May 11 at 9:24pm
Manage Discussion Entry
Discuss your initial response to a news story involving a legal nursing concern. A link to the story need not be supplied but be sure to explain enough about the situation to enlighten your colleagues on its content. What impact did regulatory organizations have in this situation?
In December 2017, a registered nurse working at Vanderbilt University Medical Center made a significant medical error, ultimately leading to a patient becoming brain dead. RaDonda Vaught, a registered nurse, took a patient for an MRI after suffering from a subdural hematoma. However, before the MRI, the patient received a one-time dose of midazolam but instead received vecuronium. After administration of the medication, the patient became paralyzed, went into respiratory distress, and was placed on a ventilator. The following day the family withdrew care. However, Vaught immediately admitted to the hospital staff that she was responsible for the medication error. Shortly after the patient’s death, Vaught was fired from Vanderbilt. However, Vanderbilt officials obscured the fatal medication error from the government and the public. Ultimately Vanderbilt negotiated an out-of-court settlement with the patient’s family but requested that they not speak publicly about the death or medication error.
During mid-2018, Vaught started working at a different medical center in Nashville but was not in a clinical position. An anonymous tip alerted state and federal officials about the unreported medication error that led to the patient’s death. As a result, the Centers for Medicaid and Medicare Services conducted a thorough investigation against Vanderbilt. They threatened to pull Medicare payments if they did not seek corrective action to ensure another fatal error would not happen again. In late 2018, knowledge of the deadly mistake went public for the first time and led to Vaught being charged with reckless homicide and impaired adult abuse. Ultimately, the Tennessee Board of Nursing revoked Vaught’s nursing license. Vaught’s criminal case went to trial in late March of 2022.
Discuss the legal and ethical issues involved in this situation and the implications for health care policy. Be sure to consider cultural, social, spiritual, political, and economic factors.
Medication errors often happen because of an accident. However, according to Tariq et al. (2021), “Approximately 7,000 to 9,000 people die as a result of medication errors in the United States each year” (para. 1). The case against Vaught is challenging, in my opinion. A few stand out when looking at the ethical principles regarding the matter. For example, beneficence ultimately means to act in a way that is beneficial for the patient (Burkhardt & Nathaniel, 2014). In this situation, Vaught did not operate to benefit the patient. The three significant components of beneficence include “do or promote good, prevent harm, remove evil or harm” (Burkhardt & Nathaniel, 2014, p. 70). Second, nonmaleficence is like beneficence. However, nonmaleficence requires us to avoid causing harm (Burkhardt & Nathaniel, 2014). Although Vaught did not intentionally cause damage to the patient, the event still occurred.
Despite the ethical principles of beneficence and nonmaleficence being broken, Vaught did follow through with the moral principle of honesty. Veracity relates to telling the truth (Burkhardt & Nathaniel, 2014, p. 73). Immediately after the fatal event, Vaught admitted blame for the error. Consequently, the event is a sentinel event and should immediately be reported. The Joint Commission defines a sentinel event as an “unexpected occurrence involving death, serious injury, or psychological injury” (Patra & DeJesus, 2021, para. 1). Unfortunately, Vaught still received charges of reckless homicide and impaired adult abuse, causing her to appear in a criminal trial in March 2022. Guido (2020) refers to criminal law as “A conduct that is offensive or harmful to society as a whole, acts that are expressly forbidden or prohibited” (p. 6). There still needs to be corrective action to ensure that the same mistake is not repeated.
Compare and contrast your initial response to your response after analyzing the legal and ethical issues.
As I read the article, my initial reaction was feelings of shock. I wondered how a nurse could make such a significant mistake. However, I quickly realized that these mistakes were more common than I thought. For example, I recently encountered a situation where while conducting a bedside report with the previous shift, we were reviewing current IV infusions that were running on the IV pump. When I looked at the bags hanging to verify with the pump, I quickly realized that the patient had two vasopressin bags hanging instead of one vasopressin and one rocuronium. I immediately stopped the infusion, changed the tubing, and discussed the situation with the previous nurse. We reported it to the proper chain of command and completed the documentation. Mistakes happen; however, I wonder if Vanderbilt handled the situation differently from the start and reported the sentinel event correctly if there would have been a difference in the outcome. Ethically, it seems slightly suspicious that charges were filed only after an anonymous tip was made. It makes the situation appear that the hospital only made the corrective action due to the potential for public scrutiny. However, I do struggle with understanding the legal aspect. Even in court, the nurse admits that she made a mistake and thoroughly understands the required actions that need to be taken. She discusses the need for a better system for medication administration to aid in the verification of medications. According to Patra and De Jesus (2021), hospitals must provide education following a sentinel event to ensure that training prevents a similar occurrence.
Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing (4th ed.). Delmar Cengage Learning.
Guido, G. W. (2020). Legal & ethical issues in nursing (7th ed.). Pearson Education, Inc.
Patra, K., & De Jesus, O. (2021). Sentinel Event. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK564388/
(Links to an external site.)
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2021, July 25). Medication dispensing errors and prevention. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK5190