Long hours contributed to fatal medical errors
Nurse escapes felony charge, but concern grows in the healthcare community over criminalizing errors

It’s every nurse’s worst nightmare.  After a series of mistakes that killed a patient last summer, Wisconsin nurse Julie Thao was charged with a felony.

No one doubted it was an accident when Thao took an epidural anesthetic from a drug locker before she’d received doctor’s orders, and later mistakenly injected it intravenously, instead of penicillin, into a teenager who was giving birth. The new mother died. Her baby survived.

Facing criminal prosecution for negligence, Thao took complete responsibility for her errors and later pleaded no contest to two misdemeanors instead.

Prosecutors agreed to drop the felony charge under pressure from nurses, doctors and hospitals, all of whom said unintentional mistakes should not be considered criminal offenses.

At a December hearing, Thao tearfully said she’d give her own life in exchange for the 16-year-old mother’s.

The former St. Mary’s Hospital nurse had her license suspended until April, was placed on three years of probation and was barred from working long hours for at least two years. State officials who decided the case said Thao’s long hours had contributed to her medical errors.

That’s precisely the issue, says Candice Owley, president of the Wisconsin Federation of Nurses and Health Professionals and an AFT vice president.

“We all make mistakes, and if we’re tired and work too many hours, we’re apt to make more mistakes,” she says, adding that one of the remedies in Thao’s case—not letting her work long hours—perhaps should be applied to every healthcare professional.

Owley has several other concerns that may foreshadow things to come:

• The whole movement to curb medical errors is based on sharing information, including errors. If you make a mistake and think you may be charged with a crime, you might be tempted “to lie and try to cover it up,” Owley says.
• If district attorneys in Wisconsin and other states pursue more such cases as felonies, it will have a chilling effect on the people willing to work in direct patient care, making the nurse shortage even worse. One solution may be to raise the threshold for criminal charges from “negligence” to “gross negligence,” as is done for drunk driving.
• The vast majority of errors require corrections to systems or procedures, not witch-hunts.

“To punish a nurse for making an unintentional mistake will not improve quality of care,” Owley notes.

In fact, it could worsen care. Thao had taken out the epidural medicine to anticipate doctor’s orders. “Anticipation is usually viewed as a good thing because it helps speed things along,” says Owley, adding that waiting for orders could bog down patient care.