Sometimes too much is too little

People shouldn’t go to prison for things they didn’t choose.

But she chose to disregard the warnings from the cabinet, and she chose to not read the label, and she chose not to monitor the patient, and a bunch of other choices that those in the medical field could explain better than I. Had she made the right choice in even one of those cases, the patient would have lived. This is not one wrong choice; it’s a whole string of them.

To find somebody guilty of a crime, you do have to prove intent - intent to do the act you did.

But it’s another issue whether your intentional act led to the outcome you intended. If we limit ourselves to only finding criminal behavior when somebody intended the result, we risk creating a standard where people aren’t incentivized to act carefully or avoid recklessness.

Imagine a person decides to engage in target practice in their backyard; they have every intent to shoot their target, but simply don’t bother to worry about what they might hit if they miss the target. Are we really going to just let them avoid criminal liability if they end up shooting the neighbor while he’s walking his dog?

What about a guy who thinks it’s great fun to see how fast he can actually drive his car, and figures it’s easiest to do on a residential street? Are we really going to refuse to hold them criminally liable if they take out some pedestrians because they really thought they had the car under total control when they approached that turn?

What about the guy who decides that dynamite is the best way to clear out the underbrush in his backyard? I mean, maybe it might send shrapnel flying, but he doesn’t think it will. Does that then absolve him of the consequences of his plan?

In society, we don’t just expect people to not try to hurt each other. We’ve also decided to demand people behave carefully enough that they don’t endanger others because they didn’t bother to care.

For recklessness, we sue them or impose other sanctions, such as taking away a license, etc.

In most areas, discharging a firearm in city limits is a crime. Thus you had the intent to break the law. Thereby you can be held criminally liable for the results. Now if you are out in areas where hunting is legal, and your round hits some other person by accident, that is almost never held to be a crime. We even had a Vice President shoot someone by accident.

Same holds for your other examples.

So, I’m an engineer and part of my job when deciding on the design of the equipment is to make sure that it can and will be used safely.

Part of good design is making sure warnings are NOT overused and, sometimes, you need to come up with systems that aren’t immediately obvious. I currently work on paint processing equipment but, in the past, I helped with a project in install automatic guided vehicles (AGVs) which are basically robot forklifts. Usually, when you have AGVs where humans might be, you have them beep when they move to announce their presence so that the humans know where they are. This became a problem for this project because we had 6 AGVs and they were moving basically constantly and beeping all the freaking time. It was cacophany and, instead of the humans being aware of the AGVs, they tuned out the warning system. And an operator did get contacted by an AGV (but not hurt, thank goodness). What made sense to the experts and the engineers on paper did not make sense in real life. I am not 100% sure what they did to fix that problem because I left that job before anything else happened.

But I take the lesson in this anyway. One - warnings only work if they don’t become routine. Two - you need to have awareness of how your stuff will actually work in the real world and adapt your design if it doesn’t work how you intended it to.

I’d be interested in reading your opinion on the case.


I’m pretty sure every state has some form of criminally negligent or reckless homicide. And whether someone gets charged with it is going to depend on the specifics of the case. As far as I know Alec Baldwin was not arrested for the “Rust” incident - but that doesn’t mean that a firearms instructor who spent years teaching firearms safety* wouldn’t be charged if he killed somebody by firing a weapon he said thought was unloaded or hit his neighbor while target shooting in his backyard where discharging a firearm is legal. In fact, people have been charged with some form of homicide for not securing firearms, even though the person charged didn’t fire the fatal shot.

You might not think we should jail people for negligence or recklessness - but society as a whole does not seem to agree.

* There are different versions but all that I have seen and heard include these:

  1. Treat every gun as a loaded gun
  2. Don’t point the muzzle at anything you don’t intend to shoot
  3. Know your target and what is behind it

Sure. To begin with, I defer to the jury in this case, there was an RN and a respiratory therapist on the jury, and they convicted. Very well.

Based on what I read in the last couple of days I don’t think I would have, perhaps they know something I don’t, perhaps I know something they don’t.

Caveat: I’m a bedside nurse working for a large, for-profit healthcare corporation, and I have some bias about the way they present themselves to the community and the way they actually behave (their actions in this case, to me, are as good as an admission that their safety protocols were flawed).

This is a complicated case and I’m getting a lot of my opinion from this timeline and its embedded links.
The RaDonda Vaught case is confusing. This timeline will help. (
The links are to, in order of occurrence, the anonymous tip to the state and the feds (the hospital did not report in the way they are required to), to the letters from the Tenn nursing board to the nurse and the hospital, and to the corrective action plan struck between the hospital and the feds. The corrective action plan is long, redundant, and has a lot of step by step details about what happened that day.

Couple of interesting points, the anon tip is very thorough and specific, whoever wrote it had seen the post event analysis, they weren’t someone who just heard about it in the breakroom. Also, the letter from the Tenn dept of health to the hospitals’ Chief Nursing Officer (I think), in explaining that they won’t be pursuing action against the nurse’s license, concludes with the statement “We appreciate you notifying our office of your concerns, and while the outcome may not have met your expectations, please be assured that a legal assessment was made based on the statutes and rules governing this profession.” Italics added because I find this odd.

Shortly after this, the feds arrive for an unannounced audit, the corrective action plan that resulted included changes to the automatic medication dispenser, as well as changes to the transport and monitoring policy. Any one of which probably would have prevented the outcome, had they been in place at the time.

Some timeline details. The patient was already in the Radiology dept. they were the ones to obtain the order for sedation. The primary nurse (who was not Vaught) told radiology they could not come but would send another nurse and that the pt would not need to be monitored. Vaught, who was on her way to the ER, was asked to stop by radiology, gave the drug and left, the pt was moved into a holding area, and later was discovered unresponsive.

I did not see a statement from Vaught as to whether or not she believed the someone in radiology would be monitoring the pt, but the corrective action plan suggests to me that there was ambiguity in the chain of responsibility.

Blah, that’s enough for tonight, I’ll answer questions, if people have them.

I did a tour of a factory/warehouse about a decade ago, and rather than expect humans to heed the warnings, the robots had sensors that detected humans. If there was one in its operating area, it would cease all movement, and then, in a surprisingly condescending tone for a robot, would say, “Please move, you are impeding progress.”

The ones in that plant had those sensors too but they were made to move too quickly that, if a human was unexpectedly detected, they could not reliably stop in time. There was a lot of complicated factors that had to do with how the sensors worked and the product they were transporting. (They got a lot of nuisanse trips on the product spills that the AGVs would have been fine to drive over.)

I didn’t know about that. So as to the mistakes the nurse was culpable for,

  • was distracted by a colleague (I think I read trainee?) when at the medicine cabinet
  • overrode the medicine cabinet’s safeguard (SOP at the time)
  • ignored four warnings at the medicine cabinet (SOP at the time)
  • didn’t notice she had the wrong drug when she had to reconstitute it
  • didn’t check label before administering
  • didn’t take notice of the warning on the top of the vial
  • didn’t monitor patient after administering (primary nurse told her not to?)

And this is the warning on the vial cap she missed, or didn’t notice the significance of:


Thinking about looking at the cap versus the label, I am reminded of a recent movie


I’m not a nurse. But there were so many opportunities to catch this before it turned tragic. The first being that the provider ordered versed, and it wasn’t in the med safe that way. Provider should have ordered midazolam. Should the nurse have known the generic? Nurses aren’t pharmacists, and it shouldn’t rely on them memorizing the generic / trade names. The med safe should have cross referenced the trade name/ generic. I don’t know if it did, but it should have.

The systemic issue seems to be the need for routine overrides.

I have also heard (no idea if it’s true) that the charge nurse told Vaught not to chart the med error. Again, I am not a nurse, but everything should be charted. If the charge nurse was trying to hide that, to me that’s a bigger deal. Med errors happen, it’s tragic, but they happen. By not charting you are tampering with a legal document. If it’s hidden, it can’t be audited for fixing the system.

The nurse did not verify the label, and in the photo above missed the warning on the cap.I think the nurse is absolutely at fault of the med error, and should probably lose her license, but she should not be charged criminally.

Sorry if I was unclear, I understood that conversation to have been between the primary nurse and one of the radiology staff. What Vaught was told I don’t know.

Thank you for your expert thoughts.

Was this nurse not violating the law when she dispensed a drug to a patient for whom it had not been prescribed? That error led to a death, ergo she can be held criminally liable for the results, regardless of her lack of intent (presuming recklessness in her conduct, which I think is evident here)

In that case, never mind the last strikethrough.

^ yes, thank you for looking at it.


Negligence, Gross Negligence, Recklessness, Intent. Four degrees of fault from least to most culpable. Generally negligence is not punished criminally. Gross Negligence may be if very serious harm results. Recklessness and Intent almost always are.

What I have seen in my short life is the shift in attitude to define something as a greater in culpability than in was prior. I’ve seen DUI go from negligence to gross negligence to recklessness to a middle state of depraved indifference. Cell phone use while driving went from being a-okay, that is what they are designed for, to negligence, then gross negligence, then recklessness.

The attitude seems to have shifted to “Someone is dead, so someone has to pay.” I’m sort of on the fence about this, but I really hate to see someone go to prison who by all accounts isn’t someone that you would worry about being out walking the streets. Maybe or certainly not a nurse anymore, but not a felony conviction.

I concur. America imprisons too many people anyway.

In cases like this, there are other sanctions that could be applied.


The nurse in the story was sentenced to three years probation – no jail time.

Not trying to sidetrack the thread, but here’s an article I ran into this morning that reminded me of this thread and I thought it would interest folks.
A nurse was just sentenced to 3 years of probation for a lethal medical error
It raises the question - are we losing good nurses because of things like this?