Husel Trial -- NOT GUILTY

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coffeebythelake said:
I am most curious to see what some of our colleagues in hospice and palliative medicine think about this case.
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I am HPM board certified and I care for compassionate extubations frequently. Seeing the orders he entered (shown at trial) I am concerned that he was not simply trying to prevent suffering by treating pain and dyspnea. He was also trying to treat staff suffering by preventing patients from lingering after extubation. This can be tough for staff and families to watch.

Do I think that in his heart of hearts he thought he was doing the right thing and relieving suffering? Yes
Do I think he knew the doses he was ordering were likely to hasten the patients' deaths? Yes

[edit: What follows is a rule of thumb and requires significant adjustments based on individual patient characteristics, this is not a guideline for others to use.] When I'm recommending post-extubation meds for a patient I look at what they've been getting for the past few days and calculate their opioid dose per 24hours. Then I order a basal infusion rate that will make up for 50% of that and I order a bolus dose that is 10% of their 24 hour need, and allow that bolus to be given every 10 minutes. Somebody stands at the bedside and uses their assessment (often augmented with an RDOS and ABBEY) to determine if boluses are needed. If the boluses are insufficient, I increase the bolus. If the boluses are sufficient, but are needed frequently, then I'll double the basal rate. I use benzos to treat anxiety that does not respond to pain/dyspnea treatment and patient repositioning/reorientation and, frankly, I rarely need benzos.

With this approach my patients are comfortable, their family's are not distressed, and I've never had to give a 1000mcg fentanyl or 10mg hydromorphone bolus dose.
 
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dpmd said:
Only 2 of the 25 nurses got a year's suspension as far as I could find. Two pharmacists paid fines of 1000 for one and 2000 for the other. The rest as far as I could find got no sanctions.
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2 nurses got suspended for a year.

Two pharmacists were fined.

Why?

Because everything checked out okay?
 
Southpaw said:
I don't disagree with a lot of what you say. Just a couple quick points - some number of those patients had been in the ICU for weeks, intubated, on fentanyl or other opiate gtts. I wouldn't classify them as opiate naive. Yes, the bolus doses were still high and not what most would do.

He's charged with 14 counts of murder. It is on the prosecution to show he had a pre-meditated plan to kill people, and his actions killed people. Like you said, those people were dead within 1 hr of terminal extubation regardless of what happened. Perhaps sooner for many of them. It is on the prosecution to prove beyond a reasonable doubt that it was the fentanyl that killed them and not their disease. I don't believe they can do that. Some of those patients lived 20-30 minutes after the initial bolus of fentanyl. Can you definitively, beyond all doubt, tell me it was the fentanyl that killed those patients and not their disease state considering how sick they all were? In my opinion absolutely not. Keep in mind one of the patients (that the prosecution tossed out because they knew it would look awful for their case) lived 9 days after high initial fentanyl boluses!

Does that mean it was perfectly fine to go around willy nilly bolusing grams of fentanyl to everyone? No. It just means in my opinion he isn't guilty of murder.
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Never underestimate a jury. Remember, these jurors were picked from the same pool of people who thought their loved ones had fighting chances.
 
 
southerndoc said:
Never underestimate a jury. Remember, these jurors were picked from the same pool of people who thought their loved ones had fighting chances.
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I'm not sure if the families actually thought that. I think they were handed money by the hospital before all this **** came down and they accepted with open hands
 
dpmd said:
Because the hospital made claims, but for the 35 other staff members despite those claims everything checked out ok.
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Yet, "they were just easing suffering." But.... the CEO felt the need to resign apologetically, for some reason. And...two dozen people were fired. And...a doctor is on trial for alleged serial murder. And...a bunch of patients' families are left thinking, "Maybe they did have a chance, after all?"

No matter how this turns out, it's a catastrophic poop-storm of historic proportions.
 
dpmd said:
Only 2 of the 25 nurses got a year's suspension as far as I could find. Two pharmacists paid fines of 1000 for one and 2000 for the other. The rest as far as I could find got no sanctions.
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That are publicly available. There are several settlement agreements in play during trial that explicitly state they cannot testify for the defense and must be a prosecution witness.

Really, really shady

Trial is probably just a sixth of the way done, but my overall impression reading between the lines

-virtually everyone knew for years what husel was doing
-a single (new) pharmacist asked husel about a 1,000 mcg dose. Exact details of that conversation were not talked about in court. He talked to another pharmacist about it first who told him it was a "normal dose" for husel
-the pharmacist's supervisor got involved when he escalated the issue. What private conversations they actually had, presumably about euthanasia, are not known. The emails about this situation are worded in a very careful way
-pharmacist supervisor escalated it to risk management, who referred the matter to peer review. Two separate VOICE reports are made, one by pharmacy supervisor for one case and another by risk management. A third occurs shortly after #2.
-an RCA was done for main cases involved. The conclusions of the RCA did not definitively prove the fentanyl was the cause of death
-while the RCA was being done, the VPMA wanted to appear "transparent" and send the case to the prosecutors office. I think, this is just my opinion, no one thought actual murder charges would be brought. Entire thing spins out of control.
-Mount Carmel gets to all the witnesses before the cops do. Settlements are all completed before criminal trial, many of those terms dictate who can be a witness for what side
-Now there is a murder trial!
-Prosecutors have to stick to their guns. I think hospital said there might be an issue so Ron O'brien just took Mount Carmel at their word it was murder and detectives start doing a murder investigation. The first witness was a murder detective who was clearly uncomfortable outside of the pew pew pew kind.

The families were not aware of any POSSIBLE wrongdoing until long after the fact after they were contacted when cops were involved.

Here's my hottake:
entire landmine issue could have been sidestepped by a single meeting with Husel and the VPMA, where VPMA goes, "dude, stop. Don't do that again. Just let them linger, suffer and die like everyone expects." Sweep it under the rug and move on. Issue is way too controversial. He's going to be a hero to some and a murderer to others without a clear, beyond-a-reasonable-doubt viewpoint.

But this is the hill Ohio wants to die on so they are throwing everything at it.
 
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Birdstrike said:
Yet, "they were just easing suffering." But.... the CEO felt the need to resign apologetically, for some reason. And...two dozen people were fired. And...a doctor is on trial for alleged serial murder. And...a bunch of patients' families are left thinking, "Maybe they did have a chance, after all?"

No matter how this turns out, it's a catastrophic poop-storm of historic proportions.
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I agree with your last statement, I just disagree with where you seem to be assigning the blame for it.
 
AlmostAnMD said:
That are publicly available. There are several settlement agreements in play during trial that explicitly state they cannot testify for the defense and must be a prosecution witness.

Really, really shady

Trial is probably just a sixth of the way done, but my overall impression reading between the lines

-virtually everyone knew for years what husel was doing
-a single (new) pharmacist asked husel about a 1,000 mcg dose. Exact details of that conversation were not talked about in court. He talked to another pharmacist about it first who told him it was a "normal dose" for husel
-the pharmacist's supervisor got involved when he escalated the issue. What private conversations they actually had, presumably about euthanasia, are not known. The emails about this situation are worded in a very careful way
-pharmacist supervisor escalated it to risk management, who referred the matter to peer review. Two separate VOICE reports are made, one by pharmacy supervisor for one case and another by risk management. A third occurs shortly after #2.
-an RCA was done for main cases involved. The conclusions of the RCA did not definitively prove the fentanyl was the cause of death
-while the RCA was being done, the VPMA wanted to appear "transparent" and send the case to the prosecutors office. I think, this is just my opinion, no one thought actual murder charges would be brought. Entire thing spins out of control.
-Mount Carmel gets to all the witnesses before the cops do. Settlements are all completed before criminal trial, many of those terms dictate who can be a witness for what side
-Now there is a murder trial!
-Prosecutors have to stick to their guns. I think hospital said there might be an issue so Ron O'brien just took Mount Carmel at their word it was murder and detectives start doing a murder investigation. The first witness was a murder detective who was clearly uncomfortable outside of the pew pew pew kind.

The families were not aware of any POSSIBLE wrongdoing until long after the fact after they were contacted when cops were involved.

Here's my hottake:
entire landmine issue could have been sidestepped by a single meeting with Husel and the VPMA, where VPMA goes, "dude, stop. Don't do that again. Just let them linger, suffer and die like everyone expects." Sweep it under the rug and move on. Issue is way too controversial. He's going to be a hero to some and a murderer to others without a clear, beyond-a-reasonable-doubt viewpoint.

But this is the hill Ohio wants to die on so they are throwing everything at it.
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The seems like a very rational assessment. In my opinion, the most rational way to advocate for reform of our laws related to death and dying doesn't look like anything that was done in this situation.
 
dpmd said:
I agree with your last statement, I just disagree with where you seem to be assigning the blame for it.
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I don't know all the evidence from both sides and therefore can't assign any blame. The jury will do that. I'm only reacting to what I've read on this thread. You must have missed my opinion on the question of responsibility in this case. Here it is, again:

Birdstrike said:
I know nothing about this Husel case other than what I've read in this thread. As far as I'm concerned, he's innocent, until proven guilty.
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Birdstrike said:
I don't know all the evidence from both sides and therefore can't assign any blame. The jury will do that. I'm only reacting to what I've read on this thread. You must have missed my opinion on the question of responsibility in this case. Here it is, again:
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Maybe you believe that to be true, but your posts don't reflect that.
 
WilcoWorld said:
I am HPM board certified and I care for compassionate extubations frequently. Seeing the orders he entered (shown at trial) I am concerned that he was not simply trying to prevent suffering by treating pain and dyspnea. He was also trying to treat staff suffering by preventing patients from lingering after extubation. This can be tough for staff and families to watch.

Do I think that in his heart of hearts he thought he was doing the right thing and relieving suffering? Yes
Do I think he knew the doses he was ordering were likely to hasten the patients' deaths? Yes

When I'm recommending post-extubation meds for a patient I look at what they've been getting for the past few days and calculate their opioid dose per 24hours. Then I order a basal infusion rate that will make up for 50% of that and I order a bolus dose that is 10% of their 24 hour need, and allow that bolus to be given every 10 minutes. Somebody stands at the bedside and uses their assessment (often augmented with an RDOS and ABBEY) to determine if boluses are needed. If the boluses are insufficient, I increase the bolus. If the boluses are sufficient, but are needed frequently, then I'll double the basal rate. I use benzos to treat anxiety that does not respond to pain/dyspnea treatment and patient repositioning/reorientation and, frankly, I rarely need benzos.

With this approach my patients are comfortable, their family's are not distressed, and I've never had to give a 1000mcg fentanyl or 10mg hydromorphone bolus dose.
Click to expand...

If an intubated patient is on 200mcg/hr of fentanyl for vent tolerance, their 24 hr requirement is 4800 mcg. So you’re bolus dose, 10% of that, is essentially 500mcg? And that’s on top of a basal?
 
Southpaw said:
If an intubated patient is on 200mcg/hr of fentanyl for vent tolerance, their 24 hr requirement is 4800 mcg. So you’re bolus dose, 10% of that, is essentially 500mcg? And that’s on top of a basal?
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100mcg/hr plus 500mcg repeated q 10 gets to doses more than husel ordered in under an hour if my math is not off
 
Southpaw said:
If an intubated patient is on 200mcg/hr of fentanyl for vent tolerance, their 24 hr requirement is 4800 mcg. So you’re bolus dose, 10% of that, is essentially 500mcg? And that’s on top of a basal?
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Those calculations are where I start. Then I look at the results and adjust based on my clinical judgement. This isn't a set it and forget it thing.

In the hypothetical situation you described the answer is "no", because after vent withdrawal the need for vent tolerance has gone away. So, while I'll start with higher doses than I would for an opioid naiive patient, I would not continue their vent tolerance opioid infusion dose.

Similarly, if I'm managing a patient with a hip fracture, I expect their opioid needs to go down after their hip has been fixed.
 
WilcoWorld said:
I think this thread has reached the (unfortunately common) point where posters are actively trying to misunderstand each other.
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Oh, don’t give up on us anesthesiologists yet….😜

But serious question, based on your starting formula I have to assume you’ve ordered 500mcg boluses. Is this correct?

I actually don’t care about the basal as these folks have been in the unit presumably for days to weeks on fentanyl gtts and the context sensitive halftime of fentanyl dictates that turning the gtt off isn’t leaving them with no fentanyl.
 
Robotic Wis-Hipple said:
But serious question, based on your starting formula I have to assume you’ve ordered 500mcg boluses. Is this correct?
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No, I've never started at that high of a bolus. The 10% is a rule of thumb, just to get me into the ballpark. If I look at the number & know it's going to result in a call from the pharmacist and a panicked nurse, I adjust down.
 
One thing I'd want to see as a juror would be to hear from the doctor. If he did what he did to provide comfort care, with no intent to kill, then tell me directly, as a juror. It would be a lot easier to vote for acquittal if he did so and came across as compassionate, reasoned and believable. Speak to those jurors as you would if they're family members of your patients. If you acted out of compassion and with no intent to harm, it should be easy to explain.

But, since he already pled the 5th and refused to answer any questions from the medical board, according to the news article I posted above, it seems unlikely he'll testify in his own defense. I think that's very unfortunate.
 
Birdstrike said:
One thing I'd want to see as a juror would be to hear from the doctor. If he did what he did to provide comfort care, with no intent to kill, then tell me directly, as a juror. It would be a lot easier to vote for acquittal if he did so and came across as compassionate, reasoned and believable. Speak to those jurors as you would if they're family members of your patients. If you acted out of compassion and with no intent to harm, it should be easy to explain.

But, since he already pled the 5th and refused to answer any questions from the medical board, according to the news article I posted above, it seems unlikely he'll testify in his own defense. I think that's very unfortunate.
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Hopefully the defense brings up a few physician experts that would speak to that
 
Southpaw said:
I don't disagree with a lot of what you say. Just a couple quick points - some number of those patients had been in the ICU for weeks, intubated, on fentanyl or other opiate gtts. I wouldn't classify them as opiate naive. Yes, the bolus doses were still high and not what most would do.

He's charged with 14 counts of murder. It is on the prosecution to show he had a pre-meditated plan to kill people, and his actions killed people. Like you said, those people were dead within 1 hr of terminal extubation regardless of what happened. Perhaps sooner for many of them. It is on the prosecution to prove beyond a reasonable doubt that it was the fentanyl that killed them and not their disease. I don't believe they can do that. Some of those patients lived 20-30 minutes after the initial bolus of fentanyl. Can you definitively, beyond all doubt, tell me it was the fentanyl that killed those patients and not their disease state considering how sick they all were? In my opinion absolutely not. Keep in mind one of the patients (that the prosecution tossed out because they knew it would look awful for their case) lived 9 days after high initial fentanyl boluses!

Does that mean it was perfectly fine to go around willy nilly bolusing grams of fentanyl to everyone? No. It just means in my opinion he isn't guilty of murder.
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Yea man well written. Without hearing any of the actual testimony, I think this Husel guy is up shiiiits creek without a paddle. Husel will testify that he was trying to reduce suffering of these terminally ill patients. he's going to have to prove they were suffering terribly. I'm not sure how easy that will be. If I were the prosecution, I would pull every trauma / burn patient he's ever taken care of over the past few years:

1. "Doc, you took care of this poly-trauma patient who had a broken pelvis, broken femur, and a smashed foot. Why did you only give him fentanyl 100 mcg x2? Wasn't he suffering too? Why not 1000 mcg fentanyl? Just like these other patients?"
2. "Doc, you took care of this guy who has 20% burns to his body. You only gave him 2mg dilaudid IV x2 over 2 hours. Why didn't you give him 1000 mcg of fentanyl? Wasn't that guy in a lot of pain?"
3. "Doc, you took care of this woman who is a sickler. She was having a VOC. All you gave her was dilaudid 2mg IM x3 over 3 hours. Why not more?"

I hope for Husel's case that he always gives 500-1000 mcg fentanyl. All the time. Then his care is defensible. But I doubt that.
 
Birdstrike said:
I'm not a palliative care specialist. But in my Pain fellowship we did a month of palliative care. On my first day, we had a 99-year-old terminal patient who was extubated, taken off all O2, not receiving any tube feeds, and only receiving 10cc/hr of saline sub-Q. If I asked 100 doctors how long that person would live, 99 would say she'd die in 3 days. 100 would likely say she couldn't live longer than a week. She had been alive before I came on service and she was still alive when I went off service a month later. She actually smiled when you'd come see her. Nothing is 100% in Medicine.
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Wat? What is this you speak of?
 
Arch Guillotti said:
I have to believe that there is zero chance a nurse would give such a big dose of fentanyl at once. Then again, didn’t a nurse give vecuronium instead of versed in the MRI scanner or somesuch?
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Don't mean to intrude, but... as critical care RN, never given more than 100 of fent in a single dose. Gave 8mg of hydro one time, after checking that it had been titrated up to that dose over the past week from 1 up until 8... and tbh 8 didn't really seem like enough for that one either. Maximum I've ever run a drip for palliative purposes was 450mcg/hr, but again, titrated up and not started at that dose.

Can't say I'd really want to receive an order for a thousand straight up. I can see giving more than a thousand in an hour, for a palliative care patient, if I'm accompanying drip increases with bolus doses, but there's going to be a paperwork trail in which I am giving moderate doses at frequent intervals with suffering lessening until a palliative dose is achieved, which is different.

There is a special place in hell for the people who think 25 of fent q1hr is enough for an end stage respiratory/cardiac failure who's been in the ICU for a month, though.
 
coffeebythelake said:
Would it have made a difference to you if the fentanyl was given an hour, 2 hour, 6 hours before terminal extubation vs. After extubation? Why?
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Because we have established that 1000 mcg fentanyl IVP is a massive dose for 99.99% of people. There just is no reason beyond profound opiate tachyphylaxis to give that dose.
 
dpmd said:
Are you of the opinion that people with criminal and civil charges are acting suspiciously if they don't answer the questions a licensing board asks?
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I'm of the opinion that if I was a juror, I'd want to hear directly from him that he was acting solely to prove comfort and ease suffering. I'd want to hear his reasoning including for what he gave and why, just like he'd explain it to a family. If what he did was out of compassion and not to harm, I'd want to hear it directly from him, not only from a lawyer. That shouldn't be hard. Surely he explain what he did and why to the patient's families? Right?

R i g h t . . . ?

A juror has every right to feel that way and no one has any ability to make them feel otherwise. He has the right to refuse. And the jury has the right to determine where he spends the rest of his life. He's at their mercy.

On a personal level, I've had a complaint filed against with a medical board. It was a false accusation. I had no problem explaining my side, the truth of what happened, in writing and in person, if needed (it wasn't). I didn't plead the 5th amendment. I defended myself against false charges. I didn't send some lawyer to do the defending for me. The medical board agreed with my assessment and I won. The charges were dismissed in full.
 
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Nope, you give hyaluronidase first and it makes it more comfortable. We'll do it in our Peds ED for dehydrated kiddos with difficult IV access. Plump 'em up with subQ fluids, then get the IV when you can.

Of course, if they're peri-code you go for the IO...
 
dpmd said:
I know it is a thing in vet med but isn't it not a thing for humans because it hurts a lot due to the way our sub q is structured versus animals?
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It's a thing, in end-of-life care (and peds).
 
Birdstrike said:
I'm of the opinion that if I was a juror, I'd want to hear directly from him that he was acting solely to prove comfort and ease suffering. I'd want to hear his reasoning including for what he gave and why, just like he'd explain it to a family. If what he did was out of compassion and not to harm, I'd want to hear it directly from him, not only from a lawyer. That shouldn't be hard. Surely he explain what he did and why to the patient's families? Right?

R i g h t . . . ?

A juror has every right to feel that way and no one has any ability to make them feel otherwise. He has the right to refuse. And the jury has the right to determine where he spends the rest of his life. He's at their mercy.

On a personal level, I've had a complaint filed against with a medical board. It was a false accusation. I had no problem explaining my side, the truth of what happened, in writing and in person, if needed (it wasn't). I didn't plead the 5th amendment. I defended myself against false charges. I didn't send some lawyer to do the defending for me. The medical board agreed with my assessment and I won. The charges were dismissed in full.
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Did you have a criminal charge against you at the time? If not then your anecdote is irrelevant. Whether or not he answered questions to the licensing board has no bearing on whether or not he will take the stand in his criminal trial.
 
Birdstrike said:
I'm of the opinion that if I was a juror, I'd want to hear directly from him that he was acting solely to prove comfort and ease suffering. I'd want to hear his reasoning including for what he gave and why, just like he'd explain it to a family. If what he did was out of compassion and not to harm, I'd want to hear it directly from him, not only from a lawyer. That shouldn't be hard. Surely he explain what he did and why to the patient's families? Right?

R i g h t . . . ?

A juror has every right to feel that way and no one has any ability to make them feel otherwise. He has the right to refuse. And the jury has the right to determine where he spends the rest of his life. He's at their mercy.

On a personal level, I've had a complaint filed against with a medical board. It was a false accusation. I had no problem explaining my side, the truth of what happened, in writing and in person, if needed (it wasn't). I didn't plead the 5th amendment. I defended myself against false charges. I didn't send some lawyer to do the defending for me. The medical board agreed with my assessment and I won. The charges were dismissed in full.
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When an individual takes the Fifth, silence or refusal to answer questions cannot be used against him in a criminal case. A prosecutor cannot argue to the jury that the defendant's silence implies guilt.

That being said I agree with you 100% that the likeability of Dr Husel and how he js perceived by the jury is more important than the facts presented.
 
WilcoWorld said:
Nope, you give hyaluronidase first and it makes it more comfortable. We'll do it in our Peds ED for dehydrated kiddos with difficult IV access. Plump 'em up with subQ fluids, then get the IV when you can.

Of course, if they're peri-code you go for the IO...
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Hmm, interesting. Had no idea. Then again by the time I'm seeing kids they have IV access. I can't think of a single end of life patient I have had where hydrating them would be desirable, but mine tend to be more the mostly dead terminal extubations rather than the bad diagnosis killing them slowly version.
 
dpmd said:
Did you have a criminal charge against you at the time?
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No, I did not and never have. My case was due to an imaging study ordered by a completely different doctor in a different practice, that wrongly had my name put on it.

dpmd said:
Did you have a criminal charge against you at the time? If not then your anecdote is irrelevant.
Click to expand...
My example was in relation to the Medical Board. He pled the Fifth before the medical board on Jan 22, 2019. He had no criminal charge against him at the time. He wasn’t charged until June 5, 2019.
 
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Birdstrike said:
No, I did not and never have. My case was due to an imaging study ordered by a completely different doctor in a different practice, that wrongly had my name put on it.


My example was in relation to the Medical Board. He pled the Fifth before the medical board on Jan 22, 2019. He had no criminal charge against him at the time. He wasn’t charged until June 5, 2019.
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The criminal investigation for him was announced before this hearing and the civil lawsuits were filed beforehand as well.
 
Birdstrike said:
No, I did not and never have. My case was due to an imaging study ordered by a completely different doctor in a different practice, that wrongly had my name put on it.


My example was in relation to the Medical Board. He pled the Fifth before the medical board on Jan 22, 2019. He had no criminal charge against him at the time. He wasn’t charged until June 5, 2019.
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…it’s kind of disingenuous to compare a misidentification study to a potential murder investigation.

If you’re being charged with any crime potentially, especially murder, you stfu and do what your lawyer says to do. If they say talk you talk. If they say shut your mouth you do it.

A person who lacks charisma will get crucified by people who make a living out of vilifying people. An inadvertent comment might damn you, or a poorly interpreted phrasing might too.
 
ToliBro said:
There is a special place in hell for the people who think 25 of fent q1hr is enough for an end stage respiratory/cardiac failure who's been in the ICU for a month, though.
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A common morphine dosage is 2-4 mg IV q1hr at end of life, for air hunger.
 
Today ended early after more sidebar than testimony.

The mount carmel physician executive on the stand today testified he saw five different reports ran regarding doses of 500 mcg or higher given to patients outside of OR or "procedure areas." His carefully worded answer indicated only husel did these doses.

Then things really got out of hand. Apparently months later an additional report was run. That doc on the stand saw the report, so did the vpma from yesterday and both had testified with knowledge loosely around that report.

The problem is the report is privileged. I do not know why. Defense raised many objections about testimony being allowed from people viewing privileged material. This caused a work stoppage for the day that involved defense attorneys, prosecutors and the hospital attorneys (three sets of lawyers!).

There is a separate issue about external peer review. The cases were sent to external peer review but these were also mentioned and are privileged. I do not know their contents.

I suppose I can speculate because prosecutors want the peer reviews and whatever this other report is buried. Maybe its damaging to the prosecutors case?? An MD/JD can comment here but I dont know why else prosecutors and hospital attorneys would care otherwise.

I guess everyone has to go home and write essays to the judge about what should be privileged or not. They turn them in a 2p tomorrow for judge to review so no trial on Friday. Court will resume Monday with a decision.

Lots of lawyering today but no meaningful progress.


Also, I agree with whoever said husel should not testify. In ohio no murder suspect testifies. He is an anesthesia critical care doctor, not a lawyer. Prosecutors are out for blood and they will tear him up. Even if he answers every question flawlessly he would have so much mud slung at him by prosecutors it would still look bad to the jury. Would be very surprised if he testified, defense would only do this if they really saw a winning benefit.
 
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