First Healthcare Compliance CONNECT November 2022

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Automatic Dispensing Cabinets & the Case of RaDonda Vaught: Q&A Catherine Short Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX, has a unique background, having worked in many different facets of healthcare, securities, cybersecurity, as well as international law and business throughout her career. Her practice focuses on a variety of cybersecurity, health care and securities law, False Claims Act and Dodd- Frank matters and issues related to compliance, transactional work, litigation as well as representing persons before government agencies. As a member of the First Healthcare Compliance Editorial Council, Rachel is a frequent presenter at educational events. For more information regarding this topic please view the related webinar for further discussion and learning. Below, Rachel answers some common questions and provides explanations related to the education surrounding Automatic Dispensing Cabinets, Patient Care, and the Case of Nurse RaDonda Vaught. Can you describe what exactly is an Automatic Dispensing Cabinet and what does it hold? Fundamentally, an Automated Dispensing Cabinet, which is also known as an ADC, is essentially a drug storage device. It typically electronically dispenses medications or different types of scrubs, for example, or other items that you may see in the operating room or in the emergency room. The alleged benefit is to dispense these items in a controlled fashion in a way that normally integrates with an electronic health record system, or with a procurement software within a hospital, that then tracks the use and has almost a real-time data so that the staff can know when to replace or when a supporting traditional unit dose delivery system may need to be utilized. The other type of dispensing cabinet does not hold pharmaceuticals or drugs. Rather, it holds items that a nurse or a physician would use during surgery or in the emergency room such as sterile suture packs or gauze. What are some important things to know about an ADC? Medications are dispensed in a controlled fashion. ADCs are not new. In fact, they came in to being in the 1980s. And then by the 1990s, their use was very prevalent. Having said that, their safety and 8 Panacea Healthcare Solutions LLC © 2022
efficacy began to be studied. And the studies that came out even 20-30 years ago, are still relevant today because of some of the safety and patient care issues that were highlighted at that time. For example, the mislabeling of drugs, the improperly filling of dispensing cabinets, the lack of safety record procedures, numbers of doses dispensed, and the ability to override system access tracking. Today, now more than ever, and especially with the advent of the HIPAA Security Rule, which has been in effect since 2005, and then we now have the HITECH Act, in effect, the HIPAA Omnibus Rule, and then we have other laws and the related regulations as well, such as the Cybersecurity Act of 2015, all of which espouse the requirements of having adequate technical, administrative, and physical safeguards. One of the most fundamental safeguards is user ID and unique user password. There should be for every individual accessing a cabinet, there needs to be an individual user ID and password. Alternatively, some types of these devices use a biometric or fingerprint. And from there, organizations really need to look at two-factor identification. These are areas which can create significant liability, not only from a cybersecurity standpoint, but more importantly, from a patient care standpoint, which is one of the issues in the RaDonda Vaught case. Tell me about the role of the Automatic Dispensing Cabinet and the facts of the RaDonda Vaught case? What’s interesting is that there was a quote that was made by her attorney that said, while it’s not all her fault, meaning all his client’s fault, there are some real systemic problems with the way a medical center dispenses medicine through the automated dispensing systems. And so, in this case unfortunately, the nurse, the defendant, did have personal errors. It wasn’t solely the fault of the ADC. However, there were a lack of technical, administrative, and physical safeguards, there was a lack of check and balance. And that led to Ms. Murphy the patient, dying as a result of this error. So, our players in this case are Ms. Murphy, the deceased patient, RaDonda Vaught, the nurse and defendant, Vanderbilt University Medical Center (“Medical Center”), the district attorney, who The Most Comprehensive Healthcare Compliance Course The Fundamentals is a user-friendly, four-module online course designed to help healthcare professionals understand the essential principles and practices of compliance. BUY COURSE NOW Contact Toll Free: 888-54-FIRST 9
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