Opinion | Prosecuting a Nurse for a Medical Error

Jennifer E. Engen

To the Editor:

Re “When Does a Nurse’s Mistake Become a Crime?,” by Daniela J. Lamas (Opinion guest essay, Sunday Review, April 17):

While systems absolutely need to improve to prevent medical errors, we must not ignore one of the most pertinent contributors to errors that Dr. Lamas alludes to several times: “overworked doctors and nurses” who are “juggling multiple high-stress tasks.”

People want to have affordable access to excellent health care. And we want our nurses and doctors to be healthy, well rested and focused on us. So why do we expect them to take care of so many patients and for such long hours? Why do we work them to their breaking point? The answer: the bottom line.

Yes, we need systems checks for all procedures. We also need nurses and doctors who have time to listen to and evaluate our patients, and time to consider diagnostic and treatment plans. For this to happen we must stop thinking of health care as a profit producer for insurance companies, pharmaceuticals and health care corporations.

We must prioritize human health, not corporate wealth. The health of all of us is at stake: patients, doctors and nurses.

Nancy Bermon
Nyack, N.Y.
The writer is a family physician and assistant professor at the Center for Family and Community Medicine, Columbia University.

To the Editor:

As graduate students in nursing, we learn multistage checks for medication safety, performed under the intimidating eyes of our clinical instructors. At my institution, we watch a heart-rending video of a parent describing the pain of losing their child to a medication error, an educational experience that leaves students terrified — at best — and more often traumatized. We come to work exhausted from studying and terrified of committing the same mistakes that now surely haunt RaDonda Vaught, the nurse who administered the wrong medication and was convicted of negligent homicide.

As Dr. Daniela J. Lamas noted, this terror inculcates an attitude of constant vigilance and personal responsibility that exhausts and reduces critical thinking, as numerous studies on toxic stress have shown. Still, the medical system has no answer for managing the immense responsibility of this role and the need to fail safely as part of the learning cycle.

Without a systemic response to well-documented drivers of medical errors and workarounds, such as high patient-to-nurse ratios and the inequitable liability for such errors thrust upon the registered nurse, we will see more experienced nurses leave the field.

Mags Hines
Oakland, Calif.
The writer is a student at the U.C.S.F. School of Nursing.

To the Editor:

Dr. Daniela J. Lamas’s endorsement of better systems to reduce medical errors is right on target. For example, the now universally performed operating room “time out,” a brief pause before the start of surgery to confirm that the correct procedure is about to be done on the correct patient and to allow anyone in the operating room to express any concerns, has greatly reduced wrong-site and other avoidable surgical errors.

However, there is another reality that must be pointed out and strongly emphasized when adjudicating medical errors: Health care professionals are human, and where humans are involved errors will inevitably happen. When human error becomes a criminal offense, we are all in trouble — and not just in the area of health care delivery.

Mitchell Stein
Scarsdale, N.Y.
The writer is an ophthalmologist.

To the Editor:

Re “The Unseen Scars of the Remote-Controlled Kill” (front page, April 17):

The evolution of military weaponry has to become more destructive, more indiscriminate and remotely impersonal. The catchphrase “destroying the enemy’s will to fight,” often accompanied by dehumanizing propaganda, became the justification in World War II for large-scale destruction of nonmilitary targets and mass killing of noncombatants. It was possible because it was accomplished remotely, impersonally.

But drones have made warfare personal, have humanized the enemy, have challenged the operator’s sense of morality, often destroyed his self-image, and — in Capt. Kevin Larson’s case, told in the article — taken his life.

Unfortunately, we have come to accept it as just another casualty of war.

K. Neal Snyder
Columbus, Ohio
The writer is a retired Air Force colonel.

To the Editor:

Re “The Culture Wars Have Gone Global,” by David Brooks (column, Sunday Review, April 10):

After several decades in which pundits have been selling us on globalization’s democratizing magic, it turns out that much of the world is busily rejecting Western values. But this should come as no surprise.

The world is big. It’s filled with the diversity the West claims to value. As globalization advances, it naturally adapts to the culture — and the values — of the country embracing it.

To assume that China, for example, would somehow become more like the West and embrace its democratic values as a response to globalization ignores the power of culture and reflects a Western bias.

Just because our values have been rejected somewhere doesn’t mean that globalization is dead. Technology ensures that globalization will continue to advance, but its advance will be independent of our values, and according to the values of the cultures participating in its march. The failure of globalization, if there is any, is in the West’s presumption that globalization look and feel Western.

The irony is that the word “globalization” itself implies an embrace of all things and many ways, not just the Western way.

Dean Foster
Brooklyn
The writer is the founder and president of Dean Foster Global Cultures, a consulting organization for business working globally.

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