Appraisers Take Heed

Nurse’s Plight Signals Dystopian Future for Occupational Licensees; Appraisers Take Heed

To err is human, but not if you’re a licensed nurse in the Regulatory Republic of Tennessee, where “dog eat dog” has become the state’s unofficial motto.

In a first of its kind, a medical accident has resulted in both a license revocation and a criminal prosecution as a nurse was both stripped of her license and convicted of a felony for inadvertently administering the wrong drug to a patient. Despite immediately reporting her error in accordance with hospital policy, she now faces years of jail time.

Her plight is an attack on occupational licensees everywhere. The nation’s long-suffering real estate appraisers, under attack by Congress in an election year, should pay close attention to what has happened in Nashville.

In the fateful error, nurse RaDonda Vaught, 38, mistakenly administered Vecuronium, a powerful paralyzing agent, to a 75-year-old stroke victim. She believed it was Versed, a sedative. The mix-up resulted in the death of the patient. In the incident’s aftermath, Vaught followed hospital protocol and immediately reported the error to her employer, Vanderbilt University Medical Center, which, according to reports, then covered up the incident and settled secretly with the patient’s family.

When investigators discovered Vanderbilt’s cover-up of the accident, Vaught somehow became the scapegoat.

In a hearing before the Tennessee Board of Nursing last year, Vaught, who was fired by Vanderbilt, admitted she had allowed herself to become “complacent” and “distracted” while using the electronic medication cabinet and did not double-check which drug she had withdrawn despite multiple opportunities to do so and a number of red flags she should have caught. She did not shirk responsibility for the error.

The state board revoked her professional nursing license, fined her $3,000, and an additional $60,000 in investigation costs.

But in the politically charged atmosphere – one in which the state’s most prestigious hospital had egg on its face – Vaught was also criminally charged with reckless homicide and gross neglect of an impaired adult in connection with the patient’s 2017 death.

Nowhere in the court filings do prosecutors allege that she had intended to hurt the patient or was impaired by any substance when she made the mistake. Vaught’s prosecution is a rare example of a health care worker facing years in prison for a medical error.

Her trial has been closely monitored by doctors and nurses across the United States. They fear it will set a precedent of criminalizing medical mistakes. The conviction should send a chill down the spine of all occupational licensees. It ushers in a new world in which elected district attorneys might piggyback off the findings of state licensing board to enhance their political prospects.

Experts believe her criminal prosecution, on top of the license revocation, will make health care more unsafe in the long term.

“This is bad,” said Houston anesthesiologist Kristina Braly. “Let me be very clear about the consequences of naming health-care workers guilty whenever they make a mistake that results in harm or accidental death of a patient. We have a very particular set of protocols – internal processes that create a safe space for transparency – for admitting to mistakes, for reporting errors, for owning up to a mistake you made without fear of criminalization. [It] helps create a safer health-care environment for the next patient.”

Janie Harvey Garner, RN, the founder of “Show Me Your Stethoscope,” a nursing group on Facebook with more than 600,000 members, fears Vaught’s conviction will have a chilling effect on nurses disclosing their own errors or near errors, which could have a detrimental effect on the quality of patient care.

“Health care just changed forever,” she said after the verdict. “You can no longer trust people to tell the truth because they will be incriminating themselves.”

In the wake of the verdict, the American Nurses Association issued a statement expressing similar concerns about Vaught’s conviction, saying it sets a “dangerous precedent” of “criminalizing the honest reporting of mistakes.” Some medical errors are “inevitable,” the statement said, and there are more “effective and just mechanisms” to address them than criminal prosecution.

Testimony from a Tennessee Bureau of Investigation agent seemed to support defense arguments that Vaught’s fatal error was made possible by systemic failures at Vanderbilt. Vaught’s attorney, Peter Strianse, has described his client as a “disposable person” who was scapegoated to protect the invaluable reputation of the most prestigious hospital in Tennessee.

Vanderbilt has, of yet, received no punishment for the fatal drug error or its alleged cover-up of the incident.

Vaught was convicted of gross neglect of an impaired adult and negligent homicide after a three-day trial. Vaught, with no prior convictions, now faces sentencing in mid-May. Her future likely holds a prison sentence of three to six years for neglect and one to two years for negligent homicide, according to the state’s sentencing guidelines.

Chad Jackson, the assistant district attorney who gave the state’s closing argument, compared Vaught’s actions to those of someone driving with their eyes closed. Her defense attorney differed.

“RaDonda Vaught is like the scapegoat in the Old Testament,” said her defense attorney in closing arguments.

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Jeremy Bagott

Certified General Real Estate Appraiser at Bender Rosenthal Inc

Jeremy Bagott is a real estate appraiser and former newspaperman. His most recent book, “The Ichthyologist’s Guide to the Subprime Meltdown,” is a concise almanac that distills the cataclysmic financial crisis of 2007-2008 to its essence. This pithy guide to the upheaval includes essays, chronologies, roundups and key lists, weaving together the stories of the politics-infused Freddie and Fannie; the doomed Wall Street investment banks Lehman and Bear Stearns; the dereliction of duty by the Big Three credit-rating services; the mayhem caused by the shadowy nonbank lenders; and the massive government bailouts. It provides a rapid-fire succession of “ah-hah” moments as it lays out the meltdown, convulsion by convulsion.

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