The first day of witness testimony finished Tuesday night in the trial for a former Vanderbilt University Medical Center nurse, following the death of a patient in her care.
RaDonda Vaught is accused of killing Charlene Murphey, who received the wrong medication and became unable to breathe in 2017. Murphy entered the hospital because of a brain bleed. In the following months after Murphey's death, Vaught was fired from the hospital.
The jury was seated on Monday after COVID-19 delayed the initial trial date. Opening statements concluded Tuesday morning after about an hour.
Opening Statements
In their opening statements, the prosecution began by showing a nursing pin, reminding the jury of what nursing students learn in school. Assistant District Attorney Debbie Housel said Vaught recklessly ignored what she learned in school.
Housel continued, saying Murphey was prescribed 1-2 milligrams of a sedative named Versed. Instead, the patient was prescribed a deadly dose of vecuronium, which stopped her breathing.
She said Vaught used a medication dispensing machine called Accudose, which pulls up medications based on their generic name. Versed is a brand name, so it didn't pull up. Instead, Vaught allegedly used an overwrite function and typed in Versed, but hit the wrong name. Vecuronium is a paralytic used for patients who are intubated. Housel said Vaught ignored multiple warnings on the machine.
Housel then described how two Vanderbilt techs found Murphey unresponsive in a PET scan room and began CPR. The room then filled with doctors and nurses, who revived and intubated Murphey. Housel said Vaught also skipped the step of scanning Murphey's armband, along with the medication. If she had, Housel said an alarm would have gone off.
The prosecution continued, saying Myrphey's family heard the code blue and became concerned. At this point, Housel said Vaught was rushing to Murphey's PET scan room. She briefly interacted with the family, which was the only time they met during this series of events.
Housel said Murphey never regained consciousness after being intubated. On December 27, Murphey's family made the decision to take her off life support.
In retelling what took place, Housel said just 24 hours before, Vaught pulled the correct generic version of Versed, called Midazolam. Housel told the jury Vaught said to another nurse that she made several mistakes and shouldn't have rushed through the override process.
In her closing statement, Housel said based on all the state's proof, the jury will have enough evidence that Vaught is guilty beyond a reasonable doubt.
Next, defense attorney Peter Strianse opened his statement by reciting the words "to err is human, to forgive is divine" from an Alexander Pope poem.
Strianse argued the state neglected to mention that VUMC was having what he called major issues with its primary computer system. He said overwriting medication was standard practice due to those issues.
He then said an anonymous whistleblower reported Vanderbilt's issues to the Center for Medicare and Medicaid Services, which led to charges being filed.
Strainse told the jury Murphey's doctor prescribed no monitoring for the Versed medication, adding that decision was not made by Vaught. He said Vaught did an override on the Accudose machine because that was standard procedure at the time due to the software issues.
He argued Vaught could not scan Murphey's armband because there wasn't a scanner on that floor.
Strainse then went on to say the Tennessee Bureau of Investigation report indicated Murphey's original medical condition could have also led to her death. If it was a small dose, he says, vecuronium may have played no role in her death.
"This is a musical chairs game of blame," Strainse told the jury, adding Vanderbilt, other nurses and doctors potentially to blame have all found a seat but, "in the blame game, there's no seat for RaDonda Vaught."
He ended his statement by asserting the jury will believe she is not guilty.
State Witness Testimony
The state called Chandra Murphey as its first witness. She is the victim's daughter-in-law.
Chandra described to the court why Charlene was admitted to the hospital. She said the family held off all Christmas activities together in hopes of Charlene recovering.
She recounted that on Dec. 26, Charlene was feeling well, with the exception of a headache. She said therapy was going well and doctors were indicating she might be able to be discharged the next day.
Chandra said she told doctors her mother-in-law would need to be sedated because she was very claustrophobic. She became emotional as she described how she wasn't allowed to go with Charlene for the PET scan. Chandra told the court when she heard the code blue, she knew it was about Charlene.
She confirmed it was her who asked Vaught if the blue alert was for her mother-in-law. This was their only interaction during this series of events.
As Chandra described Charlene's final hours, Vaught looked visibly upset in the courtroom. She put her head down on the defense table as the DA's office prepared an image to put on the screen.
The next witness called was Ethan Gulley, a nurse practitioner at the Alvin C. York VA currently. In December 2017, Gulley was in the Vanderbilt Neuro-ICU in the step-down unit as a registered nurse.
Gulley described for the court how the Accudose machine works. He testified that there were some software issues with the machine during the fall of 2017, and that overrides were sometimes necessary.
He then testified that there was a time-sensitive nature to this injection as they were waiting on the PET scan to start, so Murphey needed the medication rather quickly.
Gulley said he was the first medical professional to discover what Vaught administered was not Versed and was actually Vecuronium. He said Vaught handed the vial to him to "waste" the rest of the Versed, leading him to realize it was the wrong medication.
He testified that the proper protocol for prescribing Versed involves giving the first dose and waiting to see if the anxiety goes down. If it doesn't, the second dose is given.
The state then passed the witness to the defense.
Defense attorney Strainse went through the timeline of Murphey's morning leading up to getting a PET scan. He said the initially wanted to see if Murphey could do a PET scan without medication because sometimes that can impact results. However, he said it became clear she needed something for her anxiety.
Gulley clarified that it is standard protocol to "waste" the rest of a controlled substance such as Versed. He also reiterated that the software program used for Accudose was down at the time, and nurses were having to do overrides of the system.
Next the state called Darren Crooks, a registered nurse at Vanderbilt. He said he was a new nurse at the time of Murphey's death and helped with her care in the Neuro-ICU. He testified that Vaught was her preceptor. He said he requested her because she was easy to learn from.
Crooks testified that Vaught told the medical team within 5 to 10 minutes of the patient being brought back up that there had been a medical error.
After his testimony concluded, court took a recess for lunch.
When court resumed, the state called Rebekah Smith, who administered the PET scan on Murphey. She said she didn't recall Vaught being distracted as she prepared the dose for Murphey. Smith said she found Vaught "very cavalier and abrupt" with Murphey.
Next the state called its fifth witness — Brooklyn Nicholson, a nuclear medicine technologist at VUMC.
Following Nicholson, Dr. Eli Zimmerman at Vanderbilt took the stand. She was the attending physician for Murphey's medical team.
Zimmerman said he ordered a PET scan because they were worried her cancer had spread into her brain. He told the defense there was a "possibility" of a medicine mix-up. He relayed that the brain bleed could have been the cause of death but he doesn't know for sure if that was it or the vecuronium.
In a cross-examination, Zimmerman said he thought now — knowing what they know — that the cause of death was vecuronium.
TBI Special Agent Ramona Smith, who specializes in Medicare and Medicaid fraud, said she started investigating 11 after the incident because of a tip they received. Initially, the agency didn't investigate further because healthcare companies aren't required to report incidents to the TBI. No reports had been filed.
During her court appearance, Agent Smith held up a clear plastic bag, which possessed vecuronium. The drug is used to suppress breathing for intubated patients. Throughout the investigation, Smith interviewed several Vanderbilt employees, including Vaught. The interview's audio was recorded and played in court.
During the recording, Vaught told the TBI investigator she could tell the difference between versed and vecuronium under "normal circumstances." But Vaught said she was distracted.
She relayed during the recording there's more she could and should have done.
"I probably just killed a patient," she said during the recording.
Holding tissues in front of her face, Vaught leaned over the table crying.
"My mistake caused a patient essentially to die," she said in the recording. "Am I going to jail? Am I going to lose my job? I was pretty sure I was going to lose my job if I could say the least. The conversation was pretty direct. There were parts of the administration process that should have been followed. Because I didn't follow them and didn't follow Vanderbilt's policy, they were going to have to let me go."
After Vanderbilt fired Vaught, she explained in the recording that she took time off from nursing.
"I wasn't sure about going back to work. I was told when they let me go that there would be some sort of investigation into my license. She gave me a copy of the letter that had been turned over to the Tennessee Board of Nursing. It was a copy of the termination letter. I was told there would be some investigation into my termination and in that time I was free to return to work. I didn't know what to do and I was hesitant to go back. I didn't know if I would be in a good place."
Vaught said she didn't hear from the nursing board for several months.
"I have good days and bad days," she said in the recording. "Ultimately, I can't change what happened. The best I can hope is that mistake can't be made again. There's nothing that can be said that is going to take away what I did to her or her family. People make mistakes. To err is human."
Smith said she appreciated Vaught being honest and "owning up to it."
"Error is error," Smith said. "We are all human."
In 2019, the Davidson County Grand Jury indicted Vaught on charges of impaired adult abuse and reckless homicide. If convicted, she could face up to ten years in prison. District Attorney Glenn Funk's office will prosecute the case. From his office, Assistant District Attorneys Debbie Housel, Chad Jackson and Brittani Flatt appeared during jury selection. Attorney Peter Strianse will defend Vaught during the case.
The Tennessee Board of Nursing unanimously voted to revoke her nursing license last summer. Vaught told the board that she was distracted while pulling the medication and didn't read the vial to confirm the drug. One board member said there were just "too many nursing flags" going off that Vaught ignored when administering the medication.
VUMC has been mum during the last three years regarding the case.
To help with her legal fund, Vaught started a GoFundMe to help with her expenses. Since it started, she has raised more than $100,000. In the note to contributors, Vaught wrote that indicting nurses for mistakes was a dangerous precedent.
"The many details of this incident deserve to be properly reviewed and addressed so that we all have an opportunity to learn from my mistake and create changes that will ensure the safety of all future patients as well as maintaining the future honesty, integrity and safe practices of all nurses," Vaught wrote. "However, now that this is a criminal matter, I must place my trust in the justice system and allow it to be handled in that realm."
Vaught pleaded not guilty to all charges.
