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Doctor allegedly ordered potentially fatal doses of pain medication for near-death patients

  

Category:  News & Politics

Via:  perrie-halpern  •  5 years ago  •  41 comments

Doctor allegedly ordered potentially fatal doses of pain medication for near-death patients
The case raises questions about whether there was an intentional or possibly illegal use of the drugs to accelerate deaths.

S E E D E D   C O N T E N T



By   Associated Press

COLUMBUS, Ohio — An intensive care doctor ordered "significantly excessive and potentially fatal" doses of pain medicine for at least 27 near-death patients in the past few years after families asked that lifesaving measures be stopped, an Ohio hospital system announced after being sued by a family alleging an improper dose of fentanyl actively hastened the death of one of those patients.

The Columbus-area Mount Carmel Health System acknowledged the doses were larger than needed to provide comfort for dying patients. That raises questions about whether there was an intentional or possibly illegal use of the drugs to accelerate deaths.

The system said it has fired the doctor, reported findings of an internal investigation to authorities and removed 20 employees from patient care pending further investigation, including nurses who administered the medication as well as pharmacists.

Mount Carmel said the situation came to light because an employee reported a safety concern. The health system shared no information about what might have prompted employees to approve and administer the excessive dosages.

"Regardless of the reason the actions were taken, we take responsibility for the fact that the processes in place were not sufficient to prevent these actions from happening," Mount Carmel President and CEO Ed Lamb said in a video statement . "We're doing everything to understand how this happened and what we need to do to ensure that it never happens again."

The attorney who brought the lawsuit said, in that case, either layers of safeguards repeatedly failed to flag a "grossly excessive" dosage of fentanyl, or the medical professionals intended to accelerate the death of the patient, 79-year-old Janet Kavanaugh.

"On balance, it's hard to believe the former occurred rather than the latter. ... This is not just a simple situation of an error," lawyer Gerry Leeseberg said Tuesday.

The lawsuit was filed Monday in Franklin County against the health system, a pharmacist, a nurse and the doctor, whom it identifies as William Husel.

Case records listed no attorney yet to comment on Husel's behalf. There is no public personal phone listing for him, and other numbers linked to him weren't accepting calls Tuesday.

Husel's case emerges amid a national debate over physician-assisted death. In such cases, physicians prescribe medications in life-ending amounts to terminally ill patients.

Five states — California, Oregon, Vermont, Washington and Colorado — allow the practice, and 20 have considered but not passed legislation to do so, according to the nonpartisan National Conference of State Legislatures. A Montana court also legalized it there, though there's no regulatory framework in place. In Ohio, the practice remains illegal. A bill that would have allowed terminally ill, mentally competent patients to self-administer a prescription to end their lives failed to gain traction in the last legislative session.

But Joe Carrese, a faculty member at the Johns Hopkins Berman Institute of Bioethics, said that such laws are carefully crafted. He said that if Husel administered lethal quantities of drugs to unwitting patients in order to end their lives, his acts didn't meet the definition of physician-assisted death.

"In this case, if that was the intent, this was essentially euthanasia, which is not legal anywhere in the United States and not at all the same as physician-assisted death," he said.

Franklin County Prosecutor Ron O'Brien confirmed that his office has met with doctors, hospital executives and attorneys and that an investigation is underway, but he wouldn't discuss details. He said they've received cooperation from Mount Carmel, which operates four hospitals around Columbus, and from parent organization Trinity Health, one of the country's largest Roman Catholic health care systems.

Records show the State Medical Board in Ohio has never taken disciplinary action against Husel. It's unclear whether that board ever received a complaint or conducted an investigation about him, as such records are confidential under Ohio law, and outcomes are made public only if the board takes formal action.

Husel was a supervised resident at the Cleveland Clinic from 2008 to 2013, according to a statement from the medical center. It's now conducting an internal investigation of his work, but it said a preliminary review found that his prescribing practices were "consistent with appropriate care provided to patients in the intensive care unit."

Carrese, from the bioethics institute, commended Mount Carmel for encouraging a culture in which medical staff and other employees can come forward without fear, but he said the extent of the allegations is concerning.

"The fact that there may be other patients, up to 26 other patients, really calls into question whether the culture of safety and reporting that they're shooting for, whether there's more work that needs to be done," he said.

The allegations carry echoes of prior Ohio cases in which patients were killed.

Nurse's aide Donald Harvey, dubbed "the Angel of Death," claimed responsibility for killing more than 50 people in Cincinnati and Kentucky hospitals during the 1970s and '80s, mostly by poisoning. Many were chronically ill patients, and Harvey claimed he was trying to end their suffering.

Admitted serial killer Michael Swango, the former physician dubbed "Dr. Death," pleaded guilty to killing four people, including one while interning at an Ohio State University hospital, and was believed to have poisoned dozens as he moved between hospitals in various places.

Leeseberg, the attorney in the Mount Carmel lawsuit, said an important difference in this case is that multiple people were involved in the patients receiving the drugs.

"The pharmacist has an obligation to question an order, and the nurse has an obligation to question the order as well," Leeseberg said. "All of those safeguards were overridden or ignored. It's like nothing I've ever seen."

Associated Press reporters Julie Carr Smyth and Andrew Welsh-Huggins in Columbus, Mark Gillispie in Cleveland, John Seewer in Toledo and Dan Sewell in Cincinnati contributed to this report.



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Perrie Halpern R.A.
Professor Principal
1  seeder  Perrie Halpern R.A.    5 years ago

This is an interesting case or life termination. I am not sure if these people were aware or not, and for me that makes a difference. I just watched my mother in law die a slow and painful death, and I know I wouldn't want to go through that. But who has the right to ask for this and who does not, I think is the ethical issue here. 

 
 
 
nightwalker
Sophomore Silent
1.1  nightwalker  replied to  Perrie Halpern R.A. @1    5 years ago

I think the choice should always be the patients, the ones doing the suffering. I disapprove of Hospitals forcing you to stay alive just so they can use all their meds and machinery. The encouragement they hand out is "they could find a treatment or a cure for your condition any day now" and "you can still beat this" is hollow, even if they found a cure in the next five minutes you'd be long dead before it's available.

When I exit, I want to be remembered for the time I drank a few beers while camping and on impulse took my shirt off and ran around the camp yelling "I'm a werewolf!" and howling at the moon and pinching the girl's butts as a werewolf attack, then THEY ran around howling and pinching other people's butts until EVERYBODY was infected and running around until we all ran out of breath. It's hard to catch your breath while laughing, know what I mean?

Or be remembered for a bunch of other things I've done sane or insane (or plan to do in the future) like the time a bad barber gave me a haircut so bad, I had a cowlick on BOTH sides of my head and my friends accused me of getting it that way on purpose to hide my horns, then as a 95lb slab of wasted flesh with raccoon eyes, hallow cheeks and looking like I'm down to my last four red blood cells while wearing a Walmart stocking cap and have friends and family marvel at all the wonderful machines and tubes I'm hooked up to.

There should come a time, when everybody knows you will not recover from your illness or disease and everyday is a hazy sea of misery and pain that's only going to get worse that you should be allowed to take a shortcut to the end of your story when you've just had enough.

Does that sound cruel to anybody?

 
 
 
Perrie Halpern R.A.
Professor Principal
1.1.2  seeder  Perrie Halpern R.A.  replied to  nightwalker @1.1    5 years ago

Great post. I have to agree with you. Existing is not the same thing as living. 

 
 
 
Gordy327
Professor Expert
1.3  Gordy327  replied to  Perrie Halpern R.A. @1    5 years ago

HI Perrie, my condolences on the loss of your mother in law. When it comes to near end of life care, ideally the patient should make that decision, preferably with personal consent or Advanced Directives. Their family should also be made aware and respectful of the patient wishes in such matters. If the patient cannot or has not made such decisions, then it falls to the family to make the decision. But emotions can run high in such circumstances and they may not make the best choice for the patient. That said, there is nothing wrong with assisted suicide by itself.

 
 
 
Perrie Halpern R.A.
Professor Principal
1.3.1  seeder  Perrie Halpern R.A.  replied to  Gordy327 @1.3    5 years ago

Hi Gordy, 

I do have an advanced directive and my family members know about it. I have no issue with assisted suicide. It's a heck of a lot better than what I witnessed first hand. 

 
 
 
Gordy327
Professor Expert
1.3.2  Gordy327  replied to  Perrie Halpern R.A. @1.3.1    5 years ago

I've always said, there are some things worse than death. For both the patient and family.

 
 
 
sandy-2021492
Professor Expert
1.4  sandy-2021492  replied to  Perrie Halpern R.A. @1    5 years ago

I'm sorry for your loss, Perrie.

 
 
 
epistte
Junior Guide
1.5  epistte  replied to  Perrie Halpern R.A. @1    5 years ago
This is an interesting case or life termination. I am not sure if these people were aware or not, and for me that makes a difference. I just watched my mother in law die a slow and painful death, and I know I wouldn't want to go through that. But who has the right to ask for this and who does not, I think is the ethical issue here. 

If the families knew of and supported this Drs actions and the patients themselves had a DNR then I would have a hard time finding this man guilty of murder because I support assisted suicide/euthanasia. 

 I told my mother about this story when I visited her because she got her nursing degree from Mt Carmel in the early 1950s. 

 
 
 
sandy-2021492
Professor Expert
1.5.1  sandy-2021492  replied to  epistte @1.5    5 years ago

My cousin works at Mt. Carmel.  She takes pics of newborns at several hospitals in that area.

 
 
 
igknorantzrulz
PhD Quiet
2  igknorantzrulz    5 years ago

i just made an appointment

to 

the thunderous applause of many round here

 
 
 
Perrie Halpern R.A.
Professor Principal
2.1  seeder  Perrie Halpern R.A.  replied to  igknorantzrulz @2    5 years ago

Not true Iggy. We all love you here!

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
3  321steve - realistically thinkin or Duu     5 years ago

multiple people were involved in the patients receiving the drugs.

"The pharmacist has an obligation to question an order, and the nurse has an obligation to question the order as well," Leeseberg said. "All of those safeguards were overridden or ignored.                                      It's like nothing I've ever seen." 

WOW

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
3.1  321steve - realistically thinkin or Duu   replied to  321steve - realistically thinkin or Duu @3    5 years ago

Who administered the lethal dosages ? 

They're gonna want to know. 

 
 
 
sandy-2021492
Professor Expert
3.2  sandy-2021492  replied to  321steve - realistically thinkin or Duu @3    5 years ago
"The pharmacist has an obligation to question an order, and the nurse has an obligation to question the order as well," Leeseberg said. "All of those safeguards were overridden or ignored. It's like nothing I've ever seen." 

That's what got me.  Besides the providers surely knowing that they're giving excessive medication, I believe most pharmacy computers give alerts when doses are too high.  And nurses don't give you any medication without scanning your wrist band into a computer, to avoid medication errors.  This was a conscious effort by several people to ignore safety guidelines.

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
3.2.1  321steve - realistically thinkin or Duu   replied to  sandy-2021492 @3.2    5 years ago
This was a conscious effort by several people to ignore safety guidelines.

I'd say this was a successful conspiracy to commit murder. 

I exspect to see people charged. 

You just dont do this. 

I'd be in jail. 

 
 
 
Perrie Halpern R.A.
Professor Principal
3.2.2  seeder  Perrie Halpern R.A.  replied to  321steve - realistically thinkin or Duu @3.2.1    5 years ago

Hi Guys,

Yes, there was a whole other issue here, which is the doctor ( and it seems a little help by his friends), decided to do this on his own. There seems to be a whole breakdown in the system. 

I don't think that it is a doc's right to do this. That being said, they do, do this in Europe with the terminally ill. My own grandmother got a strong morphine drip to move things along, and I don't think anyone was consulted about it.

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
3.2.3  321steve - realistically thinkin or Duu   replied to  Perrie Halpern R.A. @3.2.2    5 years ago
There seems to be a whole breakdown in the system. 

I would not be surprise to see charges filed.  In fact I'd be surprised if there isn't. 

I worked with terminally ill people for years, If I did this, I have little doubt I'd be in jail for many years to come. 

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
3.2.4  321steve - realistically thinkin or Duu   replied to  Perrie Halpern R.A. @3.2.2    5 years ago
I don't think that it is a doc's right to do this.

It is not. Its against the law. I look for him to be charged with murder. 

 
 
 
nightwalker
Sophomore Silent
3.2.5  nightwalker  replied to  Perrie Halpern R.A. @3.2.2    5 years ago

I don't know that I want to have doctors to start doing that, it should be the patient's or families decision although if there isn't anyone to make that decision, you'd think Doctors should be a good choice to do that.

But I don't want to set the "Doctor decision" as acceptable. I've known some Doctors that were not very nice people that might get a little early on the switch, and some that might jump the gun a tiny bit to harvest organs even if you're down to your last three organs and only one works.

Or decide you're not worth saving for some personal reason, or a mercy killing because you'll live a long time yet, but will always have pain.

I think that's the main reason they are not allowed that decision by law.

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
4  321steve - realistically thinkin or Duu     5 years ago

My terminally ill own mother asked me to kill her more than once. 

It's sad to watch someone hurt so bad they want to die, ask you to end that suffering and have to tell them no. 

Its almost as sad to watch them then die.

Sometimes reality, Well It just sucks.

Sometimes it doesn't. Especially when you work at it.

Smile  

 
 
 
sandy-2021492
Professor Expert
4.1  sandy-2021492  replied to  321steve - realistically thinkin or Duu @4    5 years ago

That had to have been awful, Steve.

We need to make physician-assisted suicide legal for the terminally ill.  She shouldn't have had to go through that, and neither should you.

 
 
 
Gordy327
Professor Expert
4.1.1  Gordy327  replied to  sandy-2021492 @4.1    5 years ago

So true Sandy. We put our pets or other animals down when they're suffering and call it humane. Why are actual people not given the same consideration? 

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
4.1.2  321steve - realistically thinkin or Duu   replied to  sandy-2021492 @4.1    5 years ago
That had to have been awful, Steve.

It was Sandy,

She was in pretty bad shape but at least not in a lot of physical pain. She had alzheimer's and macular degeneration, she was loosing her mind, her sight and her hearing, she had recently lost my dad and they had been together all their lives. Mom had also been a control freak all her life and never did lose that very annoying quality. 

So she was actually suffering much more emotionally than physically.  I was her soul 24 hour a day caregiver for about 3 years till she passed and NO... none of it was fun. 

When she started asking for me to kill her I told her straight out NO. I told her she was actually asking me to go to prison to end her suffering and NO sorry I was not wiling to do that. 

That didn't keep her from asking. Yeah, It was pretty bad. But I was glad she had me there. I'm sure it would have been much worse for her if I hadn't been. 

Ironically, when I was younger I had to do all I could to get out from under her control.  All three of her children did.  My sister left the country over it even. 

I guess ya just never know WTF life is going to throw at ya, til it does. 

 
 
 
Perrie Halpern R.A.
Professor Principal
4.1.3  seeder  Perrie Halpern R.A.  replied to  321steve - realistically thinkin or Duu @4.1.2    5 years ago

I am so sorry that you and your mom had to go through that. It sounds truly awful for both of you, but of course, worse for her at the time. 

 
 
 
321steve - realistically thinkin or Duu
Sophomore Guide
4.1.4  321steve - realistically thinkin or Duu   replied to  Perrie Halpern R.A. @4.1.3    5 years ago

Thanks Perrie, What doesn't kill us makes us stronger. 

 
 
 
devangelical
Professor Principal
6  devangelical    5 years ago

this happens every day, although in a much more protracted way. the average life span in a nursing home is 18 months when the doctors start prescribing drugs that make the inhabitants more docile. those drugs eventually take a fatal toll on the internal organs of the patients. it also happens in hospitals for the terminally ill when their morphine drip is unrestricted and the patients are allowed to OD themselves. I've witnessed both events with family members.

 
 
 
sandy-2021492
Professor Expert
6.1  sandy-2021492  replied to  devangelical @6    5 years ago

When my grandmother was in her final days and in great pain, my aunt didn't want them to give her too much morphine, as it would slow her breathing.  Finally, a doctor took her aside and told her that grandma probably had 2 weeks at most, morphine or not, and that she could have maybe 1 reasonably comfortable week with morphine, or 2 hellish ones without.  My aunt finally relented.

 
 
 
Enoch
Masters Quiet
8  Enoch    5 years ago

I concur with and support several ideas floated in this discussion thread.

1. If the person nearing the end of this life is able to think and articulate clearly and competently their wishes, those should be followed. It is their life. They, not those in the medical arts, health insurance companies, medical care and nursing home institutions, allied health care product and service industries, or the government should over ride their wishes.

2. Because few of us know, in time, when we will not be able to speak for ourselves, these possibilities should be well thought out by each person. Thee through put of such cogitation should be reduced to writing, and in a legally binding fashion be prepared and administered by an attorney specializing in relevant areas of law. Documents expressing the dying person's care directives should be on file where the person is toward the end of their days. The same holds true with having these documents on file at care institutions like hospitals in the event of surgery before the operation takes place.

3. Once a person of sound mind and body has reduced to writing their wishes in specified situations, health care providers who carry out such advanced directives should be free of legal liability for following them as directed. Safeguards can be put in place to reduce if not eliminate abuse. 

4. Anyone with a license, certification, permit or registration to practice in any area of the medical arts who refuses to follow patient directives said government permission to engage in their profession should be rescinded for cause. See the legal tool named Replevin for details. 

Enoch.

 
 
 
Split Personality
Professor Guide
8.1  Split Personality  replied to  Enoch @8    5 years ago

Ok, I certainly hesitate to do this in public and  I am certainly in no need of private conversation on this.

We have a relatively young (49) relative who was hospitalized for the last 4 years with a mystery illness finally identified as ALS.

Transferred from hospice to hospice, depending on which could manage the ventilator and feeding tube, bed sores etc.

After bankrupting the immediate family, her 80 year old parents on SS sold their home, moved to a more affordable part of the state and bought themselves a modest home ( with a mortgage)

and bought the younger couple a home (paid off)  which we all flipped and made a very modern handicapped  accessible home;

a lift, commonly used for auto engines, was donated by the local Hells Angels to get her in & out of bed, as well as a special motorized wheelchair reminiscent of Steven Hawkins' own chairs..

Too little too late, she spent less than a week there.

A year and 3 institutions later, finally on SSDI, the current hospice told us this week to be prepared and make funeral arrangements and

gave my SIL the date that they were going to pull the tracheotomy, disconnect the ventilator and stop the feeding tube.

They assured my SIL that they would make her "so comfortable" she " would not feel a thing".  In my limited experience ( my father, an aunt, an uncle) this is normal and expected.

So it is.  So shall it be.

This is in contrast to the Alaskan natives and others, anecdotally putting their "old ones on an ice floe" and pushing them out to sea.

As a species, we often do much better for our pets, cars and boats than we do for each other.

Sad.

And it's only Wednesday, I usually don't get maudlin until the weekend.....

 
 
 
sandy-2021492
Professor Expert
8.1.1  sandy-2021492  replied to  Split Personality @8.1    5 years ago

I'm sorry, SP.  I wish you, your relative, and your family peace as you let her go.

 
 
 
Enoch
Masters Quiet
8.1.2  Enoch  replied to  Split Personality @8.1    5 years ago

Dear Friend SP: I join with our good friend Sandy in wishing all concerned the best of all possible outcomes for each under the circumstances.

Moreover, the least emotional turmoil, and the fastest possible feelings healings.

If you and any of yours change your minds, I am always available for such comfort, solace and other Pastoral care as I can provide.

Peace and Abundant Blessings in These Trying Times for You and Yours.

Enoch.

 
 

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