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.
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?
We are licensed. We are supposed to be able to identify an incorrect use of a drug and refuse to give. Preferable to lose a job than to take a life. I have been in a situation where supervisor and DON wanted to place me in an inappropriate situation. I refused. When called to DONs office, I was told to sign a disciplinary form. I signed and under my signature, I wrote. . . I Do Not Concur, refer to employee’s Addendum.
The Addendum read. . . “I am sure that foremost in your mind is the safety of our patients and you would not want a nurse unskilled and unsupervised in ICU (i am L&D), to be the primary caregiver of those patients.” At the bottom I had CC: North Dakota Board of Nursing and JCAHO. Needless to say, no disciplinary action was taken and I was never placed in that type situation again. I did the same for an order of Dilaudid that exceeded the dosage. In that situation, I walked. My license and integrity were worth more than the job.
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?
Ignorance is not an excuse, at least that is what I am being told.
Sounds like this doctor believed in euthanasia for dying patients who have had life-saving measures removed. Just because they weren't trying to save their lives doesn't mean you can murder them. I definitely blame administration for being blind, purposefully or not.
While I have seen very large doses of pain meds given to either long term users that have built up an incredible resistance to their effects over the years and to Hospice patients I have never seen doses like that!
I can understand the nurses fear of job retaliation for refusing to give a patient these doses to a point, but only to a point. That's a LOT of nurses that went along to get along. I highly doubt the hospital would have been in a position to fire them all if they refused which they should have. If enough of them had been disciplined or fired for refusing to administer those doses this would most likely have come to light well before so many patients died.
I also notice no mention of reporting or disciplining the pharmacist's involved other than their being fired. Don't they also have some kind of oversight for their licensing boards? Were they reported as well as the affected nurses?
I also find it almost impossible to believe that the hospitals upper management had no clue this was going on at all. If no concerns were ever raised by anybody that got to their ears communication up the entire chain of command is broken in that place. Yet as usual they are allowed to "step down" or retire and probably with a nice severance package besides.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
20 hours ago, Lyli Lafaurie Fox said:
We are licensed. We are supposed to be able to identify an incorrect use of a drug and refuse to give. Preferable to lose a job than to take a life. I have been in a situation where supervisor and DON wanted to place me in an inappropriate situation. I refused. When called to DONs office, I was told to sign a disciplinary form. I signed and under my signature, I wrote. . . I Do Not Concur, refer to employee’s Addendum.
The Addendum read. . . “I am sure that foremost in your mind is the safety of our patients and you would not want a nurse unskilled and unsupervised in ICU (i am L&D), to be the primary caregiver of those patients.” At the bottom I had CC: North Dakota Board of Nursing and JCAHO. Needless to say, no disciplinary action was taken and I was never placed in that type situation again. I did the same for an order of Dilaudid that exceeded the dosage. In that situation, I walked. My license and integrity were worth more than the job.
Funny how when they find out they can't intimidate you (and you threaten to blow the whistle) they back off. This is why bullies need to be stood up to, not backed down from.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
13 hours ago, kbrn2002 said:
I also find it almost impossible to believe that the hospitals upper management had no clue this was going on at all. If no concerns were ever raised by anybody that got to their ears communication up the entire chain of command is broken in that place. Yet as usual they are allowed to "step down" or retire and probably with a nice severance package besides.
I'm more than willing to bet that the nurses and pharmacists who are long gone did try to report it up the chain of command. They were of course blown off. Now upper management is shocked, shocked to hear that such things have gone on.
I don't know if I believe this article exactly how it reads. I don't know if I believe someone gave those amounts in one dose. It was probably that amount was the total amount given over many times. I would like to know, if it was one dose them I absolutely think they should all be turned in to The board.
I don't know if I believe this article exactly how it reads. I don't know if I believe someone gave those amounts in one dose. It was probably that amount was the total amount given over many times.
I'm not sure why you don't believe it but believe it. And no these were not multiple doses they were one time doses. Properly administered Fentanyl does not kill people.
The one that really bothers me was where he used paralytics, I believe along with versed to do what I’m sure was a terminal extubation. Why the paralytic? Trying to make it easier for family to watch? Or covering up something? I don’t work ICU or hospice. But that isn’t a normal thing to do, right?
The one that really bothers me was where he used paralytics, I believe along with versed to do what I’m sure was a terminal extubation. Why the paralytic? Trying to make it easier for family to watch? Or covering up something? I don’t work ICU or hospice. But that isn’t a normal thing to do, right?
Sometimes people on ventilators are given a paralytic. From what I have seen it is fairly common in the ICU to have someone on a ventilator and IV paralytics.
One sure as hell doesn't push a paralytic UNLESS the PT is on a ventilator. Ask nurse Rhonda in Tennessee what happens when you do that......
This article explains how overly large doses of fentanyl were able to be given in ICU for those being removed from a vent due to terminal illness.
Physician worked night shift, gave verbal/written STAT orders allowing for PYXIS override.without pharmacist overview of order.
Quote
If he was challenged by nurses or pharmacists over his prescriptions for pain medication, the doctor often would tout his residency work as an anesthesiologist at the Cleveland Clinic, then offer long medical explanations to justify his decisions, the staff members said...
.... Husel’s behavior went undetected for nearly four years because of hospital policies that were loose enough to allow Husel to work around them and go unchecked.
Post review Dr Husel's prescribing, health system has instituted stricter limits on narcotic medication orders and dispensing across their hospitals. Facility now requires that nurses and doctors receive pharmacy approval before administering drugs during the removal of a ventilator. Additionally, Health System has a pharmacist Medication Safety Officer position posted.
News reports high fentanyl dosing-- I wonder if nurses considered opiod naivety or chronic opiod use which would support need for higher that average fentanyl dose during med retrieval & administration.
Quote
Nurses, the letters say, knew or should have known that the drugs would be harmful and that there is no documentation that they questioned orders or consulted with others involved in patient care.
Most patients referenced in the nursing board letters received single doses of fentanyl ranging from 200 micrograms to 2,000 micrograms, along with other drugs....
...In three patient cases, the board also questions the use of paralytics, twice with no documentation of a need for such drugs and once listed as necessary for a CT scan. One nurse was said to have failed to question the removal of a breathing tube after administration of a paralytic, which could cause respiration to stop...
,,,Many of the now 25 wrongful-death lawsuits filed in the matter have named nurses and pharmacists, but attorney Craig Tuttle of the Leeseberg & Valentine firm said Mount Carmel has agreed to accept liability for the employees, so they will be dropped from the several suits filed by that firm.
Found one newspaper report stating nurses VERBALLY reported concerns to supervisor. Anytime one has serious concerns regarding this type situation needs to follow-up verbal conversation with email note /letter, even incident report aka occurrence report to CYA.
Nurses should follow this situation as may have serious repercussions affecting future nursing practice.
Lyli Lafaurie Fox
1 Post
We are licensed. We are supposed to be able to identify an incorrect use of a drug and refuse to give. Preferable to lose a job than to take a life. I have been in a situation where supervisor and DON wanted to place me in an inappropriate situation. I refused. When called to DONs office, I was told to sign a disciplinary form. I signed and under my signature, I wrote. . . I Do Not Concur, refer to employee’s Addendum.
The Addendum read. . . “I am sure that foremost in your mind is the safety of our patients and you would not want a nurse unskilled and unsupervised in ICU (i am L&D), to be the primary caregiver of those patients.” At the bottom I had CC: North Dakota Board of Nursing and JCAHO. Needless to say, no disciplinary action was taken and I was never placed in that type situation again. I did the same for an order of Dilaudid that exceeded the dosage. In that situation, I walked. My license and integrity were worth more than the job.