Husel Trial -- NOT GUILTY

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harrismeyer said:
Thanks for that good discussion. Having read the the Board of Pharmacy and Board of Nursing reports on several of these cases, I can say that all those things you discussed are exactly what happened. Mollette died within an hour of Husel's discussion with the family at 9 p.m., according to the record. Many of the patients died within half an hour of being administered 500 to 2,000 micrograms of Fentanyl plus other opioids and being extubated, some within a few minutes. Some or many of them had not received prior pain medication. In many or most of these cases, he gave verbal orders for the Fentanyl and other opioids and the medications were administered via Pyxis override, without prior approval of the pharmacist. These are not disputed facts though Husel's defense attorneys are trying to obscure them or prevent them from being entered into evidence. They have particularly sought to block testimony that Husel was the only staff doctor outside the ED ordering those huge doses of Fentanyl. In fact, the other Mount Carmel ICU doctors generally did not even use Fentanyl for palliative extubations. They generally used much smaller doses of other opioids, as Dr. Moody testified.
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Any pt that survived >10min after delivery of whatever dose of apnea inducing medication claimed/recorded was not fatally overdosed with said medication.

The doses were definitely large if administered as a bolus and not recorded as a cumulative dose. But I agree with an above poster, anesthesiologists give doses in the 100-250mcg range literally every day. So the dose alone is not criminal.

I think the issue here is his intent. If you have examples of patients getting 500-2000mcgs of fentanyl and not passing for 30+ minutes this implies significant tolerance or cumulative titrated to effect administration mis-charted as a single bolus (outside of nonfunctional IV or other route of administration type of issues). So, if he was giving 250-500mcgs for comfort care and folks were surviving 30min or more I think we have to consider that he was A.) comfortable with these doses as an anesthesiologist and B.) seeing patients that were tolerating (for lack of a better word) such dosing and therefore reinforcing this behavior. The fact that some patients passed immediately with these doses may prove over-zealous and outside of standard of care practice but seen in concert with his other cases will be difficult to prove without a doubt his intent was euthanasia.

Any harried or dishonest assessment of pt survivability or brain death insinuation on his part for the purpose of proceeding with comfort care and terminal extubation speaks to the opposite.
 
harrismeyer said:
One of the defense's big problems is they can't find any credible medical experts to testify that they believe it's acceptable medical practice to order those huge one-shot doses of Fentanyl and that they themselves have done that in their practices. In contrast, there are countless medical experts, like Dr. Ely, who are available to testify that they've never heard of such doses used for palliative extubations. I quoted two in my Medscape story.
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I’m an anesthesiologist. I don’t do ICU or palliative care. I agree - they’ll have a tough time finding people to defend the dosing. They however, would not have a difficult time finding physicians who would say those 14 were dying, dead very soon, and nothing was changing that.
 
Southpaw said:
This seems easy to prove. Show me all the ‘healthy’ icu patients under his care, who weren’t dying, who got 1000mcg fentanyl boluses
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I think most people who do palliative care would agree they use doses and combos they would not use in patients whose goal is prolongation of life.
 
Southpaw said:
This seems easy to prove. Show me all the ‘healthy’ icu patients under his care, who weren’t dying, who got 1000mcg fentanyl boluses
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Yeah, it’s really hard to justify an IV push of 1000mcg. 250mcg q5-10min four times I can see in rare circumstances.

But it’s just so hard for me to accept the narrative that he’s so pathologic he was talking families into withdrawing care and then pushing 1000-2000mcgs of fentanyl at once. But perhaps he was.
 
southerndoc said:
Remember, to the DA, this is a game. A conviction is a win for the DA, and that goes on their record for re-election. The bigger the conviction, the better it looks for them. Seriously, that's why innocent people end up in prison sometimes -- because the prosecutors don't want to consider evidence against their case. They will consider offering a plea or lesser charges when it looks to them like they are going to lose the murder case.
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I agree, 100%.
 
harrismeyer said:
One of the defense's big problems is they can't find any credible medical experts to testify that they believe it's acceptable medical practice to order those huge one-shot doses of Fentanyl and that they themselves have done that in their practices.
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That's kind of a problem, isn't it?
 
W
Birdstrike said:
When you're routinely giving boluses of 500-2,000mcg of fentanyl to extubated, opiate naive patients, I think it's pretty clear what the intent is.
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1000 and 2000mcg bolus? Yes. Absolutely. 500mcg? Remains grey imo. Outside of standard of care? Sure. But still grey imo.

We aren’t sure all were opioid naive. We aren’t sure he gave all 1000mcg+. We aren’t 100% sure it was always boluses.

Maybe he felt that it was better for most terminally extubated patients to pass painlessly and promptly rather than even one of them to suffer pain. That intention, while still illegal is quite a bit different than blatant murder imo.

If he did as it’s said, then surely it’s illegal. But his intent may still be misguided rather than pathologically criminal.
 
Robotic Wis-Hipple said:
W

1000 and 2000mcg bolus? Yes. Absolutely. 500mcg? Remains grey imo. Outside of standard of care? Sure. But still grey imo.

We aren’t sure all were opioid naive. We aren’t sure he gave all 1000mcg+. We aren’t 100% sure it was always boluses.

Maybe he felt that it was better for most terminally extubated patients to pass painlessly and promptly rather than even one of them to suffer pain. That intention, while still illegal is quite a bit different than blatant murder imo.

If he did as it’s said, then surely it’s illegal. But his intent may still be misguided rather than pathologically criminal.
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Mollette had peripheral arterial disease leading to a dead toe that got amputated but progressed to a dead foot anyway. Anybody really think that guy was opioid naive?
 
Robotic Wis-Hipple said:
W

1000 and 2000mcg bolus? Yes. Absolutely. 500mcg? Remains grey imo. Outside of standard of care? Sure. But still grey imo.

We aren’t sure all were opioid naive. We aren’t sure he gave all 1000mcg+. We aren’t 100% sure it was always boluses.

Maybe he felt that it was better for most terminally extubated patients to pass painlessly and promptly rather than even one of them to suffer pain. That intention, while still illegal is quite a bit different than blatant murder imo.

If he did as it’s said, then surely it’s illegal. But his intent may still be misguided rather than pathologically criminal.
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I'm going to say I agree, mostly. Mainly, because I just ran a marathon this morning, my legs are delusionally painful, I'm walking like a baby deer and my brain is functioning at approximately that same level. Any disagreement could tip the delicate balance I between not dying and planning what massive feast I'm going to have when my legs won't snap like rubber bands.
 
Ah, now that's a glorious degree of suffering. Which one? (or just 26.2 for the hell of it? Which I would have doubted people would just do until I ran a few.) Enjoy the post long-race delirium and the inevitable salt/alcohol indulgence you are now entitled to.
 
Robotic Wis-Hipple said:
Yeah, it’s really hard to justify an IV push of 1000mcg. 250mcg q5-10min four times I can see in rare circumstances.

But it’s just so hard for me to accept the narrative that he’s so pathologic he was talking families into withdrawing care and then pushing 1000-2000mcgs of fentanyl at once. But perhaps he was.
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He’s not Dr Death, that’s for sure. If he was trying to off people left and right there’d be a bigger trail of destruction. Not 14 people who were for all intents and purpose, dead dead dead.

I honestly think he played a part in a very large system. Nurses were in on it. Pharmacy played along. Other physicians absolutely knew. For years no one said anything. I think he’s taking the fall for everyone.
 
dchristismi said:
Ah, now that's a glorious degree of suffering. Which one? (or just 26.2 for the hell of it? Which I would have doubted people would just do until I ran a few.) Enjoy the post long-race delirium and the inevitable salt/alcohol indulgence you are now entitled to.
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Yes! Lol. Thank you. I did a full 26.2. Ouch!
 
Southpaw said:
He’s not Dr Death, that’s for sure. If he was trying to off people left and right there’d be a bigger trail of destruction. Not 14 people who were for all intents and purpose, dead dead dead.

I honestly think he played a part in a very large system. Nurses were in on it. Pharmacy played along. Other physicians absolutely knew. For years no one said anything. I think he’s taking the fall for everyone.
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Piss poor leadership. Part of your job as CEO is to protect the hospital from malpractice. Husel was Doctor of the year at his hospital. The CEO should have worked with Dr Husel not against him.
 
So, by this point it seems pretty clear what he did, right? Ordered supranormal doses of opiods for patients in order to facilitate a rapid and comfortable terminal extubation.
 
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turkeyjerky said:
Some have apparently argued that this is appropriate practice:

Humane terminal extubation reconsidered: the role for preemptive analgesia and sedation

Should patients receive general anesthesia prior to extubation at the end of life?
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I mean, if it was me being terminally extubated I’d prefer a dose that may be heavy handed as opposed to a perfectly safe 25-50mcg dose titrated for hours.

But that’s a personal decision that is more of a moral/ethical opinion not rooted in current law.

The two issues limiting this from ever being acceptable or allowed is 1.) the predominant idea, or frankly the ethical/legal interpretation of our oath to do no harm, as to not hasten death. And 2.) a protection for the sake of the infinitely small chance that a terminal extubation isn’t terminal. Requiring careful titration for the relief of objective symptoms allows for the possibility that if we are wrong the patient may persist or survive.

In essence society and the medical community has asked “What is better; allowing all to pass pain free rather than 1 patient experience pain in death or accepting some to experience pain in death so that none are prematurely sent to the beyond?”

And I think the answer is obvious despite the fact some on an individual level may want it to be different if it was them.
 
harrismeyer said:
One of the defense's big problems is they can't find any credible medical experts to testify that they believe it's acceptable medical practice to order those huge one-shot doses of Fentanyl and that they themselves have done that in their practices. In contrast, there are countless medical experts, like Dr. Ely, who are available to testify that they've never heard of such doses used for palliative extubations. I quoted two in my Medscape story.
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Ely is a madman that reads psalms to dead people as we found in cross. I don't care for the opinion of people that inject religion into science. Should have been a priest, not a doctor. Or at the very least not an expert witness!

We have not heard a single defense witness called yet, I don't think you can make that statement until defense experts are on stand.

I take many issues with your claims in your article. I think "survivable" is also a subjective word. The 39 year old, indeed, could have lived for another 40 years...in a vegetable garden. He had global anoxic injury as seen in trial and on the death certificate. He was down for over 40 minutes. The best thing that could happen to that guy was death. How it happens is pointless nuance.

One of the reasons I'm following this trial so closely is I'm identifying a part of my burnout as a doc from admitting dead patients. Constant trach & peg braindead folks. One guy I admitted and I'm following within the last week is from a skilled nursing facility. Now he's in renal failure. Family refuses to visit but demand everything be done. Now hospital ethicist is involved because all medical parties want the guy dead. But family forces him to live, at I'm sure a cost of a million dollars + a year from the taxpayers.

This is truly an issue like republican vs democrat. Both sides think they're right. Euthanasia is indeed illegal, but this case will get quoted in some capacity when eventually it is allowed....


Also, btw, if peer review is indeed not protected from criminal law, answer me this: why can the defense not bring them up? They clearly want to.

THE VOICE REPORTS are the only thing that has really come up. All 3 were answered as "appropriate for palliative care." IE, they went through the system and were okay'd by leadership as acceptable doses!
 
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Robotic Wis-Hipple said:
I think the issue here is his intent.
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100%. Burden of proof is on prosecution and it will be tough. The doctrine of double effect will be at play as well as his drive to "ease suffering." Even if negligent homicide is considered if not murder both will be a factor. Still hard to prove I think.

I mean, reading between the lines of watching every day of trial, did the guy euthanize these people? probably. If it was a new mom with mild pneumonia and he just up and killed her I'd be screaming for murder charges. But I have not heard one thing that convinced me so far that any celestial discharge from Husel was going to walk out of that hospital. Even Penix, the one prosecution seems to think had the best chance.
 
AlmostAnMD said:
Ely is a madman that reads psalms to dead people as we found in cross. I don't care for the opinion of people that inject religion into science. Should have been a priest, not a doctor. Or at the very least not an expert witness!

We have not heard a single defense witness called yet, I don't think you can make that statement until defense experts are on stand.

I take many issues with your claims in your article. I think "survivable" is also a subjective word. The 39 year old, indeed, could have lived for another 40 years...in a vegetable garden. He had global anoxic injury as seen in trial and on the death certificate. He was down for over 40 minutes. The best thing that could happen to that guy was death. How it happens is pointless nuance.

One of the reasons I'm following this trial so closely is I'm identifying a part of my burnout as a doc from admitting dead patients. Constant trach & peg braindead folks. One guy I admitted and I'm following within the last week is from a skilled nursing facility. Now he's in renal failure. Family refuses to visit but demand everything be done. Now hospital ethicist is involved because all medical parties want the guy dead. But family forces him to live, at I'm sure a cost of a million dollars + a year from the taxpayers.

This is truly an issue like republican vs democrat. Both sides think they're right. Euthanasia is indeed illegal, but this case will get quoted in some capacity when eventually it is allowed....


Also, btw, if peer review is indeed not protected from criminal law, answer me this: why can the defense not bring them up? They clearly want to.

THE VOICE REPORTS are the only thing that has really come up. All 3 were answered as "appropriate for palliative care." IE, they went through the system and were okay'd by leadership as acceptable doses!
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You aren't actually traching and peging brain dead folks are you? I said above that I had never seen brain dead and severely brain damaged conflated by medical personnel but I think I may have to revise that statement after this post.
 
Ohio is a super pro life place. Half the reason for this trial, really.

We have entire nursing homes dedicated to vegetable gardens.

The saddest one is the peds one that regularly sent patients to the PICU in residency. I won't even get into that. I had nightmares about those patients.

If family wants everything done here, it's hard to overrule them. All they have to do is say it's what the patient would have wanted--endlessly ****ting himself when not having random seizures on his ventilator.

The one before that was arguable worse. She wasn't brain dead, but she was end-stage dementia. But she also needed dialysis. She was kicked out of her dialysis program because she became violent with each session. When she came to me she was clearly gone, but "there" enough to resist. Daughter wanted "everything done." Stayed in the hospital for months since no one would take her. She insisted on dialysis so they had to do sedation 3x weekly to knock her out to get it done. She eventually aspirated and died and never actually left the hospital since no facility would take her that aggressive with dialysis. Her own daughter tortured her for months instead of just, you know, withdrawing dialysis. I'm not even talking about euthanasia here, she just wouldn't let us give up.

I do so, so many things that make my soul shudder. Ohio is a cruel state.

EDIT: I wont' call Ohio cruel. That shows too much bias, which probably is already seeping through my posts as-is. I'll just say Ohio is very "pro-life."
 
AlmostAnMD said:
Ohio is a super pro life place. Half the reason for this trial, really.

We have entire nursing homes dedicated to vegetable gardens.

The saddest one is the peds one that regularly sent patients to the PICU in residency. I won't even get into that. I had nightmares about those patients.

If family wants everything done here, it's hard to overrule them. All they have to do is say it's what the patient would have wanted--endlessly ****ting himself when not having random seizures on his ventilator.

The one before that was arguable worse. She wasn't brain dead, but she was end-stage dementia. But she also needed dialysis. She was kicked out of her dialysis program because she became violent with each session. When she came to me she was clearly gone, but "there" enough to resist. Daughter wanted "everything done." Stayed in the hospital for months since no one would take her. She insisted on dialysis so they had to do sedation 3x weekly to knock her out to get it done. She eventually aspirated and died and never actually left the hospital since no facility would take her that aggressive with dialysis. Her own daughter tortured her for months instead of just, you know, withdrawing dialysis. I'm not even talking about euthanasia here, she just wouldn't let us give up.

I do so, so many things that make my soul shudder. Ohio is a cruel state.

EDIT: I wont' call Ohio cruel. That shows too much bias, which probably is already seeping through my posts as-is. I'll just say Ohio is very "pro-life."
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Well at least they claim the patient would want it. I once had a case where the patient was stuck in the hospital due to having a trach and intermittent vent needs, peg for tube feeds, plus dialysis. I got to talk with the patient on a day she was clear (mental status waxed and waned) and she was 100% clear that she did not want to live like this so I started making arrangements for stopping dialysis and other support. Family came in all upset about this because they needed her social security check to live on so we can't just let her die. Despite involving social work they would not budge on their position, and the attending just went along with the family and continued everything and took me off the case.
 
dpmd said:
Family came in all upset about this because they needed her social security check to live on so we can't just let her die.
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Appalling. But not surprising.
 
Yeah, that depresses me too. I see that maybe once a month where they actually volunteer that info.

Spending 15-25k/day in the ICU for what, a $400 monthly check? Not the first time I've heard that or the last. Gov't would actually save a lot of money by just cutting them a 10k "death check" or something. Of course that would give the opposite incentive....man I dunno, I don't have the answers. I just complain. That's why I'm here, that's why I'm watching the trial...
 
AlmostAnMD said:
Yeah, that depresses me too. I see that maybe once a month where they actually volunteer that info.

Spending 15-25k/day in the ICU for what, a $400 monthly check? Not the first time I've heard that or the last. Gov't would actually save a lot of money by just cutting them a 10k "death check" or something. Of course that would give the opposite incentive....man I dunno, I don't have the answers. I just complain. That's why I'm here, that's why I'm watching the trial...
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By the way, in my line of work, I see a tremendous amount of patients on government (Medicare) disability. 95% of it is fraud. It's mind boggling and I'm not exaggerating one bit. I had to stop doing certifications almost immediately, because almost every single patient was expecting me to lie for them and were intent on doctor and lawyer shopping until they got labeled "disabled." Then a pay check and medicare health insurance, for life. And 95% still work jobs under the table. Pathetic. Sad.
 
Birdstrike said:
"On November 20, Penix sat up in her bed and complained of stomach pain, according to attorneys. A few hours later, Leeseberg said Husel told the family Penix was brain dead shortly after 9 p.m. The family was encouraged to remove care, to which they consented.

Leeseberg said Penix was given a 2,000 mcg dose of fentanyl at 10:48 p.m. and was pronounced dead five minutes later."

What brain death protocol was used to determine brain death?

If the patients brain was dead, how were they able to feel pain?

If they weren't able to feel pain why did they need fentanyl? If they were in pain, how can you say they were brain dead?

(Allegedly)

tinyurl.com

Attorney: Husel gave patient 2,000 mcg dose of fentanyl before being removed from hospital

An attorney representing the family of a woman who died at Mt. Carmel West Hospital in November of 2018 is planning to file a wrongful death lawsuit Thursday.
tinyurl.com tinyurl.com
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There was another report from that same news site back in 2019 that Husel gave Penix nimbex and vec prior to giving the fentanyl. It’s not something that seems to have come up again, so I’m guessing they disproved it?
 
FiremedicMike said:
There was another report from that same news site back in 2019 that Husel gave Penix nimbex and vec prior to giving the fentanyl. It’s not something that seems to have come up again, so I’m guessing they disproved it?
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Not sure, but news articles often have errors, so it's never a given that a media article or report is automatically accurate.
 
Nothing in trial so far, even from mud being slung at him to see what sticks, is about paralytic usage. The prosecution is only part way through their case so maybe it will come up later but it definitely has not come up yet.
 
AlmostAnMD said:
Nothing in trial so far, even from mud being slung at him to see what sticks, is about paralytic usage. The prosecution is only part way through their case so maybe it will come up later but it definitely has not come up yet.
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If he had given a paralytic or they had any proof he ordered it he’d be looking at a Do Not Pass Go, go directly to Jail scenario.

Certainly that’s sensationalism or poor reporting.
 
dpmd said:
You aren't actually traching and peging brain dead folks are you? I said above that I had never seen brain dead and severely brain damaged conflated by medical personnel but I think I may have to revise that statement after this post.
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Not legally brain dead people. But in pediatrics it takes two exams. So some families will request transfer to a special facility after the first brain death exam for trach/PEG/vent long term care. The kid isn't legally brain dead. However, as the AAP states below, no child has ever recovered after meeting adult brain death guidelines so there is an exceedingly high likelihood that the child is brain dead and we just didn't meet the legal criteria to declare by completing the second exam.

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations
 
PTPoeny said:
Not legally brain dead people. But in pediatrics it takes two exams. So some families will request transfer to a special facility after the first brain death exam for trach/PEG/vent long term care. The kid isn't legally brain dead. However, as the AAP states below, no child has ever recovered after meeting adult brain death guidelines so there is an exceedingly high likelihood that the child is brain dead and we just didn't meet the legal criteria to declare by completing the second exam.

Guidelines for the Determination of Brain Death in Infants and Children: An Update of the 1987 Task Force Recommendations
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That is crazy that would be allowed.
 
Highlights today:

Defense lost their Thursday appeal to cross over the privileged data that the trinity health executive Roth gave testimony from. It was confusing then but this seems to be the issue:

Multiple reports regarding husel were run. Defense only received Roth's summary report. Roth is the only one that has seen the raw data and defense is upset they cannot see the data. They allege roth is lying about husel being the only doc to give these doses and the only way to confirm if he really is the only doc is to view the raw data which was denied. So they only have a summary report prepared by trinity health.

More discussion of Tracy Young. The reports given to prosecutors did not include her. Correct me if I'm wrong but it seems she received a single bolus extubated of 2,500 mcg fentanyl. But she did not die within 120 minutes so that case was not shared with prosecutor.

Roth seems scummy. He has a sharp memory for specifics but when questions about HR and risk management interviewing staff before police had a chance came up a lot of "I dont specifically recall" answers.

"I dont specifically recall" came up again quite a bit when asked on cross regarding off the record interview to the Columbus dispatch were disclosed. This was discussed in the context of project lighthouse, the smear campaign started against husel that had a lot of I dont recalls.

My hot take summary: Roth is the guy that leaked the initial details to the dispatch regarding the news breaking. Project lighthouse was about controlling the narrative for the hospital system so he got a head start with his leaks.

Afternoon was with Rolston (sp?) Husels boss and medical director of icu. Not a lot of big hits here, they go over details of specific records and bicker about how much pain brain dead people feel and definitions of brain death. This is a recurrent and now largely circular argument over how much pain meds to give. He stopped short of criticizing husel directly but said in his practice and training he would give less.

Day ended with a mount carmel hospitalist that wrote a discharge summary for one of the patients even though he never saw the patient, also said he wrote the summary based off of notes without viewing the MAR showing a large fentanyl dose. Not the first time a hospitalist has testified to this. Cross was the same as the last hospitalist cross, asking why he didn't look at meds given. Weak afternoon overall but fun morning conspiracy with the c suite
 
Birdstrike mentioned this bit of background on Husel, which I quote from Wikipedia:

"[...in 1994,] he attended Wheeling Jesuit College where he crafted a pipe-bomb, storing it until he had used it to explode a trash can near a health and recreation center on the college's campus on November 9, 1994. Husel attempted to frame another student by planting bomb-making material in his car. Another man was also charged in connection with the incident; Husel was charged with malicious damage by means of explosive device, possession of an unregistered explosive device, and unlawful making of an explosive device, and was sentenced to six months to serve in a community confinement center, along with one year of supervision."

Besides the question we might have of how Dr. Husel got admitted to medical school after such a criminal conviction*, does anyone else think this behavior may be relevant to an assessment of his character? I mean it seems that most of the comments on this thread portray his actions as highly altruistic and compassionate. Maybe he had a miraculous change in character since that time just 3 days before his 19th birthday he set off a bomb on his college campus and tried to frame an innocent fellow student for his crime? I suppose that's possible.

I do not discount the possibility that his intentions may have been compassionate. I think from what I've heard and seen about this case (on Court TV, where the trial is televised) that he pretty much acted on his own to bring an end to these patient's lives without letting anyone else (either the patients or their families) know exactly what he was about to do. And making brief prognostic comments while asking ominous questions of family members about their patient care wishes doesn't really come close to satisfying what we think of as real informed consent.

*this topic has been raised numerous times on the SDN pre-med forums by students worried that their crimes (usually minor compared to the one Husel was convicted of) might affect their chances of getting into medical school.
 
neurodoc said:
Birdstrike mentioned this bit of background on Husel, which I quote from Wikipedia:

"[...in 1994,] he attended Wheeling Jesuit College where he crafted a pipe-bomb, storing it until he had used it to explode a trash can near a health and recreation center on the college's campus on November 9, 1994. Husel attempted to frame another student by planting bomb-making material in his car. Another man was also charged in connection with the incident; Husel was charged with malicious damage by means of explosive device, possession of an unregistered explosive device, and unlawful making of an explosive device, and was sentenced to six months to serve in a community confinement center, along with one year of supervision."

Besides the question we might have of how Dr. Husel got admitted to medical school after such a criminal conviction*, does anyone else think this behavior may be relevant to an assessment of his character? I mean it seems that most of the comments on this thread portray his actions as highly altruistic and compassionate. Maybe he had a miraculous change in character since that time just 3 days before his 19th birthday he set off a bomb on his college campus and tried to frame an innocent fellow student for his crime? I suppose that's possible.

I do not discount the possibility that his intentions may have been compassionate. I think from what I've heard and seen about this case (on Court TV, where the trial is televised) that he pretty much acted on his own to bring an end to these patient's lives without letting anyone else (either the patients or their families) know exactly what he was about to do. And making brief prognostic comments while asking ominous questions of family members about their patient care wishes doesn't really come close to satisfying what we think of as real informed consent.

*this topic has been raised numerous times on the SDN pre-med forums by students worried that their crimes (usually minor compared to the one Husel was convicted of) might affect their chances of getting into medical school.
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Acted on his own? In order for it to be classified that he acted on his own, he had to personally remove the drug from the Omnicell and personally administer it to the patient.

I am appalled that he is charged with murder, but the pharmacist that verified the order nor the nurse that administered it are not at least charged with accessory to murder.

If his intention was to just kill the patient, he could've administered a potassium bolus, paralyzed the patient without them being on a ventilator, etc. It seems that the accessories to murder would just blatantly follow whatever he ordered if things played out as they are portrayed.
 
I'm not appalled he was charged with murder, giving some people a bolus of 2,500 mcg fentanyl. The problem is it might be hard in a court of law to prove he wanted to kill them. Anyway...I agree that I would pursue a criminal charge against the pharmacist if they approved that, unless it can be shown it was overridden by the doc or nurse himself.

I don't think much will help this guy except evidence that he regularly, all the time, treated people with huge boluses of fentanyl in the ICU no matter what the cause.
 
The last few days have been nursing testimony. I haven't caught up to yesterday but I will today.

Not a lot of it convinces me of murder. Honestly I thought the nursing testimony would be a slam dunk for, well, anyone but it hasn't been riviting testimony. I mean, it's not like anyone questions if there was diversion or if these meds were ordered secretly so last few days haven't had a lot of new or interesting information.

One nurse was saying patient was begging for "the plug to be pulled," another describes another patient getting 10 mg of morphine every hour and only writhing in pain to the point where family asked for "something else."

Prosecution asking a lot of dumb questions. They asked like 20 different times about "how many syringes" are used, like that has any real bearing on anything. Each time he asks he puts a nefarious tone to it.

thegenius said:
2,500 mcg fentanyl
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The 2,500 mcg dose patient died 9 days after the dose. That's probably why that patient was excluded as a murder charge but defense keeps bringing her up (tracy young).

I, too, read the blurb about his bomb making exploit. The article is written without any other source. Either he's a psychopath or he's a prankster, I would assume prankster rather than overt pyschopath. I mean it's not like his criminal history is any longer outside of current charges. People do dumb **** in college. The best man in my wedding had two DUI's in college and still somehow became a successful lawyer (who doesn't drink).
 
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news.yahoo.com

Nurses say they gave fentanyl doses to same patient 20 minutes apart at Husel's direction

Two former ICU nurses at Mount Carmel say former doctor William Husel prescribed two large fentanyl doses to the same patient 20 minutes apart.
news.yahoo.com news.yahoo.com

In one case described here two different nurses give 1000mcg’s 20min apart. Now either they are giving 1000mcgs to a pt that is already apneic and blue but not yet pulseless or the pt came baked in with huge tolerance (pt described as OD victim). Circumstantially it does get painted in a way as though he absolutely knew he was ordering doses that were absurd.

Second case described here got 2500mcg and allegedly was called minutes later.

This case is just so weird. Every other case has patients living for far longer than I’d expect after 1000mcgs of Fentanyl. He clearly knew he was ordering doses that would raise suspicion. But that doesn’t prove intent was overtly malicious.

He allegedly orders 2500mcgs to stop the gurgling/grimacing of a patient which implies he did it to cease these alarming signs for the family as he very easily could have bolused the fentanyl before these symptoms presented if his goal was to prophylactically prevent any outward signs of suffering, euthanasia, or murder.
 
Oh, maybe there was a second 2,500 case. Some of this runs together. It's hard for me to keep track of just watching, I can't imagine the poor jury trying to process all this.
 
southerndoc said:
\

I am appalled that he is charged with murder, but the pharmacist that verified the order nor the nurse that administered it are not at least charged with accessory to murder.

If his intention was to just kill the patient, he could've administered a potassium bolus, paralyzed the patient without them being on a ventilator, etc. It seems that the accessories to murder would just blatantly follow whatever he ordered if things played out as they are portrayed.
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The defense has argued these exact points: 1) If he was committing serial murder, why aren't multiple colleges charged as accomplices? and, 2) Why was he doing this all in the open, for years, and no one seemed to even notice the "mass murders" happening?

On the other hand I think I heard in a podcast that at least one time pharmacy denied his very large fentanyl dose, he (allegedly) overrode the Pyxis, took out 10 or 20 vials and pushed them himself (allegedly).
 
Who cares how many vials there were or that he overrode the pyxis? As a pgy2 I took out 1000-2000 mcg of fentanyl regularly.
 
AlmostAnMD said:
I, too, read the blurb about his bomb making exploit. The article is written without any other source. Either he's a psychopath or he's a prankster, I would assume prankster rather than overt pyschopath. I mean it's not like his criminal history is any longer outside of current charges. People do dumb **** in college. The best man in my wedding had two DUI's in college and still somehow became a successful lawyer (who doesn't drink).
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Wikipedia gives a footnote that refers to a news article from 2019, which mentions that the info is from US District Court documents...which you could obtain if you are interested. The behavior for which he was convicted seems more than just a simple college "prank." And planting evidence against an innocent person is a rather antisocial act. More evidence would be needed to diagnose antisocial personality disorder, let alone psychopathy.

I don't know Ohio law, but in California Murder (PC 187) is defined as the unlawful killing of a person with malice aforethought. If there is premeditation it is Murder in the 1st Degree. If just malice aforethought it is Murder in the 2nd Degree. Given the facts in this case the prosecution to prove murder would need to show it was the intent of Dr. Husel to kill his patients. It doesn't matter if he believed he was being merciful in killing them. Euthanasia** is not legal in Ohio, and in states where it is there are requirements to protect patients and assure autonomy (like informed consent etc.), none of which seem to have been followed by Dr. Husel.

Other forms of illegal killing (in California) are considered Manslaughter (PC192) and there are two broad types: voluntary and involuntary. Voluntary manslaughter requires knowledge and intent to kill. Involuntary manslaughter is unintended death caused by reckless actions (i.e "the conscious disregard of human life"). Vehicular manslaughter is a special type of unintentional involuntary (i.e. accidental) killing that may be charged depending on circumstances of the accident, with negligence of some sort being required for a criminal prosecution.

Based on Ohio law he could be found guilty of some form of murder. The jury could also find him guilty of Ohio's equivalent of some form of voluntary manslaughter. If the jury is very sympathetic he could be found guilty of involuntary manslaughter (up to 4 years here). And if extremely lucky he could be acquitted of all charges.

Disclaimer: I'm not a lawyer, I just watch them on Court TV.

**addendum: I was speaking of states with "Right to Die" laws. Neither euthanasia nor suicide is legal in the USA but what is permitted by law in these states is essentially the equivalent. [edit]
 
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Birdstrike said:
You regularly gave 2,000 mcg boluses to unintubated patients as a PGY2?
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Maybe 1000mcg’s, directly before intubation as a cardiac/liver tx induction. Old school.

I don’t think he’s saying he gave 1000-2000mcg boluses with his statement though, just that taking out x number of vials or a total amount itself isn’t criminal or outlandish per se.
 
Robotic Wis-Hipple said:
Maybe 1000mcg’s, directly before intubation as a cardiac/liver tx induction. Old school.

I don’t think he’s saying he gave 1000-2000mcg boluses with his statement though, just that taking out x number of vials or a total amount itself isn’t criminal or outlandish per se.
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Correct. He is purposefully misinterpreting statements while couching them in terms to make himself look reasonable.
 
GassYous said:
Correct. He is purposefully misinterpreting statements while couching them in terms to make himself look reasonable.
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I'm not misinterpreting anything. But I did use absurdity to illustrate the difference between what Husel is alleged to have done, which is giving 500-2,000mcg fentanyl boluses to non-intubated patients to hasten death (allegedly). That's very different than giving large amounts of fentanyl in patients who have an airway for the purposes of controlled anesthesia and the avoidance of death.

I'm not saying he's guilty, or innocent. I can't watch 8 weeks of trial video to be able to do that. The jury will decide that. I do think the concepts are worth discussing.
 
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