OH - Dr. William Husel accused of murdering 25 patients w/ Fentanyl Overdoses, Franklin Co, 2019 *not guilty*

  • #41
Motive: Enjoyed killing, enjoyed playing God, who knows.

JMO
 
  • #42
  • #43
I needed to dig a little to gain some perspective. This may be a case of serial homicide by a physician and medical staff, but there are some key components here that need to be brought up, IMO.

First, I found this article:

"Mariah Baird, 26, of Orient, is accused in the document of administering a lethal dose of fentanyl to 65-year-old Jan Thomas of the Far West Side on March 1, 2015, “knowing that such dose was grossly inappropriate.”

Since Oct. 2, 2017, Baird has been married to Dr. William Husel, 43, the physician at the center of a Mount Carmel Health System investigation into 34 near-death patients who were given excessive painkiller doses, all ordered by Husel, with all but six labeled by the health system as potentially fatal."


Per State Board of Nursing, I found that in this situation Mariah was issued her RN license on 10/8/2014. She had been a nurse for approximately 5 months, which doesn't necessarily mean she was practicing for that long depending on when she was hired, started, and trained to the unit (noting that she was not yet married to Husel, but does play into the workplace environment and professionalism or lack there of, IMO)

"knowing that such dose was grossly inappropriate" indicates experience to me and that is something she didn't have at that point. She was a novice nurse. This does not negate culpability.
Note that medication error is the #1 common mistake made by novice nurses.

Also, Studies have shown that Medication Errors is the THIRD leading cause of death in the US.

I would like to know more details in each case and circumstances which likely won't happen due to HIPPA.

Hey, Husel isn't looking good here, at all, and maybe he had a huge crew of like minded professionals that supported his alleged murderous intent, but I'm not sure of that. The media will portray that because it sells and the hospital lawyers may even find unsavory details of their pasts that will sway our attention from their potential bigger issue?

To me, it looks like a hospital that doesn't have safe guards in place to protect their employees or their patients. Everyone involved will pay, and sadly the patients and their families paid the ultimate price.

And it's not lost on me that it would be in the hospital's best interest to have Husel, some novice nurses, a few other RNs and pharmacists be the fall guys while the hospital makes all these stellar updates, replaces them, and moves on.


What is Mount Carmel Hospital doing to create a safe and high quality care environment?
What were the core safety measures in place regarding medication administration and tracking of potentially lethal drugs?
What protocols were in place to ensure patient safety since medication errors is known to be a top leading cause of death?
What parameters were in place to ensure that the medical professionals had safe guards in place for best practice?

MOO
 
  • #44
Also car break ins... It's so hard to weed out those that are truly remorseful about bad acts and those that are sociopathically manipulative (IMO).
"“Because of my poor decision making and giving in to peer pressure, I found myself spending time with people involved in criminal activity,” he wrote.

Federal court records detail how Husel participated in a series of car break-ins. He and another student were also convicted in connection with a pipe bomb that detonated in a trash can near a campus building. However, a presentence investigation report concluded that “they initially intended to detonate the pipe bomb under the vehicle of one of the students.”

Husel was sentenced to six months in a halfway house and one year of probation for his role in the crime." (snipped)

State medical board records detail criminal past of accused doctor
 
  • #45
While I was working, our medication computer system had safeguards for signaling issues with medications. We would have to override and give a reason for an unusual one-time stat dose of a med. Our pharmacists were amazing in catching things like wrong dose, overlooked allergies, drug interactions, etc and would immediately call us. The computer had also been programmed with proper dose parameters and it would kick out warnings to the MD, RN and pharmacist. It's been so long that I would have thought that these medication computer programs would be universal by now. We would scan the patient's arm band and scan the medicine. The computer would warn the nurse and program lock if she wasn't giving the appropriate medication. Also it's noted in the press that Husel would become angry when staff questioned dosage. There is a chain of command that we follow when we are concerned about an issue. Was there a breakdown in that chain?

Bugurl747, you make some excellent points regarding novice nurses and medication errors. That is one reason why I hate to see new nurses going into critical care areas. When I first began practice, we had to have at least one year under our belt before transferring to a critical care area such as the ER or ICU. It gave the novice time to recognize common meds, doses, and normal baselines. It also gave the staff the time to precept and evaluate the critical thinking and performance of the new nurse in a less critical situation and with more benign medications.
 
  • #46
While I was working, our medication computer system had safeguards for signaling issues with medications. We would have to override and give a reason for an unusual one-time stat dose of a med. Our pharmacists were amazing in catching things like wrong dose, overlooked allergies, drug interactions, etc and would immediately call us. The computer had also been programmed with proper dose parameters and it would kick out warnings to the MD, RN and pharmacist. It's been so long that I would have thought that these medication computer programs would be universal by now. We would scan the patient's arm band and scan the medicine. The computer would warn the nurse and program lock if she wasn't giving the appropriate medication. Also it's noted in the press that Husel would become angry when staff questioned dosage. There is a chain of command that we follow when we are concerned about an issue. Was there a breakdown in that chain?

Bugurl747, you make some excellent points regarding novice nurses and medication errors. That is one reason why I hate to see new nurses going into critical care areas. When I first began practice, we had to have at least one year under our belt before transferring to a critical care area such as the ER or ICU. It gave the novice time to recognize common meds, doses, and normal baselines. It also gave the staff the time to precept and evaluate the critical thinking and performance of the new nurse in a less critical situation and with more benign medications.

As you know, not all hospitals are created equal. There is a hospital in my area that is still doing PAPER CHARTING. It is a for profit hospital, a nurse can have as many as 8-9 patients, and the medication storage was akin to a big tool cabinet with one universal lock code for the entire cabinet. Med admin was so unsafe, it was unfathomable. They made the news, too. Understaffed, unsafe practice, financially unstable = increased hospital fatalities.

I think Doctor-Nurse relationships have improved over the decades but doctor intimidation and bullying is real and jeopardizes both nurses and patients. In my experience, there were a few physician's that used belittlement, humiliation, yelling, and passive aggressive tactics to try to silence you, the nurse. Numerous complaints were filed and those egos, I mean physicians, were required to go to charm school for civility training, positive personalities, leadership skills etc.

Patient advocacy requires nurses to support and protect their patients and their families. On the daily, nurses find themselves in ethically questionable situations that conflict with their personal and professional morals regarding patient's rights, conflicting loyalties, and highly charged situations involving life and death.

Speaking out for the patient and their families requires moral courage and a strong backbone. Not all can do that.

Hospitals are complex environments with so many dynamic variables. We will see what all comes to light with Mount Carmel Health, Husel, and the others.

Home Page

Mount Carmel Health System - Wikipedia


MOO
 
  • #47

My vote is Dr. Kervorkian's long lost cousin.

Seriously though, IMO, I do think he started doing this on his first few patients because he may have felt he was letting the person die peacefully and quickly. But somewhere shortly after that first one or two he became diabolical with a God complex and then he got way too carried away. Going so far as killing the wrong people even like the lady that came in with breathing issues only and really had pneumonia.

“She came to the hospital with shortness of breath and was diagnosed with pneumonia”

Attorneys say former Mount Carmel doctor might have inappropriately deemed patients brain-dead
 
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  • #48
  • #49
  • #50
They charged the dr, now charge the nurses who administered the lethal doses.
As an RN I would never administer IV fentanyl to anybody. That's the doctor's job.
 
  • #51

Wow.

This is an interesting situation because when you have a defendant that can actually afford a million dollar bail then it defeats the purpose of having such a large bail that there is no reasonable expectation the person will be out on the streets.

And if the Prosecution tries to get the judge to increase the bail to lets say 20 million or some crazy figure then the Defense can argue that other cases set a precedant for only a million or so.

Its quite the quandry.

I get worried when a murder suspect gets out for any reason and especially if they have a lot of money because now that person could make himself disappear in some far away land.
Uggggg
 
  • #52
As an RN I would never administer IV fentanyl to anybody. That's the doctor's job.

Fentanyl was the drug suspected to be placed into fake Vicodin that contributed to Prince's death.

Prince died after taking counterfeit Vicodin laced with fentanyl, prosecutor says

That stuff is very dangerous.

Fentanyl is also the drug that certain drug dealers are using to spike into heroin batches and its killing people everywhere.

"said Raymond Donovan, special agent in charge of the DEA's New York Field Office. "Fentanyl is the deadliest threat facing communities nationwide."

22 indicted on heroin, fentanyl drug trafficking charges with link to Mexican cartel
 
  • #53
As an RN I would never administer IV fentanyl to anybody. That's the doctor's job.

Not necessarily, I'm an RN and routinely give IV Fentanyl to patients in a PACU unit for post operative pain. This is absolutely within an RN's scope of practice. I've never had a Dr. give any pain medication themselves. Even if they are at the bedside they will give the order and the RN will administer the medication. However I would never even give 100mcg at one time not to mention 1,000mcg. I typically give 25mcg at a time to patients in severe pain while they are on a monitor and I am at the bedside throughout their PACU stay. We have Narcan in every PACU bay. I also have worked at facilities that used Fentanyl PCA's for pain control on a medical/surgical floor. The nurse set the PCA up to the dose the Dr. ordered and then gives the patient the PCA button so they can administer it themselves. I can't remember what the dose they were allowed but a PCA will lock the patient out after a certain dosage is given with a specific time period.
 
  • #54
Fentanyl was the drug suspected to be placed into fake Vicodin that contributed to Prince's death.

Prince died after taking counterfeit Vicodin laced with fentanyl, prosecutor says

That stuff is very dangerous.

Fentanyl is also the drug that certain drug dealers are using to spike into heroin batches and its killing people everywhere.

"said Raymond Donovan, special agent in charge of the DEA's New York Field Office. "Fentanyl is the deadliest threat facing communities nationwide."

22 indicted on heroin, fentanyl drug trafficking charges with link to Mexican cartel

While reading though the threads I was wondering if he was set up to be the fall guy ,or if the hospital pharmacy staff was switching real drugs out for fake ones . I have not got to a detailed article as of yet but I am definitely going to be following this as it goes to trial and really 24 charges and he gets out on bond?

I think if I was him I might consider becoming a doctor for the cartel. (if I was guilty )
 
  • #55
Nick was a drug addict with high tolerance that came in with AMS. How much did he weigh, was he obese?
Although not stated, it sounds like he was being sedated for intubation to be placed on a vent or the like and due to his high tolerance needed additional doses? Was the fentanyl an IV infusion?

If that is the case, the dosage is nothing like it would be in a PCA pump, or bedside setting via IV push, it is dosed as an anesthetic via continuous infusion ie: a 70-kg ( 154 lbs) patient would receive 700 mcg/hr fentanyl (see below)

**If they noticed respiratory depression after dosing why didn't they have Flumazenil the reversal agent for versed or Naloxone for fentanyl and dilaudid? Did they perform CPR?

James Nickolas Timmons, 39, of Hilliard, who went by Nick, arrived at the hospital on Oct. 22, 2018 with an altered mental status due to drug abuse. On Oct. 24, he was given 1,000 micrograms of fentanyl and 10 mg of Versed at 3 a.m. and 10 mg of hydromorphone and 10 mg of Versed after that. He died at 3:13

Here are the victims in the Mount Carmel criminal case


"Unlike most drugs, Versed dosages should be based upon the effect of the drug, rather than the weight of the patient. The dose should be adjusted based on the result of the initial dose, meaning that the patient should be given more or less of the drug based on how effective it is.

A patient's ability to tolerate alcohol consumption often gives a hint of their likely tolerance for Versed. Individuals who are a "lightweight" and become intoxicated easily may require less medication than someone who can "hold their liquor."

Surgery and Versed (Midazolam)


Drawbacks of prolonged fentanyl infusions

The recommended dosage of fentanyl is enormous.
The recommended infusion rate for fentanyl in the SCCM guidelines is 0.7-10 mcg/kg/hr. At the upper end of this range, a 70-kg ( 154 lbs) patient would receive 700 mcg/hr fentanyl, equivalent to 3,360 mg of oxycodone daily.

opium.gif

PulmCrit- Fentanyl infusions for sedation: The opioid pendulum swings astray?
 
  • #56
This guy isn't the first doctor accused of killing multiple patients. Here is another case, that guy supposedly just killed for the thrill of it. I suspect motive here could be similar.
Prosecutors Say Doctor Killed To Feel a Thrill
 
  • #57
Not necessarily, I'm an RN and routinely give IV Fentanyl to patients in a PACU unit for post operative pain. This is absolutely within an RN's scope of practice. I've never had a Dr. give any pain medication themselves. Even if they are at the bedside they will give the order and the RN will administer the medication. However I would never even give 100mcg at one time not to mention 1,000mcg. I typically give 25mcg at a time to patients in severe pain while they are on a monitor and I am at the bedside throughout their PACU stay. We have Narcan in every PACU bay. I also have worked at facilities that used Fentanyl PCA's for pain control on a medical/surgical floor. The nurse set the PCA up to the dose the Dr. ordered and then gives the patient the PCA button so they can administer it themselves. I can't remember what the dose they were allowed but a PCA will lock the patient out after a certain dosage is given with a specific time period.

While looking up info on fentanyl/versed/hydromorphone used for sedation in the ICU setting,
I came across PCA pump dosing :) IMO, there are a lot of details missing from the snippets we are getting from the news outlets. I am questioning if the order was IV push vs IV infusion related to possible sedation? MOO

PCA Dosing
  • Fentanyl 15-75 ug q3-10m
  • Dilaudid 0.1-0.5 mg q5-15m
  • Morphine 0.5-3 mg q10-20m
https://www.openanesthesia.org/analgesia_and_sedation_in_the_icu/

Patient-Controlled Analgesia (PCA)
 
  • #58
He was using "override function" to gain access to large doses of medication.
"And records released this week by state health inspectors – who conducted site surveys at Mount Carmel West and St. Ann’s hospitals – noted that the hospital “failed to ensure a system was in place to monitor and prevent large doses” of medication from being accessed via an override function on the hospitals’ medication dispensing machines."
'We are all hurting': Families of Mount Carmel patients say they’re reliving loved ones’ deaths
 
  • #59
He was using "override function" to gain access to large doses of medication.
"And records released this week by state health inspectors – who conducted site surveys at Mount Carmel West and St. Ann’s hospitals – noted that the hospital “failed to ensure a system was in place to monitor and prevent large doses” of medication from being accessed via an override function on the hospitals’ medication dispensing machines."
'We are all hurting': Families of Mount Carmel patients say they’re reliving loved ones’ deaths

Thanks @jjenny.
I was questioning whether the fentanyl was IV continuous or push.
Per the video it sounds like in many of the cases, the loved one was dying and that Husel accelerate their deaths.
Video in the link @ 02:06 states the Jim Allen received 1,000 mcg IV Push, Inject, Once.
It was heartbreaking seeing and hearing the families speak of their loved ones.
MOO
 
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  • #60
Thanks @jjenny.
I was questioning whether the fentanyl was IV continuous or push.
Per the video it sounds like in many of the cases, the loved one was dying and that Husel accelerate their deaths.
Video in the link @ 02:06 states the Jim Allen received 1,000 mcg IV Push, Inject, Once.
It was heartbreaking seeing and hearing the families speak of their loved ones.
MOO

Yes different to order 1000mcg of a continuous infusion than a 1 time IV push. I was under the impression the Fentanyl in these cases was given IV push because the article you shared earlier lists the times meds were given, for example it states that Ryan Hayes, age 39, was given 1000mcg Fentanyl at 10:53pm and then another 1000mcg at 11:15pm and then he died at 11:30 PM so I'm assuming he was given an IV push at those 2 times because if it was an infusion it wouldn't have been charted like that.

I will be very interested to see more that comes out about the nurses charting of these patients, for example what were Ryan Hayes vital signs between 10:53pm and 11:15pm? Was he on continuous monitors? Tele? Was he alert and oriented? Was a pain level documented at those times?

Just because Husel ordered these doses to accelerate death did not mean anyone had to follow his orders.
 

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