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?
Nurses should follow this situation as may have serious repercussions affecting future nursing practice.
I'm interested in hearing your opinion on how. Just like the RV case these nurses were operating far out of the standard of care. I still remember my nursing instructor drilling into us that if you have to use more than one vial to get the desired dose check the order. In one case they would have had to open 20 vials to get the requested dose. One would think that would make a prudent nurse say "wait a second". I wonder what the environment there was like to make a nurse be willing to do something like that.
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......
Right, I do understand that. But there was at least one case where there was a paralytic given immediately prior to extubating a patient.
Right, I do understand that. But there was at least one case where there was a paralytic given immediately prior to extubating a patient.
From what I read it seems like the Dr. wanted to kill folks. They aren't going to die from a paralytic while they are on a vent. The question is why would any nurse do it?
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.
All of this! I have challenged a few doctor orders in my nursing life and had management threaten me, even when the doctors themselves thanked me for catching the errors. I'd rather lose my job than my license and freedom.
On 7/18/2019 at 1:34 AM, StrwbryblndRN said:
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.
This! I don't know where the mentality of not challenging orders came from. I was taught in nursing school that we're the last line of defense and it's our duty to question bad orders and sound the alarm. But I digress, people do things differently nowadays, and call us old for not following the crowd or being minions of management.
On 7/18/2019 at 5:55 AM, 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.
My license and integrity were worth more than the job.
That’s what I hate about this profession. Nurses LOVE jumping on the bandwagon of drama and vilifying other nurses rather than digging deeper for facts. Hospitals are CORPORATIONS. Money making entities. A more likely explanation is that the BUSINESS ENTITY (hospital) had no safeguards for its employees, and HUMANS made MISTAKES. NONE OF YOU are on a high horse here...It could happen to ANY OF YOU. Under similar circumstances I imagine most of you would make the same mistakes.
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?
Because senior leadership basically runs the quantros or safety programs put into place for low level employees to notify leadership of questionable situations. If I was a nurse and had entered a quantros for an overdose situation that brought harm to a patient and nothing had been done for over a year....well, then your argument is invalid because senior leadership DID know and ignored the safety concern. This is likely why those who are stepping down and retiring are doing so....but they shouldn’t be afforded that luxury. Most leadership will create a tattle tale environment that enables that to identify who is on board with their initiatives and who isn’t, they don’t use these programs for safety as intended. They pick and choose the situations to make a priority or figure out how to punish the low level employee who keeps bringing up safety concerns that they consider “bothersome” or not friendly to the bottom line or their safety stats / reporting.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
45 minutes ago, sassyrn333 said:
Don’t fall for it nurses.
That’s what I hate about this profession. Nurses LOVE jumping on the bandwagon of drama and vilifying other nurses rather than digging deeper for facts. Hospitals are CORPORATIONS. Money making entities. A more likely explanation is that the BUSINESS ENTITY (hospital) had no safeguards for its employees, and HUMANS made MISTAKES. NONE OF YOU are on a high horse here...It could happen to ANY OF YOU. Under similar circumstances I imagine most of you would make the same mistakes.
SMH. We aren’t robots. We’re people...
You're right. We aren't robots. We are capable of autonomous thought and action. Yes, you're right; hospitals are money-making corporations. They often throw safety to the wind and get away with whatever they can. When they are caught, they look for people to throw under the bus.
That is why it is vitally important that we as individuals insist on following our own inner compass. Going with the flow only makes life easier in the moment. It only protects your paycheque today. It is not ultimately safer to go along with the group. The group (or the corporation) will not reward this loyalty when their own feet are to the fire.
That’s what I hate about this profession. Nurses LOVE jumping on the bandwagon of drama and vilifying other nurses rather than digging deeper for facts. Hospitals are CORPORATIONS. Money making entities. A more likely explanation is that the BUSINESS ENTITY (hospital) had no safeguards for its employees, and HUMANS made MISTAKES. NONE OF YOU are on a high horse here...It could happen to ANY OF YOU. Under similar circumstances I imagine most of you would make the same mistakes.
SMH. We aren’t robots. We’re people...
Do you really think a competent RN would give a paralytic and take a person OFF a vent? We learned why you wouldn't do that in my first year of RN school.
That’s what I hate about this profession. Nurses LOVE jumping on the bandwagon of drama and vilifying other nurses rather than digging deeper for facts. Hospitals are CORPORATIONS. Money making entities. A more likely explanation is that the BUSINESS ENTITY (hospital) had no safeguards for its employees, and HUMANS made MISTAKES. NONE OF YOU are on a high horse here...It could happen to ANY OF YOU. Under similar circumstances I imagine most of you would make the same mistakes.
SMH. We aren’t robots. We’re people...
No ma'am, not one patient, not two patients, but 25 patients died and that doesn't include the near misses, all under the care of the same doctor. When does it become your duty as a nurse to use common sense and realize something is wrong? Also, if other providers are ordering similar meds at far less dosages do you not realize it's something wrong? What about this physician purposely waiting to write stat orders to bypass pharmacy and patients dying?
We are people...... who were taught better, know right from wrong, and know there's a problem if the pyxis is alarming that the dosage is problematic, and if we're having to draw up multiple vials (which should have rang alarms in their heads just for that action alone), yet they continued knowing it wasn't right. The nurses are wrong in this case. There is no excuse. They should have said no, not participated, and the doc would have had to do his own dirt or management would have had to acknowledge why they're doing mass firings/hirings or having problems with nurses following this one doctors orders.
No way in hell 25 patients under the same doctors care died and upper management didn't notice. There are times to protect nurses but this ain't it.
I hunker what is surprising me is everyone’s attack on the RN. I work in an ICU. The pulmonologist / Intensivist orders extubation. The Respiratory therapist assists as does the RN. Not only does the RN not make the decision to extubate, they don’t perform it solo. If the RN gave a paralytic and then hid that from RT and the MD, then the RN is to blame but that is the only way the RN should go down solo for this. We are a TEAM for a reason, #1 being safety. Throwing any one person under the bus should be done in extreme circumstances only and if you think you are a more perfect human....good luck to you and the karma you just invited. Any monkey can Monday night quarterback. We need to act and talk like a team to have better outcomes.
I hunker what is surprising me is everyone’s attack on the RN. I work in an ICU. The pulmonologist / Intensivist orders extubation. The Respiratory therapist assists as does the RN. Not only does the RN not make the decision to extubate, they don’t perform it solo. If the RN gave a paralytic and then hid that from RT and the MD, then the RN is to blame but that is the only way the RN should go down solo for this. We are a TEAM for a reason, #1 being safety. Throwing any one person under the bus should be done in extreme circumstances only and if you think you are a more perfect human....good luck to you and the karma you just invited. Any monkey can Monday night quarterback. We need to act and talk like a team to have better outcomes.
So you missed the part about multiple RNs, pharmacists, and the doctor huh? You also missed the fact they bypassed multiple safe guards? And what about nursing education, were you not taught better? This isn't one of those times to cover for the RNs, they're all wrong.
Wuzzie
5,238 Posts
I'm interested in hearing your opinion on how. Just like the RV case these nurses were operating far out of the standard of care. I still remember my nursing instructor drilling into us that if you have to use more than one vial to get the desired dose check the order. In one case they would have had to open 20 vials to get the requested dose. One would think that would make a prudent nurse say "wait a second". I wonder what the environment there was like to make a nurse be willing to do something like that.