Ohio Hospital Fires 23 After Fentanyl Overdose Deaths

A hospital in Ohio recently fired 23 physicians, nurses and pharmacists after 25 patients died from excessive doses of fentanyl. In addition, 48 nurses and pharmacists were reported to state licensing boards for their roles in the overdoses.

Ohio Hospital Fires 23 After Fentanyl Overdose Deaths

On July 12, 2019, Mount Carmel Health System in Columbus, Ohio, announced the firing of 23 employees, including physicians, nurses, pharmacists and managers. The terminations were related to the deaths of 29 critically ill patients from fentanyl administered during hospitalization that resulted in overdoses. Additionally, the hospital’s chief executive officer announced he would be stepping down and the executive vice president and chief clinical officer would retire in late September. These events are centered around the alleged criminal activity of William Husel, DO, an intensive care physician practicing at Mount Carmel from 2013 until the end of 2018.

The Details

Dr. Husel started working at Mount Carmel in 2013 and during his employment, potentially fatal doses of fentanyl were ordered and administered to 29 of his patients. According to the hospital’s internal investigation, this included five patients whose conditions could potentially improve.. The investigation also concluded six additional patients were overdosed on fentanyl, however, it was not likely the cause of their deaths.

The affected patients were critically ill and their families had requested that all life-saving measures be stopped. While the fentanyl was ordered as a comfort measure, the doses far exceeded the amount needed for palliation. Patients received fentanyl doses as high as 2,000 micrograms, midazolam as high as 10 milligrams and several patients were also given dilaudid doses up to 10mg.

Dr. Husel has been charged with murder in the deaths of 25 patients and has entered a plea of not guilty.

Failed Safeguards

Although Dr. Husel provided the order, physicians do not practice in silos. Others played a part, many unknowingly, in administering the excess doses and safeguards to protect patients were either ignored or did not exist. These include:

  • A formal report was received related to Dr. Husel’s care on October 25, 2018, however, Dr. Husel was not removed from patient care until November 21, 2019. During this time, three patients died from potentially fatal doses of medication ordered by the doctor.
  • Layers of medical protocols were overlooked or did not exist.
    • Medications obtained through electronic drug dispensing cabinet by nurses using the override function that avoided warnings
    • Orders verified by pharmacists after administration and some overridden doses bypassed the pharmacists altogether.
  • No system in place to audit or track the amount of medications ordered, including fentanyl, prior to the first formal complaint in October 2018
  • Instances of a nurse or pharmacist raising questions about the ordered doses, but the concerns did not make it up to the higher level administrators.

Mount Carmel Health System reported 48 nurses and pharmacists to state licensing boards. The reported individuals face disciplinary actions ranging from reprimand and fines to permanent revocation.

Response By Ohio Board of Nursing

In March, the Ohio Board of Nursing sent letters to 25 nurses who administered the drugs ordered by Husel. The letters outlined state law violations based on the nurse:

  • Knowing or should have known the drugs would be harmful
  • No documentation orders were questioned or that they consulted with others involved in the patient's care.

The nursing board also questioned the use of paralytics without nursing documentation to support the clinical need. In one case, the nurse failed to question the removal of a breathing tube after a paralytic had been administered.

Corrective Actions

To address gaps in standardized procedures, policies and safeguards, Mount Carmel Health Systems implemented a detailed action plan. Examples include:

  • Adding protocols to set maximum doses for pain medications in the electronic medical record
  • Implementing an escalation policy for deviations in pain administration protocols:
  • Restricting the ability to bypass pharmacy review of medication orders
  • Increasing staff education on end of life care
  • Implementing initiatives to ensure patient medication safety

Civil Suits

Numerous families brought civil actions for the loss of loved ones given the excessive fentanyl doses. To date, reported settlements range from $200,000 to $700,000 and total 4.5 million.

What are your thoughts on the events at Mount Carmel? Where do you see safeguards failing in your area of practice?

Interested in reading more about this story?

Could Mount Carmel Deaths Have Been Prevented?

Ohio Doctor Charged With Killing 25 Patients in Fentanyl Overdoses

Mount Carmel Health Systems FAQ Related to Overdose Investigation

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J.Adderton

About J.Adderton, BSN, MSN

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A nurse with over 20 years experience in a variety of settings and nursing roles. Enjoys writing about what is encountered in her own nursing practice.

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Specializes in Cardiology.

It sounds like these are all reasonable actions. Bypassing safety measures that were in place. Not questioning MD orders by both the RN and Pharmacist (seriously, 2,000 mcg of Fentanyl and 10 mg of Dilaudid?? Hospice pmts dont even get that much at one time).

However, what really angers me is they punish the RNs and pharmacists, lower level managers (rightfully so) yet several higher ups got to "step down" and "retire". Unreal.

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Specializes in Dialysis.
19 minutes ago, OUxPhys said:

It sounds like these are all reasonable actions. Bypassing safety measures that were in place. Not questioning MD orders by both the RN and Pharmacist (seriously, 2,000 mcg of Fentanyl and 10 mg of Dilaudid?? Hospice pmts dont even get that much at one time).

However, what really angers me is they punish the RNs and pharmacists, lower level managers (rightfully so) yet several higher ups got to "step down" and "retire". Unreal.

I 100% agree. To repeatedly circumvent warnings and to go against recommendations and standards is wrong.

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52 minutes ago, OUxPhys said:

It sounds like these are all reasonable actions. Bypassing safety measures that were in place. Not questioning MD orders by both the RN and Pharmacist (seriously, 2,000 mcg of Fentanyl and 10 mg of Dilaudid?? Hospice pmts dont even get that much at one time).

However, what really angers me is they punish the RNs and pharmacists, lower level managers (rightfully so) yet several higher ups got to "step down" and "retire". Unreal.

This sounds like someone blew the whistle on a palliative sedation program. I highly doubt these were mistakes made by bypassing existing safety measures, these were likely deliberate interventions.

How would you punish non-clinician senior leadership who likely never stepped foot on those units let alone know what was happening?

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6 hours ago, J.Adderton said:

Husel was not removed from patient care until November 21, 2019. 

I assume this is a typo where I am its still July 2019. unspeakable what this doctor did to those patients.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

This sounds like a badly-run hospital where physicians were allowed to run their own programs with minimal oversight and accountability. The pharmacists and nurses who spoke out about this and refused to participate are long gone; we'll likely never hear from any of them.

The ones who stayed and played took a bigger chance than the ones who left; it doesn't seem to have paid off. This is the danger of group-think and thinking there is safety in numbers.

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Specializes in Psychiatry.

This is ridiculous! "Now that they don't want any life saving measures, let's just off them so we don't have to waste a bed on them", is the thinking that comes to mind. And I am sure that this was supported by the hospital administrators. Sick.

What I also find sick is how quick they were to fire and blame the RNs and RPNs/LPNs that administered the medication. I hope that these nurses sue the hospital, too. I am sure the ones that protested the high dose of medication were either let go, reallocated or disciplined for "insubordination", yet the ones that chose to give in to the pressure and administer as ordered and save their job to support themselves and their families are the ones to be reported to the BON and have their whole lives destroyed because of this angel of death? Its ridiculous. Not to perpetuate ideas of victimization, but nurses always seem to get the short end of the stick. Dammed if you do, dammed if you don't. These nurses that were let go should sue this hospital too for their blatant negligence and recklessness. The firing of staff was simply a PR tactic to make it look like they were taking this seriously and these fired staff were scapegoats in the tactic to save the reputation of the hospital. Its sick.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
1 hour ago, steven007 said:

I am sure the ones that protested the high dose of medication were either let go, reallocated or disciplined for "insubordination", yet the ones that chose to give in to the pressure and administer as ordered and save their job to support themselves and their families are the ones to be reported to the BON and have their whole lives destroyed because of this angel of death?

Yes. It's called ethics. I've always been prepared to dumpster-dive (or preferably wait tables or stock shelves) before I participate in something I know to be wrong. What you call giving in to pressure I call group-think. It's never the safer option that some people think it is.

They are all professionals and can be held legally accountable for their own practice. "Giving in to pressure" does not provide much of a defense in court or one's respective licensing board.

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Specializes in Psychiatry.
10 minutes ago, TriciaJ said:

Yes. It's called ethics. I've always been prepared to dumpster-dive (or preferably wait tables or stock shelves) before I participate in something I know to be wrong. What you call giving in to pressure I call group-think. It's never the safer option that some people think it is.

They are all professionals and can be held legally accountable for their own practice. "Giving in to pressure" does not provide much of a defense in court or one's respective licensing board.

I agree and this is a very valid point!

However, where I disagree is that it is actually a valid defense in court. Its called undue duress and has been argued quite successfully in cases here in Canada. If your employer places you under undue duress, you can absolutely get off the hook.

I'm a law student and I volunteer for a nursing union to gain first-hand legal experience. I have used this argument before with great success, albeit with an arbitrator (not a judge).

All the nurse has to prove is:

1. Others who spoke up were disciplined, reallocated or fired to the point where the culture was "just go with it"

2. They had extenuating circumstances that did not give them an option to leave (i.e. supporting a family, children, etc.).

3. They attempted to mediate the situation (i.e. by finding other employment).

If those 3 factors are met, you have undue duress and a valid defense. Obviously, I don't know the whole story and I am sure some of the nurses involved likely wouldn't meet this defense and willingly participated in this nonsense. But I am sure, there is probably one poor soul, one inexperienced graduate nurse, that really felt that there was no other option. And for that person, my heart goes out to him/her.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
15 minutes ago, steven007 said:

I agree and this is a very valid point!

However, where I disagree is that it is actually a valid defense in court. Its called undue duress and has been argued quite successfully in cases here in Canada. If your employer places you under undue duress, you can absolutely get off the hook.

I'm a law student and I volunteer for a nursing union to gain first-hand legal experience. I have used this argument before with great success, albeit with an arbitrator (not a judge).

All the nurse has to prove is:

1. Others who spoke up were disciplined, reallocated or fired to the point where the culture was "just go with it"

2. They had extenuating circumstances that did not give them an option to leave (i.e. supporting a family, children, etc.).

3. They attempted to mediate the situation (i.e. by finding other employment).

If those 3 factors are met, you have undue duress and a valid defense. Obviously, I don't know the whole story and I am sure some of the nurses involved likely wouldn't meet this defense and willingly participated in this nonsense. But I am sure, there is probably one poor soul, one inexperienced graduate nurse, that really felt that there was no other option. And for that person, my heart goes out to him/her.

Thanks for this. I didn't know this could be pulled off in Canada. To the best of my knowledge, it doesn't work well in the States. (But maybe it has and we just didn't hear about it.) I think the takeaway is that "going along to get along" has huge backfire potential.

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If you, as a staff nurse, were assigned to have Husel's patient and had orders to administer the lethal amount of meds, no matter what choice you made, you would be ended up in trouble. If you administered the meds, you were fired and reported to the board. If you refused to administer the meds, you were disciplined or fired. It's so sad the staff nurse's career is a matter of luck. If you were not lucky enough and got assigned to Husel's patient, you were done. Maybe only staff nurses who can afford to resign can survive in the situation.

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Specializes in CMSRN.

I'm with TriciaJ. Much simplier situations have come up and I flat out would not do them. My response, "fire me" or "write me up". I have not lost a job yet. But I am willing to do whatever job to support my family if need be.

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