Radonda Vaught Updates

Investigation: Former Vandy nurse admits she 'f----d' up, multiple overrides lead to death

NASHVILLE, Tenn. (WZTV) — The discovery from the former Vanderbilt nurse's patient abuse and reckless homicide case was returned Wednesday. 51 pages of documents and photos from the investigation detail the former Vanderbilt nurse's account of the "deadly error" and the warnings and red flags presented before the patient's death. The objects and documents from the investigation could be introduced as evidence.

Nashville nurse Radonda Vaught was part of the team providing treatment at Vanderbilt University Medical Center to Charlene Murphey on Dec. 26, 2017. Murphey died after inspection reports say Vaught administered a paralytic drug instead of a medication used to treat anxiety.

The shocking discovery includes a Tennessee Bureau of Investigation Request for Examination Report regarding a plastic bag containing one vial of Vecuronium Bromide, two syringes, one large alcohol prep pad, the former nurse's termination letter from Vanderbilt University Medical Center, and a summary of the alleged situation when medication was pulled by override function from the Accudose dispenser. More documents are being held by the state, but can be requested.

Former Vanderbilt Nurse's Interview with the TBI

In a statement to the Tennessee Bureau of Investigation, Vaught said she was working as the "Help All" nurse and that she was comfortable with the position and familiar with the Accudose machines. According to the TBI, Vaught said she had worked Dec. 25, 2017 and Dec. 26, 2017 on the 7 a.m. to 7 p.m. shift, but stated she was not overtired. Investigators noted that Vaught had a new orientation employee with her.

The Tennessee Bureau of Investigation report says when Vaught went to the Accudose machine to pull medication called "Versed" that was ordered for Murphey, she could not find "Versed" in the patient's file. Vaught claimed that she checked the Medication Administration Record in a different computer and found the order for Versed. Authorities say Vaught could not find the ordered medication in the Accudose system, so she overrode it and typed in "VE" then selected the first medication (Vecuronium Bromide) in the list. Vaught told the TBI the system asked for a reason to override, but she could not recall what she selected.

Vaught told the TBI she looked at the back of the vial and noticed it needed to be reconstituted. The TBI said she never looked at the front of the vial. The former nurse says she then went to the PET Scan Unit with the orientation employee to find Murphey and verbally verified who she was, but could not find a computer to scan the medication. Vaught said she reconstituted the vial, gave Murphey one milligram and left the patient with the PET Scan Unit tech. The TBI said Vaught never scanned the medication to put into the patient's medical record.

A code was called on Murphey and she was brought back to the NICU from the PET Scan Unit. Vaught said that's when she told a doctor and a nurse practitioner she had given Vecuronium Bromide to Murphey. She claimed their response was "I'm so sorry."

The TBI said in the interview, Vaught admitted to thinking, "I probably just killed a patient"; "What did I do to this patient if I didn't kill her?"; "What kind of life changing things did I just put this patient and her family through?"; "It's a horrible situation". Investigators said the former Vanderbilt nurse also admitted she had "f----d" up.

In court documents, the TBI notes that Vaught admitted she had never administered the paralyzing agent before and that she was distracted by talking to the orientation employee about a study they were going to do. In the TBI interview, Vaught reportedly said she should not have overrode the dispenser and claimed it is common to do so.

Sequence of Events for Override, according to court documents:

- Vaught pulls up patient profile in Accudose system and can't find medication prescribed by a doctor and reviewed by the pharmacy.

- Inspection reports say Vaught failed to contact pharmacy to confirm the medication order before overriding five times and avoiding five red flags from the system.

Warning #1: "Override medications should only be accompanied by STAT orders or when the clinical status of a patient would be significantly compromised by the delay that would result from pharmacist review." Court documents state this is when Vaught started the override by typing letters "VE" to search for Versed. Vecuronium bromide came up first on the list as the system searches by generic name, not brand name as the default. Court documents claim Versed is the brand name for medication Midazolam.

Warning #2: The system is believed to prompt users with a pop-up screen asking for a reason for the override with example justifications like: "Urgently needed such that delay might cause patient harm"; "Prescriber is physically present and can oversee administration"; etc. and states "PARALYZING AGENT" near the top of the list. Users must select a reason for the override and press another button to continue the override.

Warning #3: Screen returns to selected medication Vecuronium Bromide with a notation of "PARALYZING AGENT."

Warning #4: Another pop-up screen appears with an alert once the Vecuronium Bromide is selected warning it's a "PARALYZING AGENT."

Warning #5: User is asked to select the quantity of the drug. The top of the screen shows another warning for "PARALYZING AGENT" with a yellow caution sign and highlighted "Alert" on the screen.

Court documents claim Vaught also did not respond to five red flags from the time she was removing the paralyzing agent from the drawer to when she administered the drug to Murphey.

Red Flag #1: Vecuronium bromide comes in powder form as opposed to liquid form like Versed.

Red Flag #2: The cap for Vecuronium bromide is red and states "Paralyzing Agent".

Red Flag #3: Court documents say Vaught would need to reconstitute, meaning mix the powder form of the drug with saline and place it into a syringe, and the reconstituting process is not typically required for Versed.

Red Flag #4: To reconstitute the medication, Vaught would need to shake the bottle, which court documents say is not a process for Versed.

Red Flag #5: The former nurse would need to take a look at the red-capped bottle with the inscription "Warning: Paralyzing Agent" and syringe in order to draw 1 ML of medication to administer the dose, according to court documents.

Investigators say Murphey would have shown signs of Vecuronium intoxication, which would cause paralysis and respiratory failure within minutes after it was administered. The victim was left unattended when officials say she showed signs of the onset of respiratory failure.

"She should still be here"

Friends and family members continue to mourn the death of Charlene Murphey following the nurse's crucial mistake.

“My heart breaks for the family because it shouldn't have happened. She should still be here with us. Had they given her the right medicine, she's still be here today,” friend Joanne Riker told FOX 17 News in a Feb. interview.

Murphey worked at the Gallatin Walmart for more than 20 years and was an active member of Cottontown Baptist Church.

Nurses support Vaught

Vaught pleaded not guilty to patient abuse and reckless homicide charges in February.

"It's pretty clear that this is a mistake, not her fault and she will maintain her innocence," Vaught's lawyer Peter Strianse told FOX 17 News on Feb. 20.

Nurses from across the country have shown their support for Vaught. Some medical professionals believe criminally prosecuting the case is a slippery slope that could cause nurses to cover their mistakes instead of reporting them.

A Facebook page and GoFundMe were started to support the former Vanderbilt Nurse.

Statement from Vanderbilt:

“Because this is now a pending criminal matter, it would be inappropriate to comment at this time,” said John Howser, Chief Communications Officer, Vanderbilt University Medical Center.