NASHVILLE, TENN. — Former Nashville nurse RaDonda Vaught launched a paid national speaking tour for healthcare professionals in early 2023, beginning with an address to hundreds of industrial professionals at a meeting organized by TapRooT, a Knoxville-based company that specializes in root cause analysis. Vaught was convicted of negligent homicide and neglect of an impaired adult after dispensing the wrong medication to a patient at Vanderbilt University Medical Center in 2017.

She was sentenced to three years of probation and lost her nursing license. After about a year on probation, she began receiving offers to speak to medical audiences, and last year she told her story more than 20 times. Vaught is paid $5,000 to $10,000 per speaking event.

"It wasn't something that I wanted to happen. It wasn't even something that was on my radar to think about," Vaught said of the speaking requests. She said she hopes that healthcare professionals in an era of automation and artificial intelligence can understand the multiple factors that contributed to the deadly medication mix-up.

The patient who died, Charlene Murphey, had been ordered a sedative called Versed by a doctor to settle her claustrophobia before an imaging procedure. Vaught typed "VE" into the search function of an electronic medicine cabinet to retrieve Versed, and when the drug did not dispense, she overrode the system. During a hospital technology upgrade, nurses could use overrides to bypass delays, court records show. One of the drug options available after the override was vecuronium, a powerful paralytic. According to court records, Vaught overlooked multiple warnings about the danger of vecuronium, including a bottle cap label that said "Warning: Paralyzing Agent." She administered the drug and left the patient alone.

Vaught pleaded not guilty to all charges, claiming factors such as a new electronic health record system were causing widespread problems in the hospital. A lead investigator for the prosecution testified that the medical center also shared some responsibility. Vanderbilt University Medical Center did not initially report the error to regulators and told the medical examiner that the patient died of natural causes. The medical center fired Vaught and negotiated a settlement with the Murphey family that prevents the family from speaking publicly about the death. Vaught is not bound by that settlement. A spokesperson for Vanderbilt University Medical Center declined to comment about Vaught's public speaking or what the medical center learned from the incident.

"RaDonda speaking the way she is, she literally is transforming her mistake into a teaching moment," said Charlene Verga, who has attended the talks. "I've seen her a few times now in person, and I've never seen RaDonda tell the story and not be upset," Verga said.

"It put a stain on a proud and dedicated profession," retired nurse Gary Wood wrote in an email after Vaught's story aired. The two largest companies that make drug-dispensing cabinets, Omnicell and BD, have updated their machines with recommendations from the Institute for Safe Medication Practices. One update requires users to type more than the first two letters of a medication to pull up a list of options.