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?
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.
I didn’t miss any of that. I don’t remember reading the precise details of this situation concerning the extubation. They aren’t there as it is still under investigation. I am not assuming anything, I am sorry you are. There are multiple listed as being involved in several deaths, who did exactly what, and who said or documented exactly what we don’t know. Several people here are assuming. How about let’s assume the management was so bad this nurse didn’t get proper training or orientation. You can’t know what you don’t know. Let’s asdume she was told “shut up and follow orders, I know and you don’t because you are JUST a nurse”. I have seen and heard this. I am not assuming any one nurse would do this on her own maliciously...I guess this environment could attract the type of psychopathic nurse you see on ID Discovery shows, but they are incredibly rare...thankfully. So no...I didn’t miss those parts and I have read the article.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
22 minutes ago, ZenLover said:
I didn’t miss any of that. I don’t remember reading the precise details of this situation concerning the extubation. They aren’t there as it is still under investigation. I am not assuming anything, I am sorry you are. There are multiple listed as being involved in several deaths, who did exactly what, and who said or documented exactly what we don’t know. Several people here are assuming. How about let’s assume the management was so bad this nurse didn’t get proper training or orientation. You can’t know what you don’t know. Let’s asdume she was told “shut up and follow orders, I know and you don’t because you are JUST a nurse”. I have seen and heard this. I am not assuming any one nurse would do this on her own maliciously...I guess this environment could attract the type of psychopathic nurse you see on ID Discovery shows, but they are incredibly rare...thankfully. So no...I didn’t miss those parts and I have read the article.
I doubt that any of these nurses was psychopathic. They were just good team players. Is their team now coming to their rescue in court and with the BON? Is the doctor rewarding them for their unquestioning loyalty? Is the hospital now ponying up their legal fees?
"Shut up and follow orders.....you are JUST a nurse" is the day I turn around and walk away from that situation. Let the chips fall where they may.
I doubt that any of these nurses was psychopathic. They were just good team players. Is their team now coming to their rescue in court and with the BON? Is the doctor rewarding them for their unquestioning loyalty? Is the hospital now ponying up their legal fees?
"Shut up and follow orders.....you are JUST a nurse" is the day I turn around and walk away from that situation. Let the chips fall where they may.
I hear ya and I never fell for it. Some of these young ones being hired in out of school and no life experience are easily bullied. Hopefully they don’t let these high level life and death decisions land on the lowest rung like this. I am hoping this is your typical situation that my husband sees when you want people to turn over on others higher up. Most people don’t want to rock the boat, ruin their reputation for being a team player or lose their jobs. They will shut up until you put them in a position where they have no choice but to defend themselves. Bringing nurses before the BON and threatening action is sometimes the only way you get the whole story. Are nurses perfect, no. Are we the last in line of defense?, very often. But blaming the last possible rung on the ladder for failing isn’t going to help us fix what is wrong. A lot of us work in management situations that could easily create these scenarios. Leadership needs to take the hardest hit...not the easiest retirement. Our values and priorities are way off as a group. A lot of us individually say we would take a stand...but how often is that actually happening now that we are #27 in the world for our healthcare? We are failing each other and our patients....and this is just one example.
I have questioned physician orders several times & either got clarification or the order modified. Despite short-term tantrums by the MD, I was always supported by my supervisor. But it wasn't easy! I was VERY uneasy doing this since I tend to be non-confrontational.
What worries me are new graduates who may lack the education or example, that they do whatever the order says. I've seen that happen. I hope my concerns are unjustified.
I didn’t miss any of that. I don’t remember reading the precise details of this situation concerning the extubation. They aren’t there as it is still under investigation. I am not assuming anything, I am sorry you are. There are multiple listed as being involved in several deaths, who did exactly what, and who said or documented exactly what we don’t know. Several people here are assuming. How about let’s assume the management was so bad this nurse didn’t get proper training or orientation. You can’t know what you don’t know. Let’s asdume she was told “shut up and follow orders, I know and you don’t because you are JUST a nurse”. I have seen and heard this. I am not assuming any one nurse would do this on her own maliciously...I guess this environment could attract the type of psychopathic nurse you see on ID Discovery shows, but they are incredibly rare...thankfully. So no...I didn’t miss those parts and I have read the article.
Keep the condescension. You've made a whole thesis on assumption, what you claim others are doing. Secondly, it was more than one nurse, it was several, and pharmacists, and the MD was charged so why keep speaking as though it's one nurse when it's many. What's known is they medicated patients who died, a whole 25 of them. That is known, that's why they were fired and lost their license. Why you keep pretending like it's not true because YOU don't have intricate details is the problem here. They were wrong, full stop.
Just because someone says "shut up and follow orders...... you are JUST a nurse" doesn't mean it has to be accepted and all common sense goes out the window. If you've seen and heard this then you were in the wrong environment. I would have left it that moment, but that's just me.
The fact so many patients died and nurses medicated them resulting in their deaths doesn't excuse their complicity in this. They willingly went along with the program, despite knowing it was wrong. I can't argue on their behalf. There's no justification for this. This is the Vandy nurse on a mass scale with a psycho doctor.
I hear ya and I never fell for it. Some of these young ones being hired in out of school and no life experience are easily bullied. Hopefully they don’t let these high level life and death decisions land on the lowest rung like this. I am hoping this is your typical situation that my husband sees when you want people to turn over on others higher up. Most people don’t want to rock the boat, ruin their reputation for being a team player or lose their jobs. They will shut up until you put them in a position where they have no choice but to defend themselves. Bringing nurses before the BON and threatening action is sometimes the only way you get the whole story. Are nurses perfect, no. Are we the last in line of defense?, very often. But blaming the last possible rung on the ladder for failing isn’t going to help us fix what is wrong. A lot of us work in management situations that could easily create these scenarios. Leadership needs to take the hardest hit...not the easiest retirement. Our values and priorities are way off as a group. A lot of us individually say we would take a stand...but how often is that actually happening now that we are #27 in the world for our healthcare? We are failing each other and our patients....and this is just one example.
You're talking in circles. You can't say they're bullied, need to take a stand, go along to get along, and shouldn't be blamed but should take a stand all at the same time. Are they weak and excused or should they take a stand and be held accountable for not doing so? I can't take you serious. You're arguing both sides at the same time. Appears as though you're being obtuse for no reason.
If a nurse isn't willing to do what's right for the patient and their livelihood then they shouldn't be in nursing. To willfully look the other way while Dr. Death is on the loose and going along with it means you don't care and are only in it for the money. It also means you should be held accountable and not doing nursing.
At the same time, we have to hold nurses accountable when they're wrong instead of making excuses, engaging in whataboutism, and looking for an out and someone else to blame. Any nurse worth having a license is NOT following orders of Dr Death, especially to the tune of 25 patients dying and violating first semester nursing lessons.
At least be realistic and consistent if you're going to have a gripe, especially if you're going to be condescending and dismissive. ?
I think the story and many of these comments fails to recognize the status of the debate surrounding appropriate palliation of symptoms in patients transitioning from aggressive care to comfort-measures-only, which does not have the consensus that's being suggested.
Years ago, the idea of more proactive symptom management titration (jumping more quickly to larger doses) was primarily just a topic of conversation among critical care practitioners and ethicists, such as this article, but these days it is increasingly making it's way into actual practice, although this particular physician is hardly the role model for guiding this change. It's generally only when this practice includes other concerning aspects, such as this occurrence, where the physician in question was never reprimanded despite the concerning ulterior motive. In general though, the idea of avoiding an unnecessarily slow up-titration process when death is the only possible outcome either way is no longer really just a fringe topic.
Outside of palliative care and critical care, the topic isn't well received, partly due to a poor understanding of the challenges encountered and of the effects of terminal palliation when transitioning from aggressive care. There is for instance a belief that there is a clear line for symptom management that we don't cross, which is that symptom management doesn't hasten death, which is far from accurate, recognizing that these clear ethical boundaries don't actually exist then brings up the question of why we unnecessarily subject many of these patients to avoidable suffering despite not changing any outcomes, ethical or otherwise.
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.
Can anyone else comment as to whether or not this really is Canadian law?
My understanding is that the defense, "I was just following orders" is not a defense under the Nuremberg Principles--to which Canada is a signatory. These were established when Nazi soldiers committed war crimes. Many of these soldiers could prove to have met the 3 factors outlines above.
You're talking in circles. You can't say they're bullied, need to take a stand, go along to get along, and shouldn't be blamed but should take a stand all at the same time. Are they weak and excused or should they take a stand and be held accountable for not doing so? I can't take you serious. You're arguing both sides at the same time. Appears as though you're being obtuse for no reason.
If a nurse isn't willing to do what's right for the patient and their livelihood then they shouldn't be in nursing. To willfully look the other way while Dr. Death is on the loose and going along with it means you don't care and are only in it for the money. It also means you should be held accountable and not doing nursing.
At the same time, we have to hold nurses accountable when they're wrong instead of making excuses, engaging in whataboutism, and looking for an out and someone else to blame. Any nurse worth having a license is NOT following orders of Dr Death, especially to the tune of 25 patients dying and violating first semester nursing lessons.
At least be realistic and consistent if you're going to have a gripe, especially if you're going to be condescending and dismissive. ?
Excuse me? I don’t have to keep anything except a respectful tongue in my head. Why? Because this isn’t my personal battle. I have an opinion. Maybe not worth anything, but I was never looking to make enemies and I will not be replying to again for fear of further aggravating the situation.
My replies have been directed, not towards the story, but the direct statements here attacking s nurse for extubation after giving a paralytic. I simply said what you did....she didn’t do it alone and we should not be out to crucify one person or claims that it would never be any of us. We don’t know the full story. The stories printed don’t give those details for a reason. Where you involved? You seem awfully hot and angry. So I will just leave you with a thank you for providing a different perspective.
ZenLover, MSN, RN, NP
1 Article; 132 Posts
I didn’t miss any of that. I don’t remember reading the precise details of this situation concerning the extubation. They aren’t there as it is still under investigation. I am not assuming anything, I am sorry you are. There are multiple listed as being involved in several deaths, who did exactly what, and who said or documented exactly what we don’t know. Several people here are assuming. How about let’s assume the management was so bad this nurse didn’t get proper training or orientation. You can’t know what you don’t know. Let’s asdume she was told “shut up and follow orders, I know and you don’t because you are JUST a nurse”. I have seen and heard this. I am not assuming any one nurse would do this on her own maliciously...I guess this environment could attract the type of psychopathic nurse you see on ID Discovery shows, but they are incredibly rare...thankfully. So no...I didn’t miss those parts and I have read the article.