“Criminalizing medical error creates environments and cultures of fear,” says Institute for Healthcare Improvement

By Brian Ward

On March 25, former nurse RaDonda Vaught was convicted of gross neglect of an impaired adult and negligent homicide in Tennessee. In 2017, Vaught mistakenly gave an elderly patient a paralyzing medication instead of a sedative, resulting in the patient’s death. The investigation found that Vaught overlooked several warning signs, and Vanderbilt Medical Center claimed in court that it had resolved technical problems with their medication cabinets weeks before Vaught pulled the wrong drug.

Vaught now faces up to eight years in prison and news of her case has gone viral, with many in nursing and patient safety claiming her conviction will only make healthcare less safe. This includes the Institute for Healthcare Improvement (IHI), which put out a statement arguing against the criminal prosecution of nurses for medical errors.

Preventing medical errors requires people to come forward when those errors are made, IHI says. Otherwise, how else will healthcare organizations know there’s a problem? But nurses and other healthcare providers will be less likely to admit to an error if they fear it will send them to prison.

“We know from decades of work in hospitals and other care settings that most medical errors result from flawed systems, not reckless practitioners. We also know that systems can learn from errors and improve, but only when those systems encourage reporting, transparently acknowledge their mistakes, and are held accountable for those errors,” IHI writes. “Criminal prosecution over-focuses on the individual and their behavior and diverts needed attention from system-level problems and their solutions. This is not how safety is achieved in health care.”

IHI made note of the great strain that many healthcare workers are facing, with rampant staff shortages and long hours exacerbated by two years of the COVID-19 pandemic. Many people have left the healthcare field already, and the Vaught conviction has already convinced some nurses to leave medicine altogether. Health workers need support right now, IHI says, not fear that a mistake will cost them their livelihood.

“Criminalizing medical error creates environments and cultures of fear and blame that are directly counterproductive to patient safety, and reverses the hard-earned progress that has been made by health professionals around the world. Put simply, this prosecution makes patients less safe,” IHI writes.  

Check out future articles of Patient Safety Monitor Journal for an interview with Kedar Mate, MD,  President and Chief Executive Officer at the Institute for Healthcare Improvement (IHI), about how criminal prosecution impacts patient safety.