After three days of testimony from the state's witnesses, the trial went into the hands of the jury Thursday night for RaDonda Vaught, a former Vanderbilt University Medical Center nurse. Vaught is facing criminal charges following the 2017 death of a patient in her care.
Two years after the patient's death, Vaught was indicted by a Davidson County Grand Jury on charges of felony abuse of an impaired adult abuse and reckless homicide. If convicted, she could face up to 10 years in prison.
She 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 Tennessee Board of Nursing unanimously voted to revoke her nursing license last summer.
The first witness called on Thursday by the state was Donna Jones, a legal nursing consultant with 47 years of experience as a nurse. Jones is the prosecution's 16th witness.
Jones shared with the jury a report she prepared on this case. She listed all the ways she feels that Vaught failed to meet the standard of care for Murphey.
"Nursing 101 will tell you not to be distracted when you're administering medication," Jones said.
She testified that if Vaught didn't know the generic name for Versed, she should have looked it up.
Jones said if a patient scanner isn't available, don't administer the medication. Previous testimony revealed a scanner wasn't available on Vaught's hospital floor.
"If it's essential that the medication has to be given, double-check the medication with a second health care provider," Jones said. Despite the fact Vaught was told she didn't have to monitor Murphey, Jones said because Versed is a heavy sedative, it still should have been done.
Jones then showed the jury how reconstructing a drug works. Through the demonstration, the prosecution was attempting to show how Vaught may have seen the top of the vial that warned it was a paralytic. For a moment during the demonstration, Jones briefly misplaced the cap of the vial.
After this, the witness was passed to the defense.
Defense Attorney Peter Strianse led a tense line of questioning about how Vaught was told that Murphey didn't need to be monitored. Jones made the argument that the order not to monitor should have been disregarded as soon as Versed was prescribed.
Strianse then read a trade journal aloud that argues organizations should accept responsibility for medical failures. Jones said she emphatically disagrees with the article.
Jones and Strainse then got into a disagreement about the notion that a person doesn't have to have intent to be held criminally negligible.
"I know she didn't intend to do it. I know that," Jones said.
Strainse then mentioned that Vaught fully disclosed the error she made and participated in the investigation. However, Jones said she doesn't agree, before she listed everything Vaught admitted during the interviews.
After a short mid-morning break, the state rested its case. The jury was then excused for a moment as the defense filed a few motions, including a call for an acquittal. The court then went into another recess while Judge Jennifer Smith considered the motions. Ultimately, she denied the defense's motion for an acquittal.
Defense calls it's first witness
Leanna Craft served as the defense's first witness. She is a nurse educator at Vanderbilt University Medical Center.
Strainse asked Craft about the culture at VUMC. She testified that the hospital has a lot of younger nurses who are reliant on more experienced nurses for guidance. When asked if being a VUMC nurse is a "pretty demanding job" Craft responded, "I think so."
Craft testified that she worked with Vaught, describing the defendant as having a high maturity level given her age. Craft added that Vaught's experience was still relatively new when they worked together. She called Vaught a great nurse, testifying that Vaught developed a good relationship with family members of patients.
As many previous witnesses have testified, Craft reiterated the software issues that were happening with the pharmacy and medication system. Craft said patient-specific bins have required an override. Craft then described a situation when she couldn't find a needed medication in the Accudose system.
Craft spoke about how there wasn't a patient ID scanner in the PET scan area. She said VUMC has put a scanner in that area now.
In reference to the discussion about whether or not Vaught should have monitored Murphey while on Versed, despite a doctor ordering that it wasn't needed, Craft said as a newer nurse, Vaught would have relied heavily on doctor's orders.
Craft said Vaught was a "great nurse," especially given how new of a nurse she was. She added she developed a good relationship with family members of patients. There was discussion whether Vaught should have monitored Murphey — despite a doctor ordering it wasn't needed. Craft said as a newer nurse, Vaught would have relied heavily on doctor's orders.
Craft said, after Charlene Murphey's death, no changes were made at Vanderbilt until the CMS investigation began nearly a year later.
Shortly after those answers, the defense rested its end of the trial. The defense only called one witness instead of four.
Ultimately, Vaught waived her right to testify, with her voice only heard during the first day when an interview between her and the TBI played in court.
The judge recessed the court so council could discuss and agree on the terms of the jury instructions to move forward.
Closing arguments
For the prosecution, Brittani Flatt stepped up to the microphone for closing arguments.
"Ms. Vaught agreed to take on her care and provide her a sedative. She went to the AccuDose machine and was advised to locate and provide the drug versed. So she goes into the machine, and goes into her profile, looking for versed. But as you all know, the AccuDose defaults to the generic profile. Regardless, typing VE into the generic profile was going to give the generic drug as was given on the medical record. She didn't take the time to call the pharmacy. But when she typed it in, something popped up across the screen."
Flatt went on to say that Vaught thought it was odd it was in powder form. She iterated she didn't read the label or acknowledge the red warning that says, "paralyzing agent."
"The dispensing cabinet popped out and interestingly enough there was a warning label on top of the pocket," Flatt said. "She didn't see that. She goes into the cabinet, picks up the medication and tells Agent Smith she didn't read the label. She said she noticed it was a powder and that she turned it around to see the instructions. Interestingly enough, there are no instructions on the back of this vile to reconstitute."
Flatt said Vaught walked for five minutes with the bag and never took the time to look at it.
"As you heard from the testimony, versed can cause respiratory depression," Flatt said to the jury. "It's important to access and assess that patient and make sure they are OK and they can tolerate the medication. It would have been proper to do an initial evaluation of the patient. The defendant did no such exam and advised Ms. Murphey she was giving her something to relax."
Flatt said following the administration, Murphey said, "it burns."
"You have to stop," Vaught said. "She didn't stop. Without completing an assessment of her vitals or without monitoring her oxygen levels or waiting to determine if a second dose would be necessary, that didn't happen. The defendant left. There's been some confusion about the fact that Vaught left her with a PET scan tech. They aren't RNs and can't administer controlled substances or monitor one. The defendant abandons Ms. Murphey in the PET scan room."
Flatt said Murphey relied on doctors and nurses, such as Vaught.
"She knew what was required. That's no accident," Flatt said. "She had schooling. She had nursing training. For whatever reason, she just didn't do it."
Vaught held her head in her hands, audibly sobbing with her head against the table.
Strainse, her defense attorney, then addressed the jury for his closing statements.
"Vanderbilt controlled the narrative," he said.
Strainse brought up the fact that the TBI agent told Vaught she was glad that the former nurse was honest with her. Vaught replied she wasn't going to lie. Strainse also leaned on the argument that VUMC had medication errors previously that didn't result in a criminal trial situation.
"Common sense dictates they have enough medication events for three committees to deal with medication errors," Strainse said. "This isn't just to throw dirt on VUMC. They have to prove beyond a reasonable doubt this was reckless homicide. Remember, the burden of proof is beyond a reasonable doubt. We have dueling death certificates. I think to put it charitably, they are exercises in creative writing."
The second day of testimony comprised of the medical examiner, TBI agents, VUMC director of risk management and the VUMC medication safety director.
So far, the case has evolved around Vaught's usage of vecuronium and overriding the drug dispensing machine in an effort to retrieve Versed, the correct medication.
Terry Bosen, a pharmacist with VUMC who is the medication safety program director, said during the time of the event that labeling on the pockets for paralyzing agents gave an extra layer of warning to nurses when they remove it from the drug case.
"There's a pop-up message and another layer or warning that you're accessing a paralyzing agent," Bosen said.
Bosen held up to the jury what a vile of vecuronium looks like in size and packaging versus one of Versed.
The medical examiner Feng Li relayed to the jury his office ruled the death as an accident because there wasn't criminal intent.
