Husel Suing for $20M

[WilcoWorld]

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I only followed the case from the info posted on here, and the occasional news or medscape article, but it definitely seemed like the hospital guided the PD and prosecutors office to indictment. Basically seemed like they reported it w/ the connotation "hey this doctor has been murdering patients for years, here's the proof why it was definitely murder" rather than "hey this doctor has done this stuff. we're not sure whether it was criminal or not, but felt the need to report it just in case".

It looks like the lawsuit is filed in federal court, are impediments as high there as for states? It definitely seemed to me that they were defaming him to the media in public statements. I wonder if they could be held liable for defamation in connection w/ statements made to the patients' family members from that settlement. Unless it gets dismissed on legal grounds, I would have a hard time seeing any outcome other than a settlement.

(Hypothetically, say my wife gets into a car accident and someone is seriously injured or killed. I apologize profusely to the other party after the fact, pay them off and falsely imply she was drunk. Unbeknownst to them, we're in the middle of a contentious divorce and I hate her guts. Later on to the police, I mention that I found an empty bottle that morning and her speech was slurred before she left (leaving out the fact that I had emptied the bottle the night before myself). She's eventually found not guilty, but her reputation is ruined, she lost her job and I get to keep the cat. Can she come back and sue me for malicious prosecution?)

Sorry you got stuck with the cat.

 

[WilcoWorld]

If the interventional cardiologist on call doesn't want to take a post-arrest stemi to the cath lab, should I refer them for negligent homicide?

Hospital didn't just send a report to the NPDB, the dude was trial for f'ing murder.

Calling a code isn't equivalent to killing a patient. Declining to provide what you judge to be non-beneficial care is a very different thing from taking actions with the intent of ending a life. If you think he shouldn't have been charged - go ahead and make that argument, but please do not overlook this clear distinction while doing so.

 

[AlmostAnMD]

Calling a code isn't equivalent to killing a patient. Declining to provide what you judge to be non-beneficial care is a very different thing from taking actions with the intent of ending a life. If you think he shouldn't have been charged - go ahead and make that argument, but please do not overlook this clear distinction while doing so.

This was the hair splitting that got to me from the topic nuked by mods.

scenario one: give 50 mcg fentanyl IV, patient dies 30 minute later
scenario two: give 1,000 mcg fentanyl IV, patient dies in minutes

I mean.......if all we're looking at is results.....I can't tell you the difference between these two cases.

Also, consider culture. there are available court docs that show 48 nurses/staff writing a letter of support for Husel. The main win he has for his suit is that, clearly, everyone was in on this, but he was the target to hang it on. So, not acceptable to your practice, but locally it was clearly acceptable after multiple cases were reviewed internally until a VP at Trinity caught wind...clearly he didn't know what to do with the info and just ran to the police.

The prosecutors in that case were absolute demons. Doesn't help Ohio is a conservative state, of course. They painted him like a serial killer. I get if you don't agree with his practice, I won't dispute it's outside what you normally do, but looking at the macroscopic picture here I just....don't see a difference. Patient was alive at the start of the day, and wasn't at the end. Probably went with some nice euphoria at 1,000 mcg!


EDIT: watched entire trial, came out with a strong crush on Diane Menache. If I'm ever accused of doctor murder I'm calling her

 

[WilcoWorld]

I get it - you base your judgement on outcomes alone while I think intention plays a role in determining the morality of an action. Fair enough, this is something on which reasonable people can differ.

But if you call my differentiation splitting hairs and say that say you don't see the difference between 50mcg and 1000mcg, I guess we're just not going to be able to agree on this one.

 

[throway134]

l

I get it - you base your judgement on outcomes alone while I think intention plays a role in determining the morality of an action. Fair enough, this is something on which reasonable people can differ.

But if you call my differentiation splitting hairs and say that say you don't see the difference between 50mcg and 1000mcg, I guess we're just not going to be able to agree on this one.

Clinical context matters too.

I’ve given 10mg of dilaudid to someone iv, but they were also on a drip at 5mg/hr with leptomeningeal Mets and methadone at 30mg tid.

I don’t remember if that thread ever addressed what the base dose those patient were on was

 

[AlmostAnMD]

Oh, no arguing there, 1,000 mcg of fentanyl is a dose given with....intent. But you need to PROVE the intent, and you open a huuuuge can of worms delineating what that intent actually is. Ohio tried, and failed, to prove what you think it was 😛 Which honestly is a harder task than it sounds. If Ohio had a time machine I don't think they would prosecute, they would just tell the guy to fall more in line with people like yourself I bet

 

[turkeyjerky]

Calling a code isn't equivalent to killing a patient. Declining to provide what you judge to be non-beneficial care is a very different thing from taking actions with the intent of ending a life. If you think he shouldn't have been charged - go ahead and make that argument, but please do not overlook this clear distinction while doing so.

Honestly, I don’t remember the exact details of the case that well, but it seemed like he basically euthanized already moribund patients who had been made comfort care, which I think most everyone would agree is outside the standard of care in this country. From the not guilty verdict, it seems like there was enough of a doubt raised w/r/t actual intent or effect, given the confounders of significant drug tolerance (tachyphylaxis?) and the double effect principle or the whole thing was deemed an unnecessary spectacle and jury nullification occurred.

I feel like that is more or less settled. But, I find the question of hospital admin directed malicious prosecution very interesting. Obviously, I think they rat****ed him. But, I could see one arguing that this merely a case of beaurocratic indifference. Regardless, this guy lost his career over it.

Honestly, Im glad it hasn’t settled here’s hoping there’s a jackpot awarded in order to keep stuff at bay.

 

[CopaceticOne]

l

Clinical context matters too.

I’ve given 10mg of dilaudid to someone iv, but they were also on a drip at 5mg/hr with leptomeningeal Mets and methadone at 30mg tid.

I don’t remember if that thread ever addressed what the base dose those patient were on was

Seeing this reminded me of a sickle cell patient having a crisis I had admitting during training. The hematology team who knew the patient very well made pain control recs - fentanyl PCA 450mcg each button push. I don’t remember the frequency, but it was definitely less than q15min. I looked and patient got over 25mg of fentanyl in the first 24 hours.

They were alert and talking the entire time. Boggled my mind.

 

[throway134]

Seeing this reminded me of a sickle cell patient having a crisis I had admitting during training. The hematology team who knew the patient very well made pain control recs - fentanyl PCA 450mcg each button push. I don’t remember the frequency, but it was definitely less than q15min. I looked and patient got over 25mg of fentanyl in the first 24 hours.

They were alert and talking the entire time. Boggled my mind.

That’s mostly my point.

We don’t know this guys patient population, if they’re heavy fentanyl/“heroin” users big numbers might be needed. The number by itself certainly isnt meaningless, but it’s only suggestive Without context.

Having said all that, my strong subjective sense from these cases was this guy was attempting to euthanize people

 

[AlmostAnMD]

That’s mostly my point.

We don’t know this guys patient population, if they’re heavy fentanyl/“heroin” users big numbers might be needed. The number by itself certainly isnt meaningless, but it’s only suggestive Without context.

Having said all that, my strong subjective sense from these cases was this guy was attempting to euthanize people

Having watched the trial, that's my general gist, but prosecutors found out it is surprisingly difficult to prove that. The nuance of low dose opioids followed by death vs high dose followed by death was just too much to convince a jury it was murder (in ohio, euthanasia is murder, which is why he was on trial).

He is currently wiping the floor in his trial about Trinity smearing him. I'm honestly surprised they didn't settle with him....not sure why they want all this dug back up

 

[FiremedicMike]

Just to spice up the conversation a bit..

https://www.nbc4i.com/news/local-news/attorney-husel-gave-patient-paralytics-before-lethal-fentanyl-dose/

I thought I remembered reading this back when it first broke.. Husel also allegedly gave vec/nimbex prior to extubation, then 2,000mcg fent and 10mg versed..

 

[throway134]

Having watched the trial, that's my general gist, but prosecutors found out it is surprisingly difficult to prove that. The nuance of low dose opioids followed by death vs high dose followed by death was just too much to convince a jury it was murder (in ohio, euthanasia is murder, which is why he was on trial).

He is currently wiping the floor in his trial about Trinity smearing him. I'm honestly surprised they didn't settle with him....not sure why they want all this dug back up

Unless something has drastically changed in the last few months, euthanasia is illegal in all 50 states. The doses for physician assisted suicide (or the more modern medical assistance in dying, insert George Carlin joke about increasing syllables to make it softer) are always patient/self administered.

and I agree, they probably would have been better off bringing only a few of the worse cases. They went for too much in general with murder vs manslaughter, and all the cares instead of the worst ones.

Just to spice up the conversation a bit..

https://www.nbc4i.com/news/local-news/attorney-husel-gave-patient-paralytics-before-lethal-fentanyl-dose/

I thought I remembered reading this back when it first broke.. Husel also allegedly gave vec/nimbex prior to extubation, then 2,000mcg fent and 10mg versed..

Well it depends on the context, I’ve given vecuronium and then just kidding that’s straight up murder.

 

[AlmostAnMD]

Unless something has drastically changed in the last few months, euthanasia is illegal in all 50 states. The doses for physician assisted suicide (or the more modern medical assistance in dying, insert George Carlin joke about increasing syllables to make it softer) are always patient/self administered.

and I agree, they probably would have been better off bringing only a few of the worse cases. They went for too much in general with murder vs manslaughter, and all the cares instead of the worst ones.

ROFL @ vanderbilt dig. That nurse did get hung out to dry tho....a pharmacist told me vec isn't supposed to be able to be overridden everywhere, which she did....apparently their pyxis or equivalent was under renovation and everything could be overridden during the renovation phase.

So yeah, she should have known versed doesn't get reconstituted, but also the system was broken (swiss cheese model) to allow it to even happen.

But suing vanderbilt is harder than charging the nurse. She has some accountability, but with the above info I don't think it's 100%. She did something that was supposed to be impossible there--even ignorance cannot initiate an inappropriate override in a working system.



They DID actually filter cases, btw...his murder charges are only on half the patients known to be euthanized (supposedly). They dropped the other half of the charges pre-trial because those doses were even in a more gray area, 100-500 mcg. Prosecutors set a 1,000 mcg cutoff for trial cases. Still didn't work out!