May 13, 2022
The Institute for Healthcare Improvement (IHI) and the
IHI Lucian Leape Institute (LLI) share our deepest sympathies with the family of Charlene Murphey for their tragic loss. While we are relieved that Ms. RaDonda Vaught did not receive a prison sentence, we remain disappointed and deeply concerned about the criminalization of error in medicine, which offers no remedy for improving patient safety. In fact, Ms. Vaught’s arrest and conviction makes patients less safe.
Criminalizing medical error creates a culture of fear that is antithetical to the openness, transparency, and learning that are necessary to keep patients safe in all health care settings. Most errors in health care are caused by system failures and preventing medical errors therefore requires proactive identification and action to address system faults, not criminalizing providers.
Decades of work on how best to respond to medical errors, specifically those that result in harm or even death, have revealed a clear set of actions that providers can use to effectively respond to the pain and suffering of the victim and their family. Crucially, an effective response to medical errors when they occur also generates learning and demonstrates accountability, both of which are essential to improving systems and preventing errors in the future.
Given this and other setbacks to safety in health care in recent years, we re-dedicate ourselves to partnering with patients, families, and providers everywhere, in building a better, and safer, future.