As Friday morning became Friday afternoon, the number of nurses protesting at the courthouse in Nashville continued to grow.
The protesters were there in support of RaDonda Vaught, a nurse sentenced last Friday for her involvement in a patient's death. While the trial was about the fate of one nurse, the case spoke to a broader issue in medicine: the criminal consequences of a medical professional's actions while on the job.
The Case
Vaught had been on trial earlier this year for administering the wrong medication to a 75-year-old patient before their MRI. She was of criminally negligent homicide and abuse of an impaired adult for having administered vecuronium, a paralyzing drug, instead of versed, a pre-MRI sedative. The result of this "criminal medical malpractice" left the patient brain-dead before the error was discovered.
The case was particularly fraught because there has been a general agreement that Vaught was free from malice, which was part of the focus in Friday's sentencing. Even the most vocal critics of Vaught's actions conceded that at the time of this medical mistake, there truly was no malice.
So, why was this case criminally prosecuted rather than taking the normal route of being heard at an administrative board?
Political factors may have been at play. The district attorney, Glenn Funk, JD, who decided to is up for re-election this summer. Failing to prosecute could have been perceived as the same kind of weakness against crime that is subjecting many prosecutors to primary challenges and even recall campaigns.
The broader medical issue coming to light now is one simple question: How do other nurses feel about what happened to Vaught following her tragic mistake?
In the time between Vaught's concision and sentencing, a groundswell of support has risen among other nurses and medical professionals. Their concerns are critically important to the practice of medicine, and many were addressed by the judge during the sentencing. Davidson County Criminal Court Judge Jennifer Smith, JD, offered a long, clear, and detailed explanation of the reason behind Vaught's sentencing, first explaining that given an absence of a criminal history, she was a range one standard offender. Tennessee has four ranges of offenders: one, two, multiple, and career, and range one is someone with no criminal record. This is important because they are eligible for release after serving 30% of their sentence.
Judge Smith acknowledged that Vaught "abused a position of public trust," but clarified that she had no "sustained intent" to violate the law. Further, the court acknowledged that Vaught tried to remedy the situation and was forthright in bringing all the facts of the case to light.
Once the judge announced that the sentences on the two guilty verdicts could be served concurrently, the focus quickly shifted to whether Vaught could be eligible for diversion -- a sentence that would not involve serving time in prison. The judge spent considerable time explaining that a change in Tennessee statutes meant that Vaught could now be eligible for diversion, which the defendant had requested on both counts.
Ultimately, Judge Smith acknowledged during sentencing that although Vaught's medical error was a serious mistake, she had already endured professional, personal, criminal, and public consequences. This motivated the judge to grant diversion, sentencing Vaught to 3 years of supervised probation.
Consequences for the Medical Profession
During a conversation with my colleague Jason Matzus, JD, a Pittsburgh medical malpractice lawyer, he argued that while the sentencing was a good result under the guidelines, Vaught's conviction itself was fundamentally unfair and resulted from practical as well as system design flaws:
"While there may be certain circumstances that warrant criminal charges, I could make a better argument that the primary cause of the fatal outcome was systemic error more than individual error."
Matzus added, "RaDonda Vaught told the truth, which is an incredibly hard thing to do since doing so necessarily means you accept responsibility for killing a person. I take depositions all the time where doctors and nurses lie and defend the indefensible when the potential for jail isn't hanging over their heads. Do you think that the prospect of jail time will increase or decrease the medical providers' willingness to report preventable errors or increase the incentive to cover them up? Ultimately, will the incentive to lie increase or decrease safety?"
The Vaught case will absolutely have a chilling effect on acknowledging mistakes and reporting them. A in the AMA Journal of Ethics argues that fundamental to the creation of a just medical culture is that "human errors should be regarded as expected events, health care organizations should routinize processes aimed at human error prevention, limit negative consequences when human errors do occur, and support and educate those who have erred."
Fundamentally, doctors, nurses, and all medical professionals are held to the same reasonable standard. We want medical professionals such as Vaught to exercise their best judgment when that judgment is educated, sound, and aligned with industry standards.
While Vaught's sentencing was far more reasonable than her prosecution, the case will ultimately lead other nurses and medical professionals to fear the prospect of criminal prosecution and jail time in situations where medical boards should be reviewing questions about their conduct. The omnipresence of criminal prosecution will not create better medical practitioners or better patient outcomes. Instead, it will likely create a healthcare workforce that is overly tentative in their patient care, while leading many more professionals to leave the medical field.
is the Chief Legal Analyst for . He has taught entrepreneurship at McGill University and the University of Pennsylvania, and was elected to Fastcase 50, recognizing the top 50 legal innovators in the world.