Dr Husel trial begins

[PTPoeny]

I don’t think you can push large doses of meds just because ethically you can justify it, legally it can be seen as killing somebody. We could make the same argument that doing an abortion at 25 weeks is really no different than doing one at 15 weeks, but our society has decided that it is not legal.

This isn't quite true. As a country we decided that states get to decide if a 25 week abortion is legal, some said yes, some said no. Unless by society you are referring to your specific state or a country other than the US.

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[deleted875186]

This isn't quite true. As a country we decided that states get to decide if a 25 week abortion is legal, some said yes, some said no. Unless by society you are referring to your specific state or a country other than the US.

We have decided that comfort care is acceptable but liken hastens death, but physician prescribed ethanasia is illegal except in Oregon and a few other states. Perhaps there is a line as to how much sedation and opioid analgesia is considered reasonable before we define it as euthanasia, this to me is exactly the same as the arbitrary so many weeks of life in the abortion debate. Maybe this case tries to define that line, which we all agree would be unfortunate.

 

[Southpaw]

The hospital has already paid out more than $20 million to families who had apparently withdrawn care from their loved one. The hospital started with 35 patients cared for by Husel who the hospital believed received excessive doses. Prosecution narrowed to 25 patients who received 500mcg or more. Recently prosecution dismissed 11 cases. Now they've centered on 14 patients, all of whom care had been withdrawn, who received 1000mcg or more.

I can't describe this as anything more than a witch hunt.

Where's peer review? Nurses and pharmacy signed off on these doses. Where's the department head who surely knew about this if there was ever a question about Husel's practice? Surely this was elevated to peer review who accepted his care as appropriate or not? This is, pure and simple, a witch hunt.

 

[chessknt]

Disagree. Holy ****, some of you here need to find Jesus, or talk to a therapist or something.

Serious question--how many death certificates have you signed in the past year? I'm probably around 30-40 at this point and I fully agree that dying with dignity the ICU is near impossible. Giving generous dosing of medications to make sure they are comfortable is the only form of dignity they have left.

The hospital has already paid out more than $20 million to families who had apparently withdrawn care from their loved one. The hospital started with 35 patients cared for by Husel who the hospital believed received excessive doses. Prosecution narrowed to 25 patients who received 500mcg or more. Recently prosecution dismissed 11 cases. Now they've centered on 14 patients, all of whom care had been withdrawn, who received 1000mcg or more.

I can't describe this as anything more than a witch hunt.

Where's peer review? Nurses and pharmacy signed off on these doses. Where's the department head who surely knew about this if there was ever a question about Husel's practice? Surely this was elevated to peer review who accepted his care as appropriate or not? This is, pure and simple, a witch hunt.

Agree entirely. Pharmacists and nurses and apparently the manufacturer of fentanyl should all be codefendants in this kangaroo court case. Why did they all get a pass?

 

[chocomorsel]

I don’t think we are saying nobody in the ICU gets a dignified death. But many don’t as hospital systems and family wishes lead to multiple little more than life prolonging procedures and therapeutics are added.

Then on top of that the withdrawal and comfort care parts of management are only ever more scrutinized as evidenced by this case. If Husel gets found guilty no pt in the icu gets more than 500mcgs of fentanyl for comfort ever again. So while we all know 2000mcgs is apnea inducing in likely 99.999% of patients the context is important and to litigate limits into comfort care because society needs to split hairs and blame someone will certainly only result in more patients’ last few minutes to hours being excruciating (if they have an intact cortex). Is that justice?

In my experience, the kind of patients that go on comfort care do not require that kind of dose and I do full time ICU. Most die as soon as you turn off the pressors they are so far gone. Others, 2-10 of Morphine plus 2-4 of Ativan, take away the O2 and they drift off and are gone after a few hours. 500mcg is a lot for a dying patient. Especially with those pHs given. No one dying needs 1000mcg of Fentanyl. Unless you are actively trying to euthanize them.
Clearly that is not what this doc was trying to do based on those lab values, however, he went about it the wrong way. Very unnecessary doses. I agree that he clearly wasn't completely honest with the family even though in his mind, and I agree with him, he was doing the right thing. I suspect those doses had to be ordered while patients were on multiple pressors so as the families were unaware.
We live in a country where doctors, fortunately and unfortunately, don't get to make unilateral decisions like that without consequences.

 

[nimbus]

In my experience, the kind of patients that go on comfort care do not require that kind of dose and I do full time ICU. Most die as soon as you turn off the pressors they are so far gone. Others, 2-10 of Morphine plus 2-4 of Ativan, take away the O2 and they drift off and are gone after a few hours. 500mcg is a lot for a dying patient. Especially with those pHs given. No one dying needs 1000mcg of Fentanyl. Unless you are actively trying to euthanize them.
Clearly that is not what this doc was trying to do based on those lab values, however, he went about it the wrong way. Very unnecessary doses. I agree that he clearly wasn't completely honest with the family even though in his mind, and I agree with him, he was doing the right thing. I suspect those doses had to be ordered while patients were on multiple pressors so as the families were unaware.
We live in a country where doctors, fortunately and unfortunately, don't get to make unilateral decisions like that without consequences.

True. I’ve seen some tenuous patients like those on Husel’s list arrest or nearly arrest with fentanyl 100mcg. It doesn’t take much of anything to kill a patient with a BP of 38/21 and a pH<7.

 

[chocomorsel]

People on this thread are fencing and hedging and dodging.
Q:
For those who have been involved in end of life care, Who hasn't seen or given sedation or pain med orders that were "liberally" interpreted? E.g., interpretations of grimacing, dyspnea, etc. where the true purpose was to hasten death to end discomfort for the patient or the family members who were watching their loved one slip away?

Our order sets is for every 1 hour or 2 hours one gets 2mg of Morphine and 1 of Ativan.
1000mcg for Fentanyl is about 100mg of Morphine. Have never seen anyone on comfort measures require that much. They usually die fast, or they are transitioned to another floor where who knows, maybe they get a total of 100mg of Morphine. But not at once.
Just think about it, how many vials does it take to get 1000mcg? Who outside of the heart room has those giant vials of 1000mcg? They are not kept in regular ICU Pyxis I highly, highly doubt. So everyone should be involved and sued as it takes multiple vials to get that much Fentanyl and that alone should have stopped the RNs and Pharmacists in their tracks.
I agree the patients were already on death's door and some had passed it and returned a few times, but the doses he ordered are what set off alarms.
Again, for me it wasn't the principle. It was the execution that causes me pause and raises alarms that either he's not that smart and doesn't realize it takes a fraction of that to hasten death, or he was not totally honest with these (albeit delusional) family members.

Now let me get on to sign those death certificates as in the past four days, I placed 5 patients on comfort measures.

 

[Robotic Wis-Hipple]

In my experience, the kind of patients that go on comfort care do not require that kind of dose and I do full time ICU. Most die as soon as you turn off the pressors they are so far gone. Others, 2-10 of Morphine plus 2-4 of Ativan, take away the O2 and they drift off and are gone after a few hours. 500mcg is a lot for a dying patient. Especially with those pHs given. No one dying needs 1000mcg of Fentanyl. Unless you are actively trying to euthanize them.
Clearly that is not what this doc was trying to do based on those lab values, however, he went about it the wrong way. Very unnecessary doses. I agree that he clearly wasn't completely honest with the family even though in his mind, and I agree with him, he was doing the right thing. I suspect those doses had to be ordered while patients were on multiple pressors so as the families were unaware.
We live in a country where doctors, fortunately and unfortunately, don't get to make unilateral decisions like that without consequences.

While I don’t disagree with you about any of that, my point isn’t necessarily that 1000 or certainly 2000mcgs is “normal” or even within 1 SD of the norm. My point is that those pts would’ve “died” immediately either way. Much the same way 100mcgs leads to them expiring. The difference is one of those doses certainly relieves any “pain” or appearance of pain to be witnessed by the family while the other provides the appearance of providing comfort and checking off the comfort care box.

Now don’t misinterpret me as critiquing you or any Intensivist as I certainly am not. The issue here is 100, 250, and maybe 500mcgs of fentanyl is arbitrarily considered to be an acceptable dose medicolegally or perhaps ethically if you believe any active hastening of death is immoral. I just find it incongruent that we practice in a world where we literally use pharmacodynamic principles like ED95 to dose drugs that absolutely have to do what we are intending them to do yet in this instance we just can’t give too much or else we look like the murderer? I get it. I wouldn’t push 1000mcgs either, but that’s a self preservation, medicolegal decision, not an ethical one (for me). I just think once the decision is made to let the pt go, under-dosing, for the sake of legal protection, rather than surely providing the relief is the bigger failure TO THE PATIENT. And this case if it goes the way I expect, will lead to further hurdles to provide the comfort in “comfort care”.

 

[pgg]

I wonder how many of these patients were conscious enough to have perceived pain and suffering. Gasping, grimacing, signs of discomfort are probably more reflexive and distressing to observers than to the patient.

Glad someone brought this up. Parts of this discussion remind me a little of threads we've had about botched lethal injections for executions, and how the observers likely mistakenly interpreted agonal respirations and other motor twitches for pain. Previous lethal injection cocktails included muscle relaxants before Oklahoma started making a mess of things.


So, question for those who are OK with 1 mg or 2 mg doses of fentanyl as "comfort care" ... are you also OK with chasing that with 50 mg of rocuronium, to avoid distressing family members more than is necessary? Or is that just a little too far over the line?

 

[deleted875186]

Glad someone brought this up. Parts of this discussion remind me a little of threads we've had about botched lethal injections for executions, and how the observers likely mistakenly interpreted agonal respirations and other motor twitches for pain. Previous lethal injection cocktails included muscle relaxants before Oklahoma started making a mess of things.


So, question for those who are OK with 1 mg or 2 mg doses of fentanyl as "comfort care" ... are you also OK with chasing that with 50 mg of rocuronium, to avoid distressing family members more than is necessary? Or is that just a little too far over the line?

This is the whole conversation, do we believe the patient is suffering or are we just watching them die. I think a small dose titrated to effect likely achieves comfort care, but I understand people wanting to go on the heavier side. I think as long as you can justify the dose, clearly 1000mcg can never be justified.

 

[Robotic Wis-Hipple]

Glad someone brought this up. Parts of this discussion remind me a little of threads we've had about botched lethal injections for executions, and how the observers likely mistakenly interpreted agonal respirations and other motor twitches for pain. Previous lethal injection cocktails included muscle relaxants before Oklahoma started making a mess of things.


So, question for those who are OK with 1 mg or 2 mg doses of fentanyl as "comfort care" ... are you also OK with chasing that with 50 mg of rocuronium, to avoid distressing family members more than is necessary? Or is that just a little too far over the line?

Ummm, yes, that’s clearly over the line. (I know you’re being overtly tongue in cheek with that)

Is 1,000mcg of fentanyl as a non-cardiac induction before intubation over the line? Also yes.

But is 500?

Or 250 followed by 250 followed by 250 in 3-5min?

Is any of those worse than 100mcg followed by 100mcg q10-15min or whenever the RN can be bothered to get another 2cc vial from the Pyxis all the while the pt is agonal breathing or in intense pain or with air hunger before they go PEA/Vtach/Vfib?

To me the question isn’t if that was too much. It’s if it was enough. Is it better for the occasional pt to suffer with low doses than it is for pts who have been ALLOWED to die to surely without question die pain-free 1min sooner?

Legal/ethical hair splitting is a travesty when in the end a Dr. and patients will suffer because of such an esoteric debate.

But yes, 1,000mcg is more than needed. But who was wronged? Not the patient, which is in theory who all of this is for.

 

[lymphocyte]

I'm curious to know what he documented. Intentions matter, especially in a murder trial.

I've gotten in the habit of very clearly documenting my intentions -- the goal is NOT to hasten death (which maybe an unintended consequence) but to provide maximal comfort at the time of death. I literally write something like that in all my comfort care notes. I think it makes whatever dose of medication used much more defensible. There's also little doubt that I know what I'm doing might cause death but 1) that's not my goal and 2) I have the patient's best interest at heart. You can also justify surpa-theraputic doses of medication (e.g. shock state, ECMO, opioid dependence, etc.).

I also don't know how much time he spent with the families, but they clearly weren't on board with some of these decisions. We all know how families can be, but working with families is core intensive care skill.

Still, by most accounts, he was a talented and dedicated doctor. What a tragedy.

 

[Southpaw]

So, question for those who are OK with 1 mg or 2 mg doses of fentanyl as "comfort care" ... are you also OK with chasing that with 50 mg of rocuronium, to avoid distressing family members more than is necessary? Or is that just a little too far over the line?

lol @ rocuronium. Nice one. I've read some of the ICU physicians were/are using versed. I don't know if that's commonplace for super way way end of life care but I also don't think that's a very good drug. If you had just a few minutes left to connect with loved ones in this god forsaken place would you want to receive a drug known to cause anterograde and retrograde amnesia? Seems worse than a massive fentanyl bolus if you ask me. But I assure you it'd get more approval by colleagues, committees, heads of hospitals, etc. Put another way, it's accepted even if someone like me who's thinking through the pharmacology sees it as very inferior given the situation.

I can't tell you what Husel was thinking. The fentanyl doses were huge, no doubt. But as an anesthesiologist what happens when you choose one single agent and forsake all others? You give more of the one tool you choose. If you intubate just on propofol (no paralytic, no benzo, no narcotic) you give more propofol. Maybe a lot more depending on the situation.

Husel picked fentanyl as his end of life med choice apparently. He also apparently cared for a lot of patients who received comfort care, as is natural for an ICU physician. Did he give massive doses to everyone? No. It appears he only did it for an extreme few. What started out as 35 patients got narrowed to 25. That's now at 14. Of the 14, it appears almost all of them had multiple cardiac arrests/multiple rounds of chest compressions and ribs broken. Just curious - if this is your loved one what do you deem an appropriate dose? I know what I'd say - enough. Enough. But definitely not too little - that's the one thing I'd ask.

Maybe his dosing would've been different if he were giving the med himself at bedside, like most anesthesiologists do but isn't commonplace anywhere else ICU included. Maybe he would've done 100-200mcg q 2-3 min until goal reached. I have no idea. All I know is that for a select few patients he chose very large doses. But he didn't do that for everyone, which leads me to believe he had a method to his ways. Maybe he chose 10x the infusion rate for vent tolerance. Maybe 20x. I have no idea.

We often lament on this board the idea that everyone wants to be a physician, but only a few want to put in the work. We're trending towards a health system which allows lots of decision makers, many of them not physicians. Admin gets a say. Nursing gets a voice. Pharmacy gives their opinion. Etc. Husel is being hung out to dry by the system - that's my biggest point here. I really don't see how anyone could see this trial any other way. Husel put the order in. Pharmacy approved. Nursing drew it up and gave it. Not a peep from his director. Nothing from peer review. CMO - silent. All of the people who want a say in how a physician practices or how medical decision making is made - well they've all run for the hills. Leaving this one guy to take the fall. I think it's wrong. And I honestly think he can defend his decision making and I hope he's exonerated. And I hope he sues everyone for defamation and gets $100 mill.

If all I can offer this world is a pressure of 60/30 after my chest gets pumped with multiple rounds of CPR and my ribs broken, body flooded with epi/vaso/levo/versed/fentanyl to sustain such feeble pulsatile flow, my sad state left to rot in my own urine/stool/vomit, pvc sticking out of every orifice God gave me, I only have a couple thoughts -

1) damn it, I did it all wrong
2) i hope my family can get me to a nice steep cliff with a beautiful mountain vista that they can toss me off of and I can enjoy just a few last seconds of freedom
3) please have some mercy and give me a nice solid hefty pour of bourbon/bolus of fentanyl to send me on to the next place. If you tap dance around with 50-100mcg of fentanyl while I struggle with my last few breaths, loved ones surrounding me, then I'll reserve a seat for you in hell.

 

[Southpaw]

This is the whole conversation, do we believe the patient is suffering or are we just watching them die. I think a small dose titrated to effect likely achieves comfort care, but I understand people wanting to go on the heavier side. I think as long as you can justify the dose, clearly 1000mcg can never be justified.

The patient could be suffering AND dying at the same time. I don't understand a small dose. I really don't. The patient isn't waking up. You don't need to titrate to respiratory rate on emergence. This is it - they are dying. They've been flogged left and right and they have nothing left. They are in the one place, dying, that none of us would choose. None of us would make the choice the be there. All of us, if we had our say, would be absolutely anywhere but the hospital when we take our last breath. Why are we being choosy with our dosing, or 'titrating to effect' (which really means underdosing, having a RN draw up more med when they get around to it/aren't dealing with another patient, etc.), when the reality is the patient is actively dying and all you can offer is comfort.

I really don't understand a system that purposely underdoses, or tries to guess the correct dose (which is likely what they start out with on everyone, treating everyone the same when all situations/patients are different), when the reality is that patient is hopefully dead in minutes regardless of what you do. What's the point? They're done, spent. The family has tossed in the towel. The one thing you can offer this patient with their last few breaths is comfort - so freaking do it. Stop 'titrating to effect' with comfort care. That's just more American healthcare BS.

 

[coffeebythelake]

The patient could be suffering AND dying at the same time. I don't understand a small dose. I really don't. The patient isn't waking up. You don't need to titrate to respiratory rate on emergence. This is it - they are dying. They've been flogged left and right and they have nothing left. They are in the one place, dying, that none of us would choose. None of us would make the choice the be there. All of us, if we had our say, would be absolutely anywhere but the hospital when we take our last breath. Why are we being choosy with our dosing, or 'titrating to effect' (which really means underdosing, having a RN draw up more med when they get around to it/aren't dealing with another patient, etc.), when the reality is the patient is actively dying and all you can offer is comfort.

I really don't understand a system that purposely underdoses, or tries to guess the correct dose (which is likely what they start out with on everyone, treating everyone the same when all situations/patients are different), when the reality is that patient is hopefully dead in minutes regardless of what you do. What's the point? They're done, spent. The family has tossed in the towel. The one thing you can offer this patient with their last few breaths is comfort - so freaking do it. Stop 'titrating to effect' with comfort care. That's just more American healthcare BS.

I agree. This is a subset of ICU patients that will die very quickly once life support is removed. The fentanyl isn't what kills them.

 

[chessknt]

Medical expert: Husel's painkiller doses enough 'to take out an elephant'

Dr. Wesley Ely, of Vanderbilt University, testified as an expert for the prosecution on Monday in the trial of William Husel.

www.dispatch.com

Well they clearly found someone who towed the right narrative with the right credentials. What a hack--he doesn't withdraw care at night? When was the last time this guy worked overnight? When is the last time he even wrote a damn order? 1000 mcg of fentanyl can kill an elephant? Super biased lopsided take on his part, hopefully the defense found someone with credentials who is actually practicing medicine outside of their 1 hour of rounds while on service before delegating it all back to the trainees.

 

[coffeebythelake]

Medical expert: Husel's painkiller doses enough 'to take out an elephant'

Dr. Wesley Ely, of Vanderbilt University, testified as an expert for the prosecution on Monday in the trial of William Husel.

www.dispatch.com

Well they clearly found someone who towed the right narrative with the right credentials. What a hack--he doesn't withdraw care at night? When was the last time this guy worked overnight? When is the last time he even wrote a damn order? 1000 mcg of fentanyl can kill an elephant? Super biased lopsided take on his part, hopefully the defense found someone with credentials who is actually practicing medicine outside of their 1 hour of rounds while on service before delegating it all back to the trainees.

He sounds like a real tool. I guess that's what 750 dollars an hour will do to a man.

Wonder why the prosecution decided to get an arm chair physician who practiced some ICU but mostly focus on delirium research, not someone who is more knowledgeable and nuisanced in end of life / palliative care? His statements are profoundly non factual. I hope he is asked on cross examination how he knows 1000 mcg of fentanyl can take out an elephant because I suspect an adult elephant can take a lot more than that.

 

[Southpaw]

Medical expert: Husel's painkiller doses enough 'to take out an elephant'

Dr. Wesley Ely, of Vanderbilt University, testified as an expert for the prosecution on Monday in the trial of William Husel.

www.dispatch.com

Well they clearly found someone who towed the right narrative with the right credentials. What a hack--he doesn't withdraw care at night? When was the last time this guy worked overnight? When is the last time he even wrote a damn order? 1000 mcg of fentanyl can kill an elephant? Super biased lopsided take on his part, hopefully the defense found someone with credentials who is actually practicing medicine outside of their 1 hour of rounds while on service before delegating it all back to the trainees.

He also alluded to monitoring the 14 patients over days to determine their progress. Not sure how anyone in medicine can look at that list of 14 and think they had more than a few minutes after pressors were stopped and extubation occurred.

 

[nimbus]

I’m pretty sure 1000mcg of fentanyl would not take out an elephant, that’s why they make carfentanyl.

 

[chessknt]

He also alluded to monitoring the 14 patients over days to determine their progress. Not sure how anyone in medicine can look at that list of 14 and think they had more than a few minutes after pressors were stopped and extubation occurred.

I get that point from a brain injury perspective somewhat but with the severe shock and multiforgan failure that is preposterous. Totally reminds me of attendings who would pop in to round for a few hours then never be seen again unless they came in to give a lecture. They would get a text when a patient died so I think their sense of timing of the entire process was pretty removed. This guy sounds like them except they would never stab a clinical colleague in the back like this guy and pretend to be more qualified.

 

[coffeebythelake]

This guy has a Wikipedia page and I suspect he wrote a lot of it himself. Reminder to self: people with Wikipedia pages are either famous (which he is not) or feigns being famous.

 

[deleted875186]

There is no way he’s found guilty. The “expert” keeps saying he would give only 12.5 or 25 mcg fentanyl at a time, maybe 50 mcg, and then wait an hour before giving more. Then at 4:55 the cross examiner shows him notes, patient terminallyextubated, 500 mcg fentanyl given, five minutes later note says “patient liftin gthemselves out of bed gasping for air”, and he admits, I would give this patient more sedation. What a joke. Truely insane to put this doctor on trial. Sounds as though he has documentation to back up the doses given. Also sounds like these patients all had prolonged ICU stay and opioid tolerance.

 

[deleted875186]

How can an expert witness say cause of death is “fentanyl overdose”, when a dose is given but patient does 40 mins later …. Truely insane.

 

[Southpaw]

There is no way he’s found guilty. The “expert” keeps saying he would give only 12.5 or 25 mcg fentanyl at a time, maybe 50 mcg, and then wait an hour before giving more. Then at 4:55 the cross examiner shows him notes, patient terminallyextubated, 500 mcg fentanyl given, five minutes later note says “patient liftin gthemselves out of bed gasping for air”, and he admits, I would give this patient more sedation. What a joke. Truely insane to put this doctor on trial. Sounds as though he has documentation to back up the doses given. Also sounds like these patients all had prolonged ICU stay and opioid tolerance.

Nurses were also documenting pain scores of 10 prior to Dr. Husel ordered doses given.

 

[Robotic Wis-Hipple]

There is no way he’s found guilty. The “expert” keeps saying he would give only 12.5 or 25 mcg fentanyl at a time, maybe 50 mcg, and then wait an hour before giving more. Then at 4:55 the cross examiner shows him notes, patient terminallyextubated, 500 mcg fentanyl given, five minutes later note says “patient liftin gthemselves out of bed gasping for air”, and he admits, I would give this patient more sedation. What a joke. Truely insane to put this doctor on trial. Sounds as though he has documentation to back up the doses given. Also sounds like these patients all had prolonged ICU stay and opioid tolerance.

12.5-25mcg’s?!! What the hell? If those doses did anything the cath lab would be stacking bodies.

And they should cross him and ask what sedative he’d use, and if he answered anything but haldol/precedex nail him to the wall as any of those meds have a much more narrow therapeutic window prior to resulting in apnea. Not to mention a sedative is clearly not the treatment or the goal in that scenario.

It’s clear that guy is either an idiot that hasn’t practiced anesthesia/CCM since the morphine days or a classic gun for hire just saying what the prosecution wants. Probably both.

 

[deleted875186]

12.5-25mcg’s?!! What the hell? If those doses did anything the cath lab would be stacking bodies.

And they should cross him and ask what sedative he’d use, and if he answered anything but haldol/precedex nail him to the wall as any of those meds have a much more narrow therapeutic window prior to resulting in apnea. Not to mention a sedative is clearly not the treatment or the goal in that scenario.

It’s clear that guy is either an idiot that hasn’t practiced anesthesia/CCM since the morphine days or a classic gun for hire just saying what the prosecution wants. Probably both.

The expert witness is a joke.

Maybe one of the major medical societies will comment or something on end of life care.

 

[coffeebythelake]

Also sounds like these patients all had prolonged ICU stay and opioid tolerance.

not at all surprising, since a lot of ICUs use fentanyl gtt for sedation.

 

[Dr. Rude]

This witness should add the initials L.F.H. After their name.

Liar For Hire.

 

[pgg]

This "expert" witness should have his board certification revoked by the ABA for misconduct. There really ought to be consequences for this kind of incompetent/mercenary behavior as a representative of our profession.

 

[Robotic Wis-Hipple]

Well, looks like he’s Pulm Crit trained so not our board. But he’s also the Chair and likely tenured and no longer actually practicing medicine so loss of his board cert probably wouldn’t matter.

But I would think a guy who has staked his career/life’s work on ICU delirium would A.) know about the drugs, doses, and comfort care and B.) not throw away his rep for a quack expert witness check.

 

[dpmd]

Well, looks like he’s Pulm Crit trained so not our board. But he’s also the Chair and likely tenured and no longer actually practicing medicine so loss of his board cert probably wouldn’t matter.

But I would think a guy who has staked his career/life’s work on ICU delirium would A.) know about the drugs, doses, and comfort care and B.) not throw away his rep for a quack expert witness check.

His religious fervor is showing. Not all super religious people would feel so much obligation to not hasten death that they use inadequate doses when they change to comfort care but there is a subset of people who would and the kind of person that makes a dying patient get flogged overnight to give the family more time to think about their decision strikes me as someone who probably discourages comfort care so as not to hasten death and would definitely give inadequate doses of meds if they can't talk the family out of extubating.

 

[deleted875186]

His religious fervor is showing. Not all super religious people would feel so much obligation to not hasten death that they use inadequate doses when they change to comfort care but there is a subset of people who would and the kind of person that makes a dying patient get flogged overnight to give the family more time to think about their decision strikes me as someone who probably discourages comfort care so as not to hasten death and would definitely give inadequate doses of meds if they can't talk the family out of extubating.

Certainly seems like this is the case.

 

[gcc322]

Wes Ely is worshipped by the Pulm/ccm guys I know. He was on acrac podcast a few months ago touting his new book about his time as a CCM doc…sounded like a real tool. Read passages straight out of the book instead of having a conversation. He said himself he hardly practices medicine anymore and is mainly a researching. This clearly shows in his testimony.

 

[Southpaw]

Wes Ely is worshipped by the Pulm/ccm guys I know. He was on acrac podcast a few months ago touting his new book about his time as a CCM doc…sounded like a real tool. Read passages straight out of the book instead of having a conversation. He said himself he hardly practices medicine anymore and is mainly a researching. This clearly shows in his testimony.

He's very well respected in critical care circles. He may be a very nice, good spirited person. He also sounded terrible on the stand yesterday. The reality is that Dr. Husel, for some patients, practiced end-of-life comfort care very different than other intensivists. I just don't necessarily believe that makes him wrong and guilty of 14 counts of murder. In fact considering the evidence so far I think that's absolutely absurd.

 

[chessknt]

Yea he has done good work but doesn't understand clinical practice because he is a researcher which is why he shouldnt be doing this. What a shameful way to trash an entire career for 10k. Judas would be proud of him.

 

[undalay]

Amyl
His criminal history has minimal bearing on his practice as a physician. He committed a crime in college got a 2nd chance and from that point forward acted in good practice through medical school and residency. Albeit my faith in the criminal justice system is minimal. If it was me who had his history I would have never made it as a physician. I do know he saved many lives in his practice many of which were folks with serious criminal backgrounds. I met with him toured his ICU with my wife. The place was scary full of biker gangs, gang members, and a huge population of poor foreigners. His goal was to prevent pain and suffering for people many physicians would not treat let alone step foot into the hospital. Life has taught me I really don’t know anyones past but what they tell me. The only person in this world I am sure of is the beautiful woman I sleep next to. I pray for him and his family and that the truth is made evident.

I don’t know him. But I do have faith in training at the Cleveland clinic. I don’t think it is that easy to graduate from that program. Thank you narcus for shedding a personal story. This is just lawyers and judges craving some headlines without ever able to walk in the shoes of ICU attending and the crazy financial pressures put on by administratorS. The crime here is the insane expense of terminally ill dying patients and the system is at fault.
we can argue about the doses but ph of 6.9 and multisystem organ failure. Also there were a lot of trained and experienced icu nurses who were defending dr Husel and they were fired for overriding pharmacy to get access to the drugs quickly.

 

[Dr. Rude]

He is a good looking, tall, fit appearing, well spoken, accomplished, successful silver haired white guy.

That gets a prosecutor to third base. The fact that his testimony is so far from the real world matters very little.

 

[Arch Guillotti]

This "expert" witness should have his board certification revoked by the ABA for misconduct. There really ought to be consequences for this kind of incompetent/mercenary behavior as a representative of our profession.

The neurosurgeons will revoke board certification for bogus testimony IIRC.

 

[amyl]

I don’t know him. But I do have faith in training at the Cleveland clinic. I don’t think it is that easy to graduate from that program. Thank you narcus for shedding a personal story. This is just lawyers and judges craving some headlines without ever able to walk in the shoes of ICU attending and the crazy financial pressures put on by administratorS. The crime here is the insane expense of terminally ill dying patients and the system is at fault.
we can argue about the doses but ph of 6.9 and multisystem organ failure. Also there were a lot of trained and experienced icu nurses who were defending dr Husel and they were fired for overriding pharmacy to get access to the drugs quickly.

I trained at the Cleveland clinic. I know him. He was in my class as was narcus

 

[narcusprince]

He is a good looking, tall, fit appearing, well spoken, accomplished, successful silver haired white guy.

That gets a prosecutor to third base. The fact that his testimony is so far from the real world matters very little.

I was taller, and better looking then him. He is a good guy in a difficult situation. I still keep up with him and send him my support.

 

[Arch Guillotti]

We all know that all these patients were going to die no matter what. The optics are terrible though. I wonder what triggered the investigation though?

 

[coffeebythelake]

The neurosurgeons will revoke board certification for bogus testimony IIRC.

Won't be surprised if this "expert" witness sits on the pulm CCM board.

 

[chessknt]

Won't be surprised if this "expert" witness sits on the pulm CCM board.

Hah. Automatically fail the boards if you answer 500 mcg of fentanyl instead of 12.5 on what dose would be most appropriate in a patient compassionately extubated with refractory cancer and shock.

 

[chessknt]

We all know that all these patients were going to die no matter what. The optics are terrible though. I wonder what triggered the investigation though?

It seems like a political witch hunt. He made someone mad who started all this and it snowballed to a murder trial. We've all seen much lower key versions of this play out in real life but this has to be the worst case scenario for the vindictive political nonsense acted out in the hospital I have ever seen.

 

[Arch Guillotti]

It seems like a political witch hunt. He made someone mad who started all this and it snowballed to a murder trial. We've all seen much lower key versions of this play out in real life but this has to be the worst case scenario for the vindictive political nonsense acted out in the hospital I have ever seen.

Of course it is a witch hunt. The question is how it got outside the hospital.

 

[chessknt]

Of course it is a witch hunt. The question is how it got outside the hospital.

Nurse manager y who is upset with this physician for some other reason is good friends with someone on the peer review committee who sits in on c suite meetings and gets the crack c team on the case to 'protect' themselves from the serial killer staffing their ICU by bringing it to the authorities before they lose control of the narrative blah blah. I can easily see several ways this worked it's way up to where it is now and none of it has to do with patient care.

 

[Dr. Rude]

I was taller, and better looking then him. He is a good guy in a difficult situation. I still keep up with him and send him my support.

I’ll take your word for it since I don’t know him personally. But sometimes good people say and do rotten things.

 

[Southpaw]

Listened to all of the patient specific testimony again from Dr. Ely. Didn't hear any of the cross. I don't agree with a fair amount of what Dr. Ely said, and he made some ridiculous assumptions under oath, but I think the defense has a lot of work to do. When all is said and done with this case no one comes out looking like a peach except the lawyers.

 

[Dr. Rude]

The neurosurgeons will revoke board certification for bogus testimony IIRC.

Actually no. They will censure, suspend or expel a member from their professional society. It Won’t affect their board certification status. The AANS has issued several dozen disciplinary actions.

ASA technically does the same thing, but have only issued two disciplinary actions despite many times that number of complaints.

 

[chessknt]

Listened to all of the patient specific testimony again from Dr. Ely. Didn't hear any of the cross. I don't agree with a fair amount of what Dr. Ely said, and he made some ridiculous assumptions under oath, but I think the defense has a lot of work to do. When all is said and done with this case no one comes out looking like a peach except the lawyers.

Remember prosecution has to prove beyond a reasonable doubt that the defendant intended to kill his patients with fentanyl. This isn't medical malpractice where if it kinda sorta seems like maybe something happened you convict, with criminal murder you need to be 100% sure