In two cases, errors made in caring for patients are being evaluated for criminal conduct, and one case has already resulted in criminal charges.
In Waukegan, Illinois, the jury at a coroner's inquest ruled a woman's heart attack death a homicide because, they concluded, she was made to wait too long for treatment at Vista Medical Center East. According to reports, 49-year-old Beatrice Vance presented at the ED with classic heart attack symptoms; she was registered and triaged within 15 minutes but was then left to wait-until she was found dead, approximately two hours later. Criminal charges are being considered by the state.
In Indianapolis, prosecutors have questioned but have not yet charged several Methodist Hospital neonatal ICU nurses and a pharmacy technician after three premature infants died of heparin overdoses. In that case, the pharmacy technician had accidentally stocked the unit with vials containing adult doses of the drug rather than infant doses. Six infants were given the incorrect doses; three recovered.
And in perhaps the most widely publicized case, a Madison, Wisconsin, nurse was charged initially with a felony, criminal neglect, after 16-year-old Jasmine Gant died during childbirth. The nurse, Julie Thao, a veteran labor- and-delivery nurse, mistakenly administered an epidural anesthetic by the iv route instead of an iv antibiotic, leading to Gant's death. Her infant son survived.
Thao pleaded guilty to two misdemeanor charges and was sentenced to two years' probation. While on probation, Thao cannot work in critical care areas, including labor and delivery. In addition, the state board of nursing suspended her license for nine months and restricted the number of hours she can work for two years thereafter.
These tragic cases represent what some fear is a trend to criminalize medical errors. If so, experts say, it may hinder the recruitment of new nurses and undermine error reporting and efforts to correct problems in the health care system that increase the risk of human error.
"It's safer for a nurse to help someone on the street than in a hospital," says Stephen Hurley, Thao's attorney, who contends that the criminalization of medical errors is a by-product of the "tough on crime" political era. "Fifteen years ago, criminalizing negligence was unheard of; there had to be some element of intent or willfulness [for charges to be considered]," he says.
Thao's prosecution was protested by members of the nursing and hospital communities and by related organizations, which say that the fatigue associated with working excessive overtime raises the risk of errors. Thao had voluntarily worked two back-to-back eight-hour shifts ending at midnight, spent the night at the hospital, and returned to the floor at 7 am before administering the incorrect medication to Ms. Gant just before noon.
Kathy Rapala, director of the Indianapolis Patient Safety Coalition and visiting associate professor at the Purdue University School of Nursing, says cases like these arise when people seek solace through scapegoating. (Rapala is the former director of risk management and patient safety at Clarian Health Partners in Indianapolis, the owner of Methodist Hospital, where the infants were given the adult dose of heparin.)
"Everyone's first inclination is to blame," she says. "The legal system is set up to find fault and place blame."
Rapala says that asking a simple question can help determine the best response to a medical error: "'Would [punishing the individual] protect the next patient from being injured?' Probably not. The nurse who made the error will never make it again, but others may. So what have you accomplished unless you fix the system?"
As a result of the Thao case, the Wisconsin Nurses Association is calling for increased awareness of the relationship between fatigue and errors and suggests that limits may have to be set on the number of hours nurses can work.
Rapala, Hurley, the Wisconsin Hospital Association (WHA), and the Institute for Safe Medication Practices (ISMP) all agree that cases like these may discourage people from pursuing a career in nursing. In a statement issued November 2, 2006, the WHA said that the prosecution of Thao "sends a chilling message to health care professionals."
In its own statement about the case, the ISMP said, "The goal of patient safety is better served by determining the system-based weaknesses that led to this error, sharing lessons learned with others, and taking action to prevent similar errors, rather than engaging in egregious criminal prosecution of a single individual."
"What we're telling nurses and all medical professionals," says Hurley, "is that we demand perfection. Combine that with the long hours and patient load, and it's a disaster waiting to happen."
Sibyl Shalo
World Health Roundup
* Higher nurse staffing in acute care hospitals in England significantly reduced rates of patient death and nurse burnout, according to a study by the Royal College of Nursing (RCN), which notes that the results are similar to those found by researchers in North America. Researcher Anne Marie Rafferty, whose study was published in the October 2006 issue of the International Journal of Nursing Studies, said in an RCN press release: "The number of lives that could potentially be saved through investments in nursing throughout [National Health Service] hospitals could be thousands every year."
* The World Health Organization's Collaborating Centre on Patient Safety (Solutions) will coordinate a five-year effort by hospitals in seven countries, including the United States, to prevent catastrophic events in patients. Known as the Action on Patient Safety, or High 5s, initiative, it will test evidence-based solutions to five common patient safety problems: wrong site-wrong procedure-wrong person surgical errors; high-concentration medication errors; errors in maintaining the continuity of patients' medications across providers; patient care handover errors; and hand hygiene problems.