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Criminalizing medical errors will undermine patient safety

Nature Medicine volume 28, pages 2241–2242 (2022)Cite this article

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On 25 March 2022, after a 3-day trial, RaDonda L. Vaught, a former nurse at the Vanderbilt University Medical Center, was pronounced by a jury guilty of criminally negligent homicide and gross neglect of an impaired adult1. The more serious offense of reckless homicide was dismissed by the jury1. The charge of criminally negligent homicide stemmed from a fatal drug error in which the muscle relaxant vecuronium bromide was substituted for a sedative, midazolam. The gross neglect charge drew on allegations that the patient in question was not properly followed after the administration of the wrong medication. Her sentence of three years of probation was announced on 13 May 2022. We argue that the approach taken in this case of criminalizing medical errors will undermine, rather than improve, patient safety.

Charlene Murphey, 75 years of age, was admitted to the Neurological Intensive Care Unit of the Vanderbilt University Medical Center on 24 December 2017 for the evaluation and management of a probable hemorrhagic stroke1. As early as two days after admission, Murphey’s condition improved such that discharge from the hospital was being considered. Midazolam was then prescribed for anxiety before a brain PET (positron emission tomography) scan. Vaught is alleged to have overlooked several warning signs in the process of securing the prescribed order. An automated drug dispensing cabinet was reportedly overridden to enable the medication error. Moreover, that midazolam is furnished in liquid form whereas vecuronium bromide is dispensed as a powder, which must be solubilized, went unnoticed.

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References

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Authors and Affiliations

  1. Brown University, Providence, RI, USA

    Eli Y. Adashi

  2. Harvard Law School, Cambridge, MA, USA

    I. Glenn Cohen

  3. Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA, USA

    I. Glenn Cohen

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  1. Eli Y. Adashi
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  2. I. Glenn Cohen
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Correspondence to Eli Y. Adashi.

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The authors declare no competing interests.

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Adashi, E.Y., Cohen, I.G. Criminalizing medical errors will undermine patient safety. Nat Med 28, 2241–2242 (2022). https://doi.org/10.1038/s41591-022-01982-1

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