Doctor skirted pharmacists, nurses
Sources: Husel’s ‘urgent’ orders, convincing ways got him around safeguards
Sidestepping pharmacists and persuading nurses to follow his orders are among the actions used by Dr. William Husel to prescribe lethal doses of pain medication for dozens of patients while working the night shift at Mount Carmel West hospital's intensive-care unit, sources told The Dispatch.
Staff members who worked in the ICU in the past five years said Husel often would give emergency orders for the powerful opioid fentanyl or some other painkiller. Those emergency orders, meant to be used in certain urgent situations, would allow him to bypass a pharmacist's pre-approval, giving the
medical staff access to drugs stored in a Pyxis machine, or secure cabinet, on the ICU floor.
Husel sometimes would tell families agonizing over removing a loved one from a ventilator that he would ease the patient's suffering with pain medication, but he didn’t tell the families he was prescribing potentially lethal dosages, family members said.
Other times, the doctor would just order the large doses of opioids without informing families or consulting with anyone else in the hospital, families have said in lawsuits.
If he was challenged by nurses or pharmacists over his prescriptions for pain medication, the doctor often would tout his residency work as an anesthesiologist at the Cleveland Clinic, then offer long medical explanations to justify his decisions, the staff members said.
The Dispatch talked to three people who have worked at the hospital and another who is close to the hospital. They did not want to be named because they feared backlash from Mount Carmel or former co-workers.
They say Husel's behavior went undetected for nearly four years because of hospital policies that were loose enough to allow Husel to work around them and go unchecked.
Mount Carmel Health System said the first formal complaint about Husel was filed on Oct. 25, and an internal investigation is reviewing whether administrators should have known about his actions sooner.
The system said in a Friday statement that it has more work to do and has engaged independent experts to strengthen processes to keep patients safe. "The industrystandard safety measures in place were not sufficient to prevent the events that have occurred," the statement said.
Among recent changes, it said, are the changing of limits on the amounts of specific medications available for emergency override through the automated pharmacy dispensing system.
Other actions include a new protocol to set maximum dosages for pain medication in the electronic medical-record system; a new escalation policy for deviations in pain-medication protocols, increased education on endof-life care and a review of hospital culture to determine needed changes.
Mount Carmel fired the 43-year-old Husel, of Liberty Township, on Dec. 5. The health system has said Husel ordered excessive doses of pain medication for 34 near-death patients. All of the patients died, but Mount Carmel has said it does not believe the drugs caused six of the deaths.
All but one of the patients identified in the investigation died at Mount Carmel West. One died at Mount Carmel St. Ann's hospital.
Several hospital sources have confirmed that Dr. Larry Swanner, the hospital's vice president of medical affairs, has been placed on leave. And the health system recently fired its pharmacy director, Janet Whittey, according to attorneys representing victims.
Whittey could not be reached, and Swanner did not return several messages seeking comment.
Mount Carmel has placed a total of 23 employees on paid leave, including pharmacists, nurses and managers. Its Friday statement said this is standard procedure in the investigative process and not meant to imply blame.
In recent years, the hospital redistributed doctors to staff more day shifts, which are busier, said two doctors who worked in the ICU in the past five years.
New doctors performing residencies as part of their training were taken off overnight shifts in 2013, Mount Carmel said, because weekly resident hours were capped at 80.
That meant Husel often was the only doctor in the ICU during large stretches at night, hospital staff members said.
Mount Carmel said best practice is to have a criticalcare doctor in the unit 24 hours a day, and Husel served in that clinical-coverage role.
Fentanyl is commonly stored in 50 microgram bottles, and nurses and pharmacists from large area hospitals in Cleveland, Cincinnati and Columbus said that any nurse should question why more than two bottles are being opened.
If Husel ordered 1,000 micrograms, as he is accused of doing for James “Nick” Timmons, that meant a nurse would have had to open 20 bottles.
Pharmacists also were supposed to retroactively approve any emergency doses that Husel ordered and review their appropriateness, the doctors who worked at Mount Carmel have said.
It is unclear what protocol was in place during Husel’s time in the ICU and whether it was followed, including an audit or accounting of how much medication was being dispersed.
It is also unclear why pharmacists required to approve the drugs and nurses who administer them may not have spoken up.
The Dispatch tried to reach out to several nurses and pharmacists named in wrongful-death lawsuits, and they declined to comment or couldn't be reached.
Each patient who died under Husel’s care would have originally been assigned another Mount Carmel doctor when they were admitted, as is normal procedure for hospitals. Those doctors would have had access to the patient charts before signing the death certificates.
The Dispatch reviewed death certificates of 11 patients named in lawsuits. Of those, only one had fentanyl or other drugs listed as a possible cause of death. The Dispatch reached out to the other doctors who treated the patients and signed the death certificates, but they either declined to comment or couldn’t be reached.
Timmons, who died Oct. 24, was the only Husel patient identified to date for whom an autopsy was performed by the Franklin County coroner. The coroner listed the cause of death as cocaine and fentanyl.
The coroner's report did not say whether Timmons used fentanyl or if it was given to him in the hospital. An attorney for Timmons' family provided medication records that show he was given 1,000 micrograms of fentanyl, 10 milligrams of the opioid Dilaudid and two 10-milligram doses of the sedative Versed all ordered by Husel — in the minutes before his death.
The coroner did not return calls seeking comment.
Husel was first hired by Mount Carmel in 2013 as an internal medicine doctor in the ICU, but during his five-plus years in that department he was not board certified, unlike an estimated 85 percent of physicians working in the U.S.
Officials at three national medical certification organizations all said Husel is not currently certified nor has he ever been certified with their boards or associations.
Board certifications are not required by the Ohio State Medical Board to practice medicine. But they serve as proof that a physician has additional expertise in a particular specialty or subspecialty in a medical practice.
Some hospitals have independently made the decision to require board certification for staff privileges. Mount Carmel said Husel's efforts toward getting credentialed were consistent with their bylaws, but it did not provide details.
The health system went public about its investigation on Jan. 14, the same day the first wrongful-death lawsuit was filed against Mount Carmel, Husel and others.
Following the initial Oct. 25 complaint, a second complaint against Husel was filed Nov. 19 and a third on Nov. 21, the day Husel was removed from patient care.
In the weeks after the first complaint was filed, the health system acknowledged, Husel overdosed three patients. Lawyers said one happened Nov. 20, after the second complaint, and involved a 2,000-microgram dose of fentanyl and 10 milligrams of Versed.
Husel’s medical license has been suspended, and an investigation has been launched by Columbus police and Franklin County Prosecutor Ron O'brien. Husel faces at least 14 lawsuits.
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