opinion).

by js2 5y ago

ikiris 5y ago

If nurses quit over criminal liability for killing someone by being that careless, everyone is better off by them not being in the field. Pharmacy has had the same rules for over a hundred years. A great example is even in the movie a wonderful life. edit: minor grammar fix

gruez 5y ago

>I agree she was negligent. I don't think she should go to prison for it. but we literally have a law for "negligent homicide"?

js2 5y ago
Yes we do, but we also give DAs discretion over when to enforce it. Given the extenuating circumstances, I don’t think it should have been enforced here. Her employer, by not creating a culture of safety, set her up for failure. I just don't see how in the long term this prosecution reduces medical errors and generally disagree with criminalizing mistakes; even ones such as this.
- ikiris 5y ago
  Enforcing criminal liability for homicidal negligence is how you force respect of even basic safety requirements that already existed. I'm not arguing that hospitals aren't currently a shitshow, I'm aware I've worked in them. That doesn't excuse this nurse's complete lack of respect for the risks she took.
  - Sakos 5y ago
    As I've said before, if aviation insisted on criminal punishment for pilots, we'd be far worse off. Many accidents are caused by fear of punishment. Culture of safety can only be implemented and enforced top-down. Why punish the nurses when they're not the ones responsible for what kind of culture exists at their institution?
    - krisoft 5y ago
      It is a bit more complicated. We do sometimes punish pilots criminaly. For example one easy way to go to prison is trying to fly a plane under the influence of alcohol. (Here is an example [1]) We do not punish criminaly pilots for other kind of mistakes. For example you are unlikely to go to prison if you miscalculate the required fuel for a flight. I don’t know the details about the nurse. Was it more like the first or more like the second? 1: https://www.bbc.co.uk/news/world-us-canada-39485928.amp https://www.bbc.co.uk/news/world-us-canada-39485928.amp
      - Sakos 5y ago

kenjackson 5y ago

If you don't go to jail for this, do you do so for any sort of negligence? What about an Uber driver that runs a red light and kills a pedistrian walking? Or is drunk and kills someone? That worries me a lot more than this story.

deleted 5y ago
[deleted]

JshWright 5y ago

> I am not a nurse, but I can easily imagine how someone could make the errors she did in an overworked and high-stress environment. There are so, so many differences between the two meds, I don't see how confusing them would be possible short of gross negligence (for context, I am a paramedic, and often administer medications (including both of the meds involved here) in a high stress environment). Vecuronium (the paralyzing drug) is a powder in the vial and you need to first inject saline it into the vial, shake it up, and then draw out the "reconstituted" med. This is very unusual (there are only a handful of medications in common use that require this, and Midazolam, the intended med, is _definitely_ not one of them). The reconstitution process means she would have had to look at the top of the vial several times, and warning on the tops of vials are, again, very uncommon. Also uncommon is the red cap on the vial. I have made errors before while caring for patients, and I will likely make them again. I am very aware of the fact that we all can make mistakes, but the number of mistakes that needed to be made here far exceeds the standard of what is reasonable, and is well into the territory of "gross negligence", in my opinion.

js2 5y ago
I appreciate your perspective as a medic. The PDF I linked enumerates the mistakes she made and the differences between the two medicines, and I have read all that. From non-professional perspective, it seems like it was inattentional blindness. But let me allow for a second that this is a case of gross negligence, despite the fact that CMS investigated Vanderbilt and found many other issues in the workplace: https://www.documentcloud.org/documents/6535181-Vanderbilt-Corrective-Plan.html https://www.documentcloud.org/documents/6535181-Vanderbilt-C... It's not clear to me how criminalizing her mistake helps prevent future medical errors. Do you think criminally prosecuting her was the right decision?
- JshWright 5y ago
  I am neutral on the idea of criminal prosecution here (for the individual, I absolutely thing there should be accountability for the organization). I am generally opposed to criminal prosecution for medical errors, but it's hard to overstate how outlier this series of mistakes was in terms of the severity of the outcome and the degree of negligence demonstrated. I think the question of "should we put this person in prison for these actions" is equivalent to any other criminal act (which isn't a clear cut answer either, in my opinion).