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I didn't bring up giving brain dead people comfort care. I said they don't get it and that is how we know the people he is charged with killing were not considered brain dead.Actually, I think you did.
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I didn't bring up giving brain dead people comfort care. I said they don't get it and that is how we know the people he is charged with killing were not considered brain dead.Actually, I think you did.
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.
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.
PreciselyI think the issue here is his intent.
Precisely
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.This seems easy to prove. Show me all the ‘healthy’ icu patients under his care, who weren’t dying, who got 1000mcg fentanyl boluses
Yeah, it’s really hard to justify an IV push of 1000mcg. 250mcg q5-10min four times I can see in rare circumstances.This seems easy to prove. Show me all the ‘healthy’ icu patients under his care, who weren’t dying, who got 1000mcg fentanyl boluses
I agree, 100%.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.
That's kind of a problem, isn't it?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.
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.I think the issue here is his intent.
1000 and 2000mcg bolus? Yes. Absolutely. 500mcg? Remains grey imo. Outside of standard of care? Sure. But still grey imo.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.
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?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.
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.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.
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.
Yes! Lol. Thank you. I did a full 26.2. Ouch!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.
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.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.
As I noted yesterday, Ohio law grants privilege to peer review materials only for civil actions, not for criminal actions.
Laws, Acts, and Legislation
archives.legislature.state.oh.us
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.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?
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.
I think the issue here is his intent.
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.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!
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.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."
Appalling. But not surprising.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.
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.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...
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?"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)
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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
Sadly common at the VA since it's SS and VA benefits together.Appalling. But not surprising.
Not sure, but news articles often have errors, so it's never a given that a media article or report is automatically accurate.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?
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.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.
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.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.
That is crazy that would be allowed.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
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.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.
2,500 mcg fentanyl
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?\
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.
You regularly gave 2,000 mcg boluses to unintubated patients as a PGY2?As a pgy2 I took out 1000-2000 mcg of fentanyl regularly.
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, 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).
Maybe 1000mcg’s, directly before intubation as a cardiac/liver tx induction. Old school.You regularly gave 2,000 mcg boluses to unintubated patients as a PGY2?
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.
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.Correct. He is purposefully misinterpreting statements while couching them in terms to make himself look reasonable.
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