Leadership changes at Mount Carmel are needed to restore faith

There is much we still don’t know about the institutional and individual failures that led to 25 charges of murder against a physician formerly at Mount Carmel Health System hospitals. A much fuller picture likely will emerge from the criminal case and the separate wrongful-death lawsuits that are underway against Dr. William Husel and the health system.

But enough is known already to be certain that Mount Carmel President and CEO Ed Lamb and Dr. Richard Streck, executive vice president and chief clinical officer, had to go if the community is ever to be confident that the health system has learned and changed as a result of this nightmare.

Lamb, who became CEO in 2017, announced his and Streck’s departures on Thursday, along with the fact that 23 Mount Carmel employees have been fired following the hospital system’s investigation of extraordinarily excessive doses of painkiller Husel prescribed for at least 35 patients.

Another 11 suspended employees will be allowed to return to work after completing education and training and one remains suspended.

The incidents covered by the investigation took place between February 2015 and November 2018. All of the patients died shortly after receiving the medication, and the hospital maintains that the painkillers were the cause of death in all but six cases.

Nurses and other employees told The Dispatch that, when Husel prescribed the extraordinary doses of fentanyl and other drugs, he used emergency protocols that enabled him to circumvent the normal requirements for a pharmacist’s pre-approval.

If a nurse or pharmacist questioned an order, they said, Husel would insist that his background in anesthesiology at the Cleveland Clinic ensured that his work was appropriate.

Some said Mount

Carmel’s policies were too loose, allowing Husel to get around them. That likely will be sorted out in court. Virtually everyone who has spoken about the case has said that the dosages Husel ordered were grossly excessive and never would be medically appropriate, yet no one registered a formal concern about it until October 2018.

That alone makes fairly clear that Mount Carmel failed at what hospitalindustry experts consider a critical requirement: establishing a culture in which every single employee feels empowered to speak up when he or she believes patient safety is at all threatened.

The fact that 34 people were found to be culpable enough to warrant being suspended and/or fired reinforces the suggestion that, over four years, dozens of people had reason to question Husel but didn’t.

Another reason to question the culture of patient safety under Lamb and Streck lies in the fact that Husel wasn’t removed from patient care immediately on Oct. 25, 2018, when someone finally filed a formal report raising concerns about him. Instead, he remained on duty another four weeks, during which time three more of his patients died after massive painkiller doses and two more formal reports were filed.

Mount Carmel’s investigation has revealed numerous flaws, including the lack of review of instances when nurses were ordered to override electronic systems meant to prevent high doses of powerful drugs such as fentanyl from being accessed. The hospital has said it didn’t have a process meant to prevent overdoses in intensive-care units.

That alone is enough to show that, whatever else Lamb and Streck might have accomplished, they allowed gaps in the patientsafety net.

To move beyond this tragedy, Mount Carmel must have new leadership.