RaDonda Vaught, a former nurse in Tennessee, was sentenced on Friday to three years of supervised probation after being convicted in March of making a fatal medication error in 2017, which resulted in the death of a patient under her care. Although Vaught isn’t being sent to prison, her conviction and sentencing, meted out for the kind of error that routinely occurs in health care institutions across the U.S., are a true travesty of justice.
That’s a far cry from what happened to William Husel, a former Ohio physician, who was acquitted of murder in April for hastening the deaths of 14 critically ill patients under his care by ordering doses of the painkiller fentanyl that were 10 times the amount ordinarily ordered for critically ill patients. Husel knowingly, and with intent, ordered the inordinate dosage of medication to patients across the lifespan — from their late 30s to their 80s — with a variety of ailments ranging from pneumonia to cancer.
Our first thought in both cases goes to the families who have endured the pain brought about by these circumstances. No amount of reparation, or prison time, or settlement money will bring back their loved ones or be the balm for their pain.
That said, these two cases highlight the unfair and injurious difference between standards to which physicians are held and standards to which nurses are held.
There is no doubt that Vaught made a grave error when she gave her patient an injection of vecuronium, a muscle relaxant that left the 75-year-old woman unable to breathe, instead of Versed, a sedative. Vanderbilt University Medical Center, where Vaught worked in an intensive care unit, enabled the safety overrides that she employed in making the medication error — as do many other health systems.
No matter how one judges her actions, or the health system’s, the outcome was the result of an error. No one argued that Vaught intentionally set out to hurt her patient.
This is in stark contrast to what happened in the case of Husel, who knew exactly the consequences of ordering large doses of fentanyl. His was not a medical error; it was a series of intentional actions that he knew would hasten the death of patients in his care. Whatever reason compelled him to do so, the basic fact is that it was not within his purview, as a physician who has taken an oath of “do no harm,” to make the decision to hasten someone’s death.
So, the nurse who made a grave error is convicted of a crime and faced serving time in prison while a physician who knowingly committed acts that hastened the deaths of multiple patients was acquitted? What is wrong with this picture? It doesn’t matter if Husel’s argument was that he was relieving their suffering — which we don’t know as he didn’t testify. The point is that it was not his decision to make to hasten their deaths.
As the Assistant Franklin County Prosecutor David Zeyen said in closing arguments, “Even if their death is assured as the sun is going to rise in the morning, if you hasten that along, you caused their death in the eyes of the law. ”
We are left scratching our heads. Was the nurse viewed as “more guilty” in light of the way the public views nurses? For many years in a row nursing has appeared at the top of the list of most-trusted professions. Does the public feel that, in some way, Vaught’s unintentional error was a greater insult to trust than that of a physician who intentionally caused harm?
The sad reality is that prosecuting nurses for errors made in the conduct of their jobs will discourage people from choosing nursing as a profession, even as the U.S. faces a critical shortage of nurses. More importantly, for those of us who work as nurses and inevitably make an error — and believe us, if you work in medicine and claim you’ve never made one, you just haven’t been practicing long enough — such prosecution will discourage nurses, physicians, and any health care worker for that matter, from reporting their mistakes.
Double standards like this only serve to undo the progress made in the past 20 years in terms of patient safety and quality care as first outlined by the Institute of Medicine in its landmark 1999 report, “To Err is Human: Building a Safer Health System.” Convicting a nurse for making a grave error versus acquitting a physician who intentionally causes harm goes against the very aim of creating a culture of patient safety.
Michelle Collins is the dean of the College of Nursing and Health at Loyola University New Orleans, where Cherie Burke is director of the School of Nursing.