Medical errors may lead to criminal punishment

RaDonda Vaught made a mistake.

In 2017, the 36-year-old intensive care unit nurse at Vanderbilt University Medical Center in Nashville, Tennessee, administered the wrong medication to a 75-year-old woman who then died.

In May 2022, a Nashville jury convicted Vaught of criminally negligent homicide and abuse of an impaired adult. She was sentenced to 3 years of probation, although she could have been sentenced to up to 8 years in prison.

“RaDonda Vaught probably did not intend to kill Miss Murphey, but she made a knowing choice,” Assistant District Attorney Brittani Flatt said during the trial, according to reports. “This wasn’t an accident or mistake as it has been claimed. There were multiple chances for RaDonda Vaught to just pay attention.”

The American Nurses Association and the American Association of Critical-Care Nurses criticized the decision as setting a dangerous precedent in criminalizing medical errors. They claim it will have a dampening effect on medical workers’ willingness to report errors and near misses and that the ability to report such instances is very important for designing systems that reduce the chances of errors. Some nurses who attended the trial said Vaught was a scapegoat being punished for a human error that occurred in the context of a busy work day. Some nurses resigned in protest.

According to news reports,¹ a key fact considered during the trial was that the medication to be given to the patient was written using the trade name Versed (midazolam) even though the medication was accessed from a dispensing machine that used the chemical names. Vecuronium was administered in error and the patient stopped breathing. The hospital apparently does not use the system of bar codes on wristbands and medications that can automatically detect such a medication mismatch.

Should making such an error be a crime?

Medical errors are not uncommon. According to a study¹ published in 2016, approximately 250,000 deaths occur in the United States each year due to such errors, making it the third-leading cause of death after heart disease and cancer. If those estimates are correct, we may soon have our prisons filled with the doctors, nurses, and pharmacists involved in those errors.

What about errors in ophthalmology?

Placing an incorrect IOL during cataract surgery, programming the wrong axis of astigmatism into the excimer laser, or injecting the wrong anti-VEGF agent in the retina clinic never kills anyone, but if making the error itself constitutes a crime, does it matter whether the patient isn’t seriously harmed by the error? And would punishment and prison sentences be effective at keeping medical personnel from making errors?

Reference

1. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353:i2139. doi:10.1136/bmj.i2139