Class Ethical Debate

 Arguing for Radonda Vaught

Introduction: (Awa Diallo)

Good morning everyone. Today, we will be discussing a case that has sparked not only widespread media attention but a larger debate within the healthcare community itself: the case of Radonda Vaught. Radonda, a former nurse at Vanderbilt Medical Center in Nashville, Tennessee, was found guilty of negligent homicide following an error where she accidentally administered the wrong medication to a patient, Charlene Murphy, ultimately leading to Murphy’s tragic passing. This outcome has led to significant backlash, with many nurses and healthcare professionals voicing their concerns, arguing that Radonda’s conviction reflects a deeper systemic failure rather than solely an individual fault. 

Our position today will be to advocate for Radonda Vaught and argue that the accountability in this case extends beyond her actions. This debate isn't simply about one nurse’s error; it’s about uncovering the systemic issues that contribute to such tragic outcomes in the first place. Rather than focusing solely on individual blame, we must question whether Vanderbilt Medical Center, and by extension, the broader healthcare system had practices and protocols in place that made such an error more likely to happen. In our defense, we’ll outline and support specific factors that point toward institutional failures. We’ll discuss issues like the persistent burnout and overworking of nurses, the culture of allowing overrides on critical systems that control medication administration, and the distractions that come with being assigned both patient care and the training of new staff members. Vanderbilt’s policies, in particular, failed to ensure a safe environment for both patients and staff, creating a setting where errors are more likely to happen, even with experienced professionals like Radonda. Throughout this debate, we’ll show that healthcare is inherently a collaborative system, reliant on multiple levels of safeguards, support, and oversight. We will present evidence of how Vanderbilt’s practices contributed to a lapse in these safeguards. For example, the fact that a two-person verification system was only implemented after the incident highlights how, with proactive measures, this tragedy might have been prevented. 

Ultimately, our thesis today is that while individual accountability is crucial in healthcare, it cannot overshadow the importance of addressing systemic flaws. Our team will bring in examples, expert opinions, and studies to support our arguments, showing that placing the entire blame on Radonda Vaught disregards the responsibility of Vanderbilt Medical Center as an institution and diminishes the role of these deeper, more pervasive issues. As we move forward in this debate, each of our team members will present points that expose these underlying problems and propose how addressing them can lead to a more just and effective approach to patient safety. We are here not just to defend Radonda but to argue that real accountability means focusing on structural reform because that is what will genuinely protect both patients and healthcare workers.

(Topic 2, Mia Montan)

Writing for sciences argumentative:

• Nurses overworked.

Nurses are an essential part of the healthcare system, tirelessly working to ensure every patient's well-being. A nurse’s efforts directly affect a patient's safety and recovery, highlighting the reason why issues such as staffing shortages and elongated shifts need to be addressed. Nurses stepping down from their roles is rapidly emerging into a major issue often leading to hospitals demanding more from an understaffed workforce. Short-staffed hospitals are starting to see severe repercussions from this adverse situation, the American Association of Colleges of Nursing (AACN) states that “looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%)” (Rosseter, 3). The possible infringement of a patient’s care poses a serious threat to what healthcare workers tirelessly aim for. Nurses often work twelve-hour shifts, leading to mental and physical exhaustion from an overwhelming environment. “Therefore, fatigue is considered as a symptom resulting from shift work, which has an impact on health. It has a significant effect on the levels of alertness, concentration, judgment, mood, and performance which might also be a reason for the increased risk of injury and medical errors” (Maram, 70). Prolonged shifts, often hindering healthcare worker’s cognitive skills present a detrimental obstacle to a person’s ability to make informed decisions.

Speech:

Nurses are the backbone of our healthcare system. they work tirelessly, taking on countless responsibilities to ensure that each and every patient receives compassionate, skilled, and attentive care. Whether it's administering medication, monitoring a patient's progress, or providing emotional support nurses play a critical role in every step of a patient’s journey toward recovery.

But as essential as nurses are, their efforts are often stretched beyond reasonable limits. Staffing shortages place a heavy burden on these vital members of the healthcare system. Hospitals struggle to maintain adequate staffing levels, and as a result, nurses are bearing the weight of high patient loads and increasingly stressful working conditions. With more patients than they can reasonably handle, nurses face the impossible task of providing safe, quality care while juggling extensive and often exhausting responsibilities.

This problem is further intensified by the length of the shifts they work. Nurses are frequently required to work shifts that extend far beyond eight hours, sometimes even up to twelve straight hours. These extended shifts might help cover gaps in staffing in the short term, but they come at a steep cost. Research has shown that longer shifts can have a significant impact on nurses' well-being. After hours of intense, demanding work, fatigue sets in. And with that fatigue, a nurse’s ability to stay alert, to concentrate, and to make quick, accurate decisions is compromised.

The consequences of this fatigue are profound. Nurses are human, and like all of us, they need time to rest and recover to function at their best. Without adequate rest, fatigue impacts their mood, judgment, and overall performance. This isn’t just a risk for nurses; it’s a risk for patients, too. Overworked and fatigued nurses are more susceptible to making mistakes, which could lead to serious medical errors that threaten patients safety. It’s a troubling reality.

Addressing staffing shortages and reducing extended shifts isn’t just about making nurses’ jobs easier—it’s about making healthcare safer and more effective for everyone. By alleviating some of this burden, we can help nurses remain alert, capable, and motivated, ensuring they have the energy and focus needed to deliver the high standard of care that every patient deserves.

This issue is not just hypothetical—it’s real, and we’ve seen its tragic consequences. in the case of RaDonda Vaught, a former nurse whose tragic error led to the accidental death of a patient and ultimately resulted in her criminal conviction. While there were multiple factors involved, this case presented the effects of issues, like understaffing and overworking, which placed immense pressure on her and her colleagues. It’s a stark reminder that when nurses are fatigued and overburdened, the risk of medical errors increases dramatically, with devastating outcomes.

The impact of RaDonda Vaught's case has resonated throughout the healthcare community, sparking conversations on accountability, systemic reform, and the need for support structures that protect both healthcare workers and patients. Her case emphasizes how essential it is to ensure that nurses have the capacity to perform at their best—physically, mentally, and emotionally—without the effects of extended hours and excessive workloads.

It’s time to recognize the sacrifices nurses make and the impact they have on our health and well-being. The healthcare system needs policies that prioritize proper staffing, fair hours, and mental health support for these crucial workers. When we take care of our nurses, we’re also taking care of our patients, our communities, and ultimately ourselves.

(Topic 3, Keila Maria)

              Another significant point is the verbal abuse that healthcare workers face. Nurses face continuous interaction with individuals, ranging from aggressive patients to challenging coworkers. This high-pressure environment can lead to feelings of being overwhelmed and can undermine their confidence, despite the vital role they play in patient care. According to , “Frequency and Impacts of Verbal Abuse on Healthcare Workers in a Secondary Healthcare Structure in Greece”,the study shows “Nurses recorded a percentage of 12.4% of  verbal abuse every week and nurses reached 31.9% that answered that the abuser was another senior member of the staff” (Toska et al., 4). Some examples of verbal abuse would be accusing and blaming, judging , ignoring,  threatening, and criticizing are the most frequent actions for nurses.Nurses often experience burnout, which can lead to feelings of anger and frustration directed toward their colleagues.

           This toxicity not only discourages nurses from remaining in the profession but also takes a significant toll on their mental well-being. Some nurses took action against the issue, others remained silent and pretended that nothing happened or some talked to hire ups. Despite taking action, many have been silenced by those in positions of authority. In this case the hospital showcased a troubling empathy, showing little regard  for the nurse by firing her so quickly. Also, they didn’t tell the victim's family until media pressure forced them to address the details surrounding the case. When news outlets reached out to the responses from the hospital leadership concerning their failure to assist, it became clear that with the implementation of stronger laws and enhanced support for nurses, this tragic situation could have been avoided altogether. This situation allows individuals to envision how the hospital addresses various issues, particularly the verbal abuse, long shifts, workload, and many other issues directed at nurses. Often, these serious matters are ignored until external pressure forces the institution to confront the reality hidden away from public view.  

            Also, according to the article, “Verbal Abuse among Nurses in Tertiary Care Hospitals”,  “A study showed that verbal abuse was experienced by 87.4% of the population during a 6-month period.One of the study showed that health workers always feel stress and hazardous in their workplace after being verbal abuse”(Kalpana et al.,15). The negligence of hospitals has serious repercussions for nurses, often pushing them to the brink of leaving or, in some cases, requiring hospitalization themselves. While hospitals may find replacements for these nurses, the powerful stories shared by those who have experienced poor treatment will lead to a significant loss of staff. This turn of events can create an overwhelming workload that cannot be managed effectively. This is by nurses making mistakes and not paying close attention to detail. So, without the dedicated commitment of nurses who would have otherwise stayed, had the hospitals shown more understanding and support for their needs. Hospitals should work to appreciate these nurses by improving nurse’s workloads and regulations that can make them feel less anxious and work more effectively with patients and coworkers and have a hospital that the nurses aren’t against. 

(Topic 4) Sherylynn Cano

In this case, the main points for this topic are a lack of transparency, accountability, and reporting from the hospital. We know that nurses use to override the system to get drugs. RaDonda is known to have used the override function in this case and is always mentioned, But what exactly is the override function? It allows a nurse to remove medication from the machine before a pharmacist reviews the order placed on the medication. However, in emergency cases, the override function is used to allow access for nurses for emergencies. According to Miller et al, the override function allows a nurse to remove medication from the machine before a pharmacist reviews the order. In hospitals usually the override functions are checked over and used sparingly. As to keep track of the reasons why medications were pulled. This leads to a lack of management from the hospital if no one is correcting or managing any of the medications taken having followed a chain of command. So does this make the hospital liable? Yes because of the lack of management, there were so many instances where the managers could have stepped in and stopped these nurses from using the machine so many times. Liability for this case falls on Ra Donda but looking at the evidence a hospital can also be held liable.

Typically, the most common scenarios in which the hospital may be liable in a wrongful death suit are: If the employees (doctors, nurses, etc) of the hospital were negligent in the deceased patient's care, causing the patient's death, as we know to be true in this case. Ultimately, Vaught was criminally prosecuted for this mistake and found guilty of criminally negligent homicide and abuse of an impaired adult (RaDonda L. Vaught vs. Tennessee, 2022). It's important to note that another nurse discovered that Vaught had administered the wrong file but it wasn't shown on the file. Dr. Hartman who was reporting this death to the Office of the Medical Examiner. Dr. Zimmerman attested to the death as a natural cause of complications of the intracerebral hemorrhage. No action was taken against Dr. Zimmerman and the Vanderbilt Hospital. The victim was pronounced dead by natural causes. Standard procedure according to biotech law.edu  “The attending physician would be expected to determine the cause of death and file the death certificate. The physician who pronounces the death must simply determine that the patient is dead. If the determination of death is difficult, a physician should consult with others and know the legal definition of death in the state.” (Biotech, 2). To determine the death of a patient, one must follow the legal qualifications to help designate the specific death. However, procedures were not followed thoroughly after that. A normal procedure is for the hospital must investigate within 24 hours. Informing the Health Department of the expected completion date of the investigation, and must provide the Health Department with a copy of the investigation report within 24 hours of completion. The Health Department regulations have been in effect since 1985. 

           Although the hospital never reported the information and determined the age of the patient as the root of death. According to the article by Kelman, the hospital also filed an out-of-court settlement with the victim's families to never speak of the incident. (Kelmen 2).  It took two months before they ever got the papers out to the authorities. And the hospital never faced repercussions. The hospital is liable for not alerting the government as to why a mistake was made and never reported. The family, despite being told it was a natural death, was paid a settlement out of court for medical malpractice before ever stepping foot into a courtroom. Although legal, this shows the lack of care for patients and nurses when dealing with errors from the Vanderbilt hospital. But the lack of hospital accountability just shows the lack of transparency for patients could potentially put nurses in danger. It discourages frontline healthcare workers from reporting issues or mistakes, fearing professional action taken against them. Which leads to a fearful work environment.

Topic 5 (Rahul Dev Ramkisoon) Your Honor, members of the jury, members of the opposing team, I wish to further build on Systemic Flaws in Vanderbilt University Medical Center’s Safety and Training Protocols highlighted earlier by my colleagues. I would like to start with this quote by Dr. Albert Einstein who defined insanity as repeating the same steps and expecting different results. I am not accusing any of my opponents of being insane. However, I am simply pointing to the fact that if the root causes of these medical errors are not addressed, there will be more mistakes. I now point to this peer-reviewed research by Mahai Roman, lead author of Failure in Medical Practice: Human Error, System Failure, or Case Severity?, it states that medical practices will probably never reach a 100% success rate (2022). If this is the case why bother making reforms? Even the news coverage by CBS (2021) has highlighted that almost every nurse has had a medication error and reported that a federal investigation also found several deficiencies at the hospital. These directly tie to the lives of the patient. How did this happen and how can it be fixed? I wish to bring to your attention to another news outlet that covers this,  The Nashville Tennessean (2022) written by Mariah Timms who has done a polling of the former nurse Vaught’s colleagues and they have stated that the workplace culture is such that roles bleed into each other.

A consequence was the frequency of the ability to override medication security access to which my colleague delivered on earlier. This largely highlights a major flaw in the hospital system regarding its approach to high-stakes medication distribution. Members of the jury, clearly the hospital system prioritized speed instead of patient safety though there are widely recognized protocols to address errors. I now bring your attention to a study done by Gunjan Singh, lead author of Root Cause Analysis and Medical Error Prevention (2024), who pointed out that the need for root cause analysis (RCA) which is deemed a mandated process put forward by the World Health Organization (WHO) and is essential for preventing costly errors like this case. Singh et al., (2024) further highlighted that proficiency in RCA application and methodology enables healthcare workers to drive change within the field. How do they achieve this? Quickly reporting errors, independent reviews of medical practices, and a general Standard Operating Procedure amicably fit the bill for taking responsible action. Errors reported quickly can help deter further patient suffering and hold staff accountable. Independent reviews of medical practices offer an outside perspective on addressing the subliminal causes of error or those that get overlooked. Utilizing a Standard Operating Protocol is in some way legally binding and takes safety into account.  In contrast, Vanderbilt Medical Center has shown evidence of lacking RCA due to its failure to have safeguards and more warning systems in place. It simply preferred to have its healthcare professionals fail by repeating the same disastrous steps and then firing them.  As such, the amount of healthcare professionals siding with former nurse Radonda seems reasonably justifiable despite the tragedy that ensued. It should not have happened or continued to happen. There has to be improvements. This focus on former nurse Radonda Vaught should be seen through both lenses as medical error and systematic faults.

Topic 6: Keria Emptage, Although there should be individual accountability, Radonda Vaught is not solely responsible for the medical error that took place. The unfortunate incident could have happened to any other nurse in her situation. Even looking outside of the other burdens placed on Radonda that day, the hospital is at fault. This is evident in the measures that the hospital put in place after the death of the patient. Healthcare is an interdisciplinary system that depends on the collaborative effort of multiple participants. 

Based on the charges presented to the board of tennessee of nurses: Vaught is placed as a “help all” nurse on the Neurological ICU. She is also tasked with orienting a new nurse to the unit. Although she was not the nurse in charge of the patient, Vaught received instructions from that nurse to administer Versed to the patient. This nurse had previously received a verbal order from the doctor. The doctor had entered the order for Versed that was later verified by the pharmacy. In order to acquire the medication Radonda types in the words “VE” and selected the first medication. She did not verify with the doctor or the pharmacy on the medication. 

The charges against her were as follows: guilty of unprofessional conduct, Abandoning or neglecting a patient in critical care, and failure to maintain a record of patient care

 The role of a “help all nurse” is not identified, however when taking into account the facts of the case and the typical working environment of nurses it was not an easy role. The ratio of nurses in an ICU is typically 1:2. Given the “help all” name it is expected that Vaught was assisting in the care of multiple patients. Going against this industry standard. It’s unrealistic to have her meet these standards in that environment.

Taking a look at this issue without an understanding of the healthcare setting, prevents a holistic view. Based on a document found in the Department of Health and Human Services Centers for Medicare and Medicaid Services: Vanderbilt implemented two-step verification processes, regular training for all professionals with access to paralyzing agents, as well as other measures to make it harder to acquire paralyzing agents. These are all standard practices in other healthcare settings. Simple two-step verification could have prevented the incident. The lax administration is directly responsible for the lack of quality healthcare, even in this situation. It should not take the death of someone to encourage a safe collaborative environment. It is also unrealistic to expect the adherence to rules that were never implemented. In addition to state laws and regulations practicing healthcare professionals are also required to adhere to the laws of their workplace. Even the grief stricken family of the deceased did not push to charge Radonda. Leaving us to question who did the verdict really benefitted. Villainizing human mistakes to mitigate negative media sets the medical field backwards. All of a sudden Radonda has become the only one that played a role in this tragedy. The hospital never even apologized to the family of the patient.It prevents the much needed transparency needed for growth and patient safety.

Topic 7: Nathalie Flores, A serious issue affecting patient care and safety within Vanderbilt University Medical Center warrants immediate attention: the repeated technical failures of the electronic medication cabinet system, an essential tool for timely and secure medication distribution. These malfunctions have caused significant disruptions, impacting the speed and accuracy of medication administration. Alarmingly, despite being aware of these problems, hospital administration has yet to implement a sustainable, long-term solution. Instead, staff have been instructed to rely on the system's override function, originally intended for emergencies only. This temporary fix has now become a routine practice, bringing its own risks and compromising safeguards critical to medication accuracy and patient safety.

The issue extends beyond mere technical inconvenience. Medication cabinets are central to ensuring that high-risk drugs are stored, tracked, and dispensed securely. When these systems malfunction, delays in medication access can result in cascading effects on patient treatment plans, particularly for those in critical care. For example, life-saving drugs such as anticoagulants, insulin, or emergency antibiotics require precise timing for administration. Any delay or error in dispensing these medications could result in severe complications or even fatalities. Moreover, frequent reliance on the override function increases the likelihood of human error, as it bypasses the built-in checks designed to prevent incorrect dosage, wrong-patient errors, or administration of expired drugs.

Staff members have voiced growing frustration with these technical issues (NPR, 2022). Citing increased workloads and stress as they scramble to mitigate the consequences of a failing system. Nurses, in particular, face the dual burden of maintaining patient safety while compensating for a tool that no longer supports their workflow. This added strain not only impacts their performance but also contributes to burnout and job dissatisfaction, exacerbating staffing challenges in an already strained healthcare system. These systemic failures place both patients and healthcare providers at risk, creating a dangerous environment where mistakes become more likely under pressure.

Accountability is at the heart of this issue. The administration's awareness of the malfunctions obligates them to act swiftly, yet they have failed to do so. Allowing daily overrides to replace a fully functional system not only places unnecessary burdens on staff but also jeopardizes patient care. Furthermore, this neglect raises ethical concerns about the hospital's commitment to prioritizing patient safety over cost-cutting measures or administrative convenience. Temporary workarounds cannot substitute for effective, lasting solutions.

If patient care is truly a priority, resolving these technical issues should be an urgent matter. The hospital must allocate resources to a permanent fix, demonstrating a genuine commitment to safety and quality in healthcare. This could involve partnering with the system manufacturer to identify the root cause of the failures, implementing rigorous testing protocols to ensure reliability, and providing staff with adequate training to adapt to any updates. Transparency is also crucial; the administration must openly communicate with staff and patients about the steps being taken to address the issue and restore confidence in the system. Anything less falls short of the standards patients deserve and risks undermining the integrity of the healthcare institution.

Conclusion (Ontora Deychoudhury) Finally, the conviction of nurse Radonda Vaught exposes a critical flaw within our healthcare systems. Although Radonda had made the fatal error, we must ask what led to this mistake in the first place? How many systemic failures were at play that may have prevented this tragedy from occurring? The circumstances in which Radonda and many other nurses have been placed, such as nurse burnout, inadequate safety protocols and high workload, reveal the imminent need for healthcare reforms. The hospital’s policy allowing nurses to frequently override the system to receive medication, along with the hospital giving nurses more responsibilities than they can handle, such as how Radonda was assigned a trainee to oversee, directly contributes to what led to these errors.  The culture of non-transparency, the prioritization of speed over safety, and the failure to address technical and training flaws at Vanderbilt Medical Center all point to an urgent need for reform. If we are truly committed to improving patient safety and supporting healthcare professionals, we must focus on systemic change rather than placing the blame solely on one individual, especially considering the numerous issues present within the system.

Works Cited:

Banakhar, Maram. "The impact of 12-hour shifts on nurses’ health, wellbeing, and job satisfaction: A systematic review." Journal of Nursing Education and Practice 7.11 (2017): 69-83.

https://www.researchgate.net/profile/Maram-Banakhar/publication/317941224_The_impact_of_12-hour_shifts_on_nurses'_health_wellbeing_and_job_satisfaction_A_systematic_review/links/5be8598ba6fdcc3a8dcecf6c/The-impact-of-12-hour-shifts-on-nurses-health-wellbeing-and-job-satisfaction-A-systematic-review.pdf

Kelman, B. (2022, March 24). In Nurse’s trial, witness says hospital bears “heavy” responsibility for patient death. NPR. https://www.npr.org/sections/health-shots/2022/03/24/1088397359/in-nurses-trial-witness-says-ospital-bears-heavy-responsibility-for-patient-dea

Rennie, V. (2024, September 26). Protecting against error: Lessons learned from the Radonda Vaught case. Nevada State University. https://nevadastate.edu/son/rn-bsn/protecting-against-error-lessons-learned-from-the-radonda-vaught-case/#:~:text=Hospital%27s%20Response%20to%20the%20Incident,from%20publicly%20discussing%20the%20case

Roman, Mihai D., et al. "Failure in Medical Practice: Human Error, System Failure, or Case Severity?" Healthcare (Basel), 9 Dec. 2022, https://doi.org/10.3390/healthcare10122495. Accessed 30 Oct. 2024.

Rosseter, Robert. "Nursing shortage." American Association of Colleges of Nursing (2014): 1-6. https://www.ic4n.org/wp-content/uploads/2020/01/Nursing-Shortage-Factsheet-2017.pdf

Singh, Gunjan, et al. "Root Cause Analysis and Medical Error Prevention." StatPearls Publishing, 12 Feb. 2024, https://doi.org/https://www.ncbi.nlm.nih.gov/books/NBK570638/.

Silwal, K., & Joshi, S. (2019). Verbal Abuse among Nurses in Tertiary Care Hospitals.   

             Journal of Nepal Medical Association, 57(218). https://doi.org/10.31729/jnma.4571

The Climate Change and Public Health Law Site. (n.d.). Declaration of Death. Declaration of death. https://biotech.law.lsu.edu/books/lbb/x553.htm

Toska, A., Saridi, M., Christakis, A., Gotsi, S., Fradelos, E. C., Papageorgiou, G., & Souliotis, K. (2023). Frequency and impacts of verbal abuse on healthcare workers in a secondary healthcare structure in Greece. Cureus. https://doi.org/10.7759/cureus.35406

Townley, J. N., Pogue, C. A., & McHugh, M. D. (2022, October). Criminal prosecution of clinician errors: A setback to the progress toward Safe Hospital Work Environments. Journal of hospital medicine.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9720757/#:~:text=Barcode%20scanning,medication%20administration%20is%20barcode%20scanning.&text=This%20point%20of%20administration%20system,medication%2C%20as%20in%20this%20case

Williams, K. N., Fausett, C. M., Lazzara , E. H., Bitan, Y.,  Andre, A., & Keebler, J. R. (2023, August 27). Investigative approaches: Lessons learned from the Radonda Vaught case. Human Factors in Healthcare. https://www.sciencedirect.com/science/article/pii/S2772501423000210