Husel Trial -- NOT GUILTY

[AlmostAnMD]

Jury selected in murder trial of Dr. William Husel

Husel is accused of ordering excessive or potentially fatal doses of fentanyl be given to patients under his care.

www.10tv.com

He's a crit care doc but I think trial is important anyway

Details have never really been released, it's all going to come out soon. He's charged with a bunch of murder counts.

Basically, in 2019 he was fired because he was giving huge doses of fentanyl, upward 1,000 mcg to "sick patients." I have had a lot of trouble finding medical information on these people. The read-between-the-lines seems to be these are the kinds of people we've all had the fantasy of just doing in and this guy did it.

38 staff--nurses and pharmacists--were fired in his wake. Clearly at least some knew what he was doing and just looked the other way, which is very telling.

Stoked for outcome because if he's found not guilty that means the person that decides code status is me (half-joking).

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[skougess]

Honestly barbaric if these were truly dying patients and he gets charged with murder. Ask palliative care at your institution what kind of opiate regimens they have patients on.

 

[WilcoWorld]

I don't know the details of his case(s), so I won't speculate. However, I want to draw attention to an important principle in medical ethics: The Rule of Double Effect.

There are things we do to patients with the intention of helping them which we know COULD lead to their death, but we are not murderers. Why? Because of The Rule of Double Effect.

Mechanical thrombectomy and opioids for the treatment of dyspnea are two examples. Each are a therapy that we hope will help, but we also know can lead to someone's death (hence "double effect"). Judging these actions can be tough, because they're only ethical when we do them with the intention of helping the patient, and intention is tough to judge.

In order for The Rule of Double Effect to apply, certain criteria have to be met:
1 - the treatment has to have a reasonable likelihood of achieving the desired outcome (stroke treatment, relief of dyspnea)
2 - the treatment has to be proportional to the desired effect
3 - your actual goal can not be for the patient to die
4 - the patient (or their decision maker) is accepting of the risks of death associated with the treatment

So, giving 50mcg boluses of fentanyl every 15 minutes MAY be ethical if your patient is opioid tolerant, severely dyspneic, and prefers relief of symptoms over prolongation of life. However, giving 1000mcg boluses of fentanyl is not going to be protected under The Rule of Double Effect because it violates criteria #2 above. I've ordered some whopping doses of opioids for Palliative Care patients on comfort focused care, but I've never bolused 1000mcg of fentanyl - that is disproportionate to the goal of dyspnea relief.

Daniel Sulmasy proposed a good rule of thumb: If you perform this intervention and the patient doesn't die, will you be disappointed? If your answer is "yes" then The Rule of Double Effect doesn't apply.

 

[Birdstrike]

Remember that old ‘standard of care’?

My guess, without knowing details of the case, is the focus is going to be on, “Were these ‘standard’ doses?” If the plaintiffs can show 1,000mcg bonuses of fentanyl were not ‘standard’ in that icu (likely they were not) and in that community, then he’s in trouble. If on the other hand, the defense can show that they normally housed a stable of high-dose opiate patients with 10 times the opiate tolerances of the average patient (doubtful) then he might have a defense.

But here’s the big question: If he’s convicted of murder, how many of those 30+ fired staff members, who new what was happening, and carried out his orders, are accessories to murder?

And if he’s charged and they aren’t, why not?

It will be interesting to follow. I hope the jury comes to a just decision.

 

[xaelia]

Stoked for outcome because if he's found not guilty that means the person that decides code status is me (half-joking).

In NZ, we do somewhat acutely determine the "ceiling of care" and the relative futility of critical care interventions.

Much of what would otherwise get the so-called "full court press" in the U.S. gets maximal medical management +/- palliative care on the floor.

 

[BoardingDoc]

But here’s the big question: If he’s convicted of murder, how many of those 30+ fired staff members, who new what was happening, and carried out his orders, are accessories to murder?

Prediction: MD is going to be convicted of something, murder/manslaughter/idk.

Prediction: other staff will have ramifications for their licence to practice in some cases, may open themselves up to civil action. No criminal charges filed.

To be clear, this is based entirely on the exceedingly limited sound bites currently available and is fueled by cynicism driven by the average American's complete and utter willingness to accept that their elderly and frail parent eventually WILL die.

 

[e30ftw]

I heard about this a couple years ago and first thought was 1000mcg of fentanyl is far enough outside SOC to create significant legal exposure.

I don’t know the details of the case but routinely placing that order and convincing staff to follow it seems.. abnormal.

I’m sure we all understand the psychological torment of watching humans hopelessly suffer in the ICU for weeks at a time while futile interventions are repeatedly thrust upon them by well-meaning but ignorant family members but you can’t just order a gram of fentanyl to end it all..

 

[AlmostAnMD]

I’m sure we all understand the psychological torment of watching humans hopelessly suffer in the ICU for weeks at a time while futile interventions are repeatedly thrust upon them by well-meaning but ignorant family members but you can’t just order a gram of fentanyl to end it all..

That seems to be exactly what Husel did, and he's pleading not guilty. That very question is the center of the trial.

Also, just FYI, they dismissed like half of the murder charges. Prosecutor's office refused to say why. Probably just want to stick with the most egregious cases, something that tells me the jury might actually be sympathetic to a few people he mercy killed.

This also makes me want to have professional juries. Explaining complex palliative care decisions to farmers and bored housewives is a bad decision. Prosecution has announced to show "how big the dose is" they are going line up all the vials of fentanyl used. Like, if you're a doc, showing me the vials that constitute 1,000 mcg of fentanyl does not change my knowledge of that dose.

 

[nexus73]

That seems to be exactly what Husel did, and he's pleading not guilty. That very question is the center of the trial.

Also, just FYI, they dismissed like half of the murder charges. Prosecutor's office refused to say why. Probably just want to stick with the most egregious cases, something that tells me the jury might actually be sympathetic to a few people he mercy killed.

This also makes me want to have professional juries. Explaining complex palliative care decisions to farmers and bored housewives is a bad decision. Prosecution has announced to show "how big the dose is" they are going line up all the vials of fentanyl used. Like, if you're a doc, showing me the vials that constitute 1,000 mcg of fentanyl does not change my knowledge of that dose.

I don't know if it's true professional juries are more likely to find for the defendant doctor. There was study where a bench trial was more likely to find for the plaintiff than a jury of lay persons. You'd expect a judge being an educated person would be more able to comprehend the medical issues than a lay person. But regardless, the judge was more likely to rule against the doctor than a jury. Be careful what you wish for.

 

[Dred Pirate]

This also makes me want to have professional juries. Explaining complex palliative care decisions to farmers and bored housewives is a bad decision. Prosecution has announced to show "how big the dose is" they are going line up all the vials of fentanyl used. Like, if you're a doc, showing me the vials that constitute 1,000 mcg of fentanyl does not change my knowledge of that dose.

i am trying to wrap my head around what type of RN or Rph would actually administer / approve doses on that level? The closest thing I can think of is the crazy intrathecal syringes for pain pumps I have made that would have 1 gram of dialudid in them. That freaked me out the first time I saw it, but never a one time dose - I mean, even in hospice care you don't (at least I haven't) seen those doses other than some crazy extreme cases where you can see a history of escalating doses.

Hell, I have had problems sometimes with Rn's refusing to give 10mg morphine doses- and that is one syringe. (but they never have issues giving 2mg of dialudid for some reason).

In regards to the number of vials, slightly off topic, but I always teach rph's/rn's that if you have to grab three of something to make a dose, do a double check because there is a good chance it is wrong.

In regards to professional juries, I get what you say, ironically I bet the average jury is less educated than the average public - I personally know 2 people who have actually served on a jury, yet I the most educated people I know do whatever they can do to get out of jury duty.

 

[RustedFox]

In regards to professional juries, I get what you say, ironically I bet the average jury is less educated than the average public - I personally know 2 people who have actually served on a jury, yet I the most educated people I know do whatever they can do to get out of jury duty.

My most recent suit settled because the attorney and insurance rep felt that; even though I was correct, had all the medicine on my side, and had corroborative testimony from another provider caring for the patient that (x and y AND z are true), that the jury would not be able to understand the science behind the decision making process, and would thus discard it in favor of "the feels".

There you have it, folks.
Your average juror is too dumb to understand the medicine, and thus is likely to ignore it.

Reason #422197 to hate the muggles.

 

[Groove]

My most recent suit settled because the attorney and insurance rep felt that; even though I was correct, had all the medicine on my side, and had corroborative testimony from another provider caring for the patient that (x and y AND z are true), that the jury would not be able to understand the science behind the decision making process, and would thus discard it in favor of "the feels".

There you have it, folks.
Your average juror is too dumb to understand the medicine, and thus is likely to ignore it.

Reason #422197 to hate the muggles.

I settled my first suit for similar reasons. It was easy to defend on paper and logical but then you have to factor in optics, difficulty in educating the jury who are not your peers and all sorts of other factors such as race, "likability", performance on the stand, performance of your expert witness on the stand, etc... All sorts of stuff that shouldn't really make a difference...yet it does. Luckily, the plaintiff didn't have much confidence that they could ultimately win it either and were willing to settle for a small amount. I'm glad you have it behind you! I know that's a relief.

 

[BoardingDoc]

My most recent suit settled because the attorney and insurance rep felt that; even though I was correct, had all the medicine on my side, and had corroborative testimony from another provider caring for the patient that (x and y AND z are true), that the jury would not be able to understand the science behind the decision making process, and would thus discard it in favor of "the feels".

There you have it, folks.
Your average juror is too dumb to understand the medicine, and thus is likely to ignore it.

Reason #422197 to hate the muggles.

I may have missed it, but I feel like you had said that there would be story time once this thing got out of the courts.

I like story time.

 

[RustedFox]

I may have missed it, but I feel like you had said that there would be story time once this thing got out of the courts.

I like story time.

It will be storytime soon; the problem is that here in FL that the board "investigates" all cases over a set amount - so the investigation is still open. Nevermind that it has been open for what seems like forever. Once that is closed, I'm free to speak about it.

 

[narcusprince]

I trained with Husel. Consider him a friend. He was solid as a resident. Extremely regimented with diet and exercise as well as competent in the operating room. I have not seen 1000 mcg dosages being boluesed in anyone. Total dosing maybe but whats the interval? Bad situation. But if he is aquitted I hope he comes after every dime he is owed.

 

[thegenius]

My most recent suit settled because the attorney and insurance rep felt that; even though I was correct, had all the medicine on my side, and had corroborative testimony from another provider caring for the patient that (x and y AND z are true), that the jury would not be able to understand the science behind the decision making process, and would thus discard it in favor of "the feels".

There you have it, folks.
Your average juror is too dumb to understand the medicine, and thus is likely to ignore it.

Reason #422197 to hate the muggles.

I heard a similar thing from my lawyer. Not quite in those exact words but something to the effect of "you did everything right and the jury will still sympathize with the plantiff."

 

[TJRock]

I heard a similar thing from my lawyer. Not quite in those exact words but something to the effect of "you did everything right and the jury will still sympathize with the plantiff."

Having served on juries in personal injury cases (no medical), your lawyer was almost assuredly correct.

 

[Apollyon]

Having served on juries in personal injury cases (no medical), your lawyer was almost assuredly correct.

More than one? I'm no scofflaw, but, I've never been even in a courtroom for jury selection. Maybe I'm lucky? Only time I've been in court was to give factual and expert evidence that sent a guy to prison for 5 to 15 (rightfully), and, another time when my buddy was a bailiff.

 

[TJRock]

More than one? I'm no scofflaw, but, I've never been even in a courtroom for jury selection. Maybe I'm lucky? Only time I've been in court was to give factual and expert evidence that sent a guy to prison for 5 to 15 (rightfully), and, another time when my buddy was a bailiff.

Maybe you are lucky or maybe I'm much older than you! 3 personal injury juries and one murder jury.

 

[Apollyon]

Maybe you are lucky or maybe I'm much older than you! 3 personal injury juries and one murder jury.

I am a member of AARP! My dad was on a civil trial, and my mother was grand jury twice. I think my sister has been called, too. However, the closest I've been is calling the telephone number and getting the automated "not today".

 

[TJRock]

I am a member of AARP! My dad was on a civil trial, and my mother was grand jury twice. I think my sister has been called, too. However, the closest I've been is calling the telephone number and getting the automated "not today".

I qualify for AARP but refuse to join. I hate to acknowledge that I'm eligible!

 

[WilcoWorld]

I am a member of AARP!

Suddenly the "I'm no scofflaw" seems much more appropriate.

 

[RustedFox]

It will be storytime soon; the problem is that here in FL that the board "investigates" all cases over a set amount - so the investigation is still open. Nevermind that it has been open for what seems like forever. Once that is closed, I'm free to speak about it.

Quoting my own post.

My first lawsuit (My Jackpot Lawsuit) has been over for years and I promised to post about it.

I've started writing about it 3 or 4 times now, and just wind up so mad that I quit each time.

Investigation concluded: "Nothing here. Doc RustedFox did nothing to warrant action."

Yet, millions were paid out.

 

[WilcoWorld]

Quoting my own post.

My first lawsuit (My Jackpot Lawsuit) has been over for years and I promised to post about it.

I've started writing about it 3 or 4 times now, and just wind up so mad that I quit each time.

Investigation concluded: "Nothing here. Doc RustedFox did nothing to warrant action."

Yet, millions were paid out.

let it out man! could be quite therapeutic

 

[Apollyon]

Suddenly the "I'm no scofflaw" seems much more appropriate.

Hey, I've always been "law and order". Justice and equity is big with me. And I don't wear socks and sandals!

 

[RustedFox]

let it out man! could be quite therapeutic

Each time, I got to the same point before wanting to throw the laptop.

I also really have to edit the language if I post it here, because SDN and wordcrimes.

 

[Birdstrike]

Quoting my own post.

My first lawsuit (My Jackpot Lawsuit) has been over for years and I promised to post about it.

I've started writing about it 3 or 4 times now, and just wind up so mad that I quit each time.

Investigation concluded: "Nothing here. Doc RustedFox did nothing to warrant action."

Yet, millions were paid out.

Notice how the lawyers set it up in that order?

Lawsuit first, with manipulation of juries with emotion, paid-for 'experts' who'll say anything for cash: Big jackpot judgement against you! Then, comes the real investigation by people that actual know medicine and no violation is found. Imagine if the board investigation came first, found no problem and then could be used as evidence for your trial. The result might be different, wouldn't it?

Try getting that changed. It would have to be done by politicians, who are...lawyers.

 

[Apollyon]

Hey, I've always been "law and order". Justice and equity is big with me. And I don't wear socks and sandals!

Well, usually. And NEVER while I'm wearing shorts!

 

[Vandalia]

Notice how the lawyers set it up in that order?

Lawsuit first, with manipulation of juries with emotion, paid-for 'experts' who'll say anything for cash: Big jackpot judgement against you! Then, comes the real investigation by people that actual know medicine and no violation is found. Imagine if the board investigation came first, found no problem and then could be used as evidence for your trial. The result might be different, wouldn't it?

Try getting that changed. It would have to be done by politicians, who are...lawyers.

That is the way it works in Indiana.

If you have qualifying malpractice insurance, any healthcare malpractice lawsuit must be reviewed by a panel of physicians first. (Or nurses, or dentists). The panel is formed as in the link below.

Indiana Medical Review Panel Formation

The panel then reaches a decision as to malpractice. A plaintiff may still file suit, but the opinion of the panel is admissible as evidence and even if not submitted by either party, the jury is informed of the panel findings.

(Note: If you are in Indiana, make sure you have a "qualifying" medical malpractice policy. If you don't then you don't get any of the med-mal protection the state enacted. This was their "soft" way of madating malpractice insurance for everyone in healthcare. I knew an urgent care physician who thought he got a great rate on insurance and then discovered it didn't "qualify" when he was sued.)

 

[GassYous]

I trained with Husel. Consider him a friend. He was solid as a resident. Extremely regimented with diet and exercise as well as competent in the operating room. I have not seen 1000 mcg dosages being boluesed in anyone. Total dosing maybe but whats the interval? Bad situation. But if he is aquitted I hope he comes after every dime he is owed.

I've given 1000 mcg in less than 5 minutes before. Also have given 500 mcgs for induction before. Maybe 1000 but I couldn't swear on it.

 

[Dantrolene FC]

I qualify for AARP but refuse to join. I hate to acknowledge that I'm eligible!

Contrary to popular belief, there is no age requirement for AARP. I joined in my 20’s.

 

[southerndoc]

Contrary to popular belief, there is no age requirement for AARP. I joined in my 20’s.

Yea, I joined about 5 years ago.

 

[Apollyon]

Contrary to popular belief, there is no age requirement for AARP. I joined in my 20’s.

But, if under 50, you can't get vendor products that are directed to those 50 or over. I don't know if, as a younger person, the AARP card discounts are worth it.

 

[Dantrolene FC]

But, if under 50, you can't get vendor products that are directed to those 50 or over. I don't know if, as a younger person, the AARP card discounts are worth it.

It’s not. I’ve never used it. I planned on using it for hotel discounts during residency interviews, but most of my interviews the programs paid for hotels, otherwise I stayed in Airbnbs.

 

[TJRock]

Contrary to popular belief, there is no age requirement for AARP. I joined in my 20’s.

Yeah, well, if there were an age requirement, I would probably still qualify. Aint doing it.

 

[thegenius]

What are the benefits of joining AARP in your 20s?

 

[Birdstrike]

What are the benefits of joining AARP in your 20s?

You get to live like an oldster 40 years early.

Early bird dinner at 4:00 pm, 20% off, bro!

 

[Dantrolene FC]

What are the benefits of joining AARP in your 20s?

I can get my hearing checked.

 

[Apollyon]

I can get my hearing checked.

What? You say something, young man? (<--- generalization, there)

 

[TJRock]

You get to live like an oldster 40 years early.

Early bird dinner at 4:00 pm, 20% off, bro!

Don't knock early dinner! Happy hour and no lines!

 

[Vandalia]

Don't knock early dinner! Happy hour and no lines!

Don't call it early dinner. It is just a really late lunch.

 

[GassYous]

What are the benefits of joining AARP in your 20s?

Discounts
15% off at dennys ballin

 

[WilcoWorld]

Don't call it early dinner. It is just a really late lunch.

Be it lunch or dinner one thing is clear, 'taint supper!

 

[TJRock]

FYI, if you are interested, the trial is being live-streamed on Law&Crime network on YouTube.

 

[AlmostAnMD]

Opening statements

hypeeeeeeeeeeeeeeeeeeeeeeeeeeee

omg

so much stuff coming out

Mt carmel literally has an email describing the strategy of painting Husel as a "villain." They did a lot a shady **** around this, palliative topics aside.

I might have to go sit in on this a day or two if I can

 

[AlmostAnMD]

They've never released the medical records or information about these patients until today

Yeah, all these people needed a good fentanyl bolus imo

 

[dchristismi]

Have not been following as daughter got married Sunday and I'm still recovering. Hell of a party, but no fentanyl.

Highest personal PCA fentanyl bolus (that I didn't start, one of the other hospice docs did) was 600mg q6 min. He didn't have a basal rate; this was just for breakthrough. He was on ketamine and methadone for basal if I remember right. But he was walking around with that dose as it had been titrated up. Colon cancer, declined to end of life over several weeks, and a really nice guy, of course.

No comment on those folks other than what we all already know looking at that list. The pressors were the only thing keeping them "alive" other than insistent families.

We had an AARP membership for awhile; AAA seemed more worthwhile so we ditched it. I'm also still 29, if anyone asks. And also, if I ever end up in a situation like any of those people on that list, a) my family knows better, and b) someone better darn well get me 1000mcg of fentanyl, get that tube out, and let me go. Sheesh.

 

[e30ftw]

The patient list is interesting and, unsurprisingly, not the way the case was presented in the media when it first came out.

It sounds like his primary failing was trying to be merciful in a system which values denial and futility.

The idea that the state is prosecuting a physician for murder when the pt is sp cardiac arrest x 4 with a ph of 6.5 is frankly terrifying.

 

[WilcoWorld]

I don't think this is the case to rally behind.

There is an ethical difference between ending a life with opioids and providing relief from suffering while a disease process ends a life. If we do not observe this distinction people may lose whatever trust they still have in physicians.

 

[Southpaw]

I don't think this is the case to rally behind.

There is an ethical difference between ending a life with opioids and providing relief from suffering while a disease process ends a life. If we do not observe this distinction people may lose whatever trust they still have in physicians.

I'm not sure what his defense will be, but if you're a physician (even an orthopedist I imagine) you know what happened after looking at that list. The guy was trying to be merciful in a health system that isn't. I don't know what we gain by putting the full court press on this poor guy, other than making it a point to say 'providers' shouldn't kill people who are already dead. We need to let them die the American way. Maybe the system could've squeezed a few extra bucks out of those poor people if he hadn't bolused the fentanyl. Also, pharmacy and nursing went along with it and they absolutely knew what the score was.