I will 100% agree with this statement. That is why I asked for my egd/colonoscopy to be with an anesthesiologist rather than trying to convince the gi to just order the nurse to give me high dose anything or have them try to use propofol.
I work at community hospitals where the blocks are not always done by the anesthesiologist for the case (from.what I have seen the prior surgery is often still going when the block gets started) and I was describing the pre op set up of one hospital where there may be a monitor in the room but no central monitoring of said monitor and there may be an airway cart in the nurses station but not in each individual room (and the nurses station is a separate room on the other side of the hallway). And the two preop nurses have to prep multiple patients at once typically. No idea if someone stays in the room with the patient from the time the block is started to the time they move to the OR. In that setting I can see being really stingy with doses. Otherwise I don't get why you would feel the need to underdose since you are in an excellent position to rescue. Especially if the plan is general anesthesia after the block anyway which it was for me.
I posted the case involving the nurse because I was interested to see if the nurse would get the same aggressive defense, on this forum, that Dr. Husel is getting.
I love droperidol so much that I put it on the fire engines. I would rather them use droperidol than ketamine. Not only did I give them standing orders to use it for its anti-psychotic effects, but they also have standing orders to use it for nausea, cannabinoid hyperemesis syndrome, gastroparesis related abdominal pain, and migraine headaches. Vitamin D used to be Dilaudid, but now it's droperidol.
Has anyone else in her case been prosecuted? What she did was obvious negligence, though I don’t see any clear benefit in placing her in prison. However, it’s difficult to argue with the logic that it’s manslaughter.
I suspected as much.
Because not knowing that vecuronium and versed are different medications and not looking them up or otherwise confirming you have the right vial of medication before administering it is remotely comparable to selecting a medication you are familiar with and choosing a higher dose for a medical reason (defense position) or an outcome related reason (prosecution position)?
Criminal negligence is negligence which rises above the simple negligence that can result in a variety of medical errors. For this type of scenario I would consider a simple negligent act something like the order is for 2 mg of versed and she goes to the pyxis and it isn't in there so she goes to another pyxis she never uses and pulls out versed but this one has 1mg/ml vials instead of 5mg/ml vials that she usually uses but she doesn't notice the difference because the lettering was too small and the vials were the same shape (no idea if either of these reflect reality) and the pyxis doesn't have the strength listed, and someone was yelling at her to hurry up and give the med and ends up underdosing the patient. Instead she is pulling up a medication she isn't familiar with in a non emergency situation with a student she is training so she has multiple reasons to stop and look the medication up to see how fast she is supposed to administer it and what meds or solutions it is compatible with if the patient already has an iv running. That step alone would have resulted in seeing the generic name (which is apparently required for this pyxis which I think is stupid that there is no cross referencing unless the order entry system corrects brand to generic names at the point of entry) as well as the fact that it only comes in liquid form for administration (rather than powder for reconstitution). But even without it vecuronium and versed are not look alike or sound alike medications so I don't see how one would be confused when they look at the label on the vial (which is a required step in medication administration and one which should be particularly drilled into a student one is training because sometimes the pyxis has the wrong med in a drawer), but even after that if the diluent solution isn't provided with the vial of vecuronium then she would have to locate what type is recommended (maybe it needs saline, maybe it needs sterile water) she has no clue which because she is unfamiliar with the medication which means she needs to ask someone or look it up at which point she would discover that versed doesn't require reconstitution. Or she can read the very small print on the vial which tells you it needs sterile water. However that means she can read the name on the vial which is not versed as well as read the numerous places where it warns you that this a paralyzing medication and that it causes respiratory arrest all of which is in bigger lettering than the reconstitution instructions. Maybe she didn't know what paralyzing medication means or what respiratory arrest means but that would be another reason to consider her not just simply bad at her job but grossly (criminally) bad at it.
I’ve never seen respiratory depression at any dose with a benzodiazepine in isolation outside of a rushed push in a child. Even that was transient and could be bagged.
I don't know all of the details and haven't sat in the jury box, in either of these cases. But, I agree that there is a big difference between a very tragic, yet completely accidental, one-time error that results in death by someone who acknowledged the error quickly, compared to purposefully, repeatedly making the same error in judgement that results in multiple deaths, over time.
Agitated trauma with concern for hemorrhage =intubation unless there’s a compelling contraindication, so not the best example. Definitely not leaving department without a tube.
one word seizres
The last line was tongue in cheek
I know - I would have probably responded which such a line to the question thou- but hey- residents are still learning. One reason I am glad I don't work in a teaching hospital.
We’re all being pedantic, I’m certainly guilty of that.
Sounds like you've fully made up your mind on this case. I'm curious where you got the "full system support" conclusion from? Not saying this is false, just that I have not seen evidence of it (admittedly, you're following the trial more closely than I).
I'm just drawing my own conclusion based off what I see.
Maybe so, but is that a defense?
Sure, the system was in 'full support' until it wasn't. It's ironic that those using the 'system was in support' defense for Husel, think it only applies when the system is giving support, but stops applying when it withdraws that support. But truly, was the system ever in full support, or just oblivious, unsure how to proceed, trying to deal with the problem internally paralyzed by legal/attorney indecision, or just incompetent? I suppose we may never know.
1) They may still be charged. We don't know. If Husel is convicted, don't be surprised if charges against the others follow.
Is it possible that he had a forceful personality and used his authority to pressure people into carrying out his orders and made them feel uncomfortable for questioning him? I don't know if that's what happened, but the testimony I've seen (which is not at all comprehensive - I admit) shows people raising concerns about his practice and then being dismissed or overridden.
Genuine question - was "brain death" not cited as a reason he's not guilty somewhere along the way? Didn't Husel himself say he was "99.9% sure" someone was brain dead? Or is brain death simply one of the (many) tangents this thread has gone on and not actually relevant to this case?
One of the prosecution witnesses testified he told them a relative was brain dead and then he extubated them shortly after. No written documentation from anyone to support this as far as I know.
He was (allegedly) routinely telling people their relatives were "brain dead" without doing brain death protocol and using that as reason to withdrawal support, and (allegedly) giving very large benzo and opiate doses.
No one besides a few family members say brain death was ever brought up and those people never said it at the time, only after the investigation was in full force so I question the accuracy of their memory or perhaps their honesty about it.
how many times have we heard people in the ED on the phone with their family members saying "grandma is brain-dead" when obviously that isn't the case? That definition is very much lost on the general population. Severe brain damage vs brain dead often means the same to the average joe with zero medical knowledge.
Because the defense lawyer doesn't realize that statement is incredibly false? Not sure why husel wouldn't have said something about it though.
Calling what Husel did an error in judgement is being quite generous to him...another difference between what Husel did and what the nurse did is that the nurse could be (and was) convicted of negligent homicide (manslaughter) whereas Husel is charged with and could be convicted of murder, which IMHO is now more likely since he chose not to take the stand in his own defense.
If I was a juror, it says a tremendous amount that a doctor who was acting purely out of compassion, to do nothing but ease pain and suffering, can’t get on the stand and say exactly that. I know it’s his right not to do so. But his lack of words says more than any words could ever express, in my humble opinion. I wonder if jurors feel the same.
