An Ohio hospital health system has fired an intensive care doctor who allegedly ordered excessive doses of medicine for nearly 30 near-death patients whose families had requested that lifesaving measures be terminated. The Columbus-area Mount Carmel Health System, a pharmacist, a nurse and the doctor, identified as William Husel, have been sued by one family that alleges that too much fentanyl was prescribed for 79-year-old Janet Kavanaugh, causing her death. The lawsuit claims Kavanaugh was given 1,000 micrograms of fentanyl, prompting her death 18 minutes later, according to The Daily Mail. 20 employees of the hospital have been suspended.
Attorney Gerry Leeseberg, the attorney representing the plaintiffs, said, "The pharmacist has an obligation to question an order, and the nurse has an obligation to question the order as well. All of those safeguards were overridden or ignored. It's like nothing I've ever seen." He hypothesized that rather than a mistake occurring because safeguards did not do their job, the medical staff involved intended to expedite the patient’s death, saying, "On balance, it's hard to believe the former occurred rather than the latter. ... This is not just a simple situation of an error.”
Mount Carmel President and CEO Ed Lamb issued a video statement in which he said, "Regardless of the reason the actions were taken, we take responsibility for the fact that the processes in place were not sufficient to prevent these actions from happening. We're doing everything to understand how this happened and what we need to do to ensure that it never happens again."
NBC News quoted Joe Carrese, a faculty member at the Johns Hopkins Berman Institute of Bioethics, as to whether Husel’s reputed actions met the standard for physician-assisted death. He stated that if the drugs administered to the patients were intended to end their lives, those actions did not meet the standard, explaining, "In this case, if that was the intent, this was essentially euthanasia, which is not legal anywhere in the United States and not at all the same as physician-assisted death.”
The Cleveland Clinic, where Husel worked as a supervised resident between 2008 to 2013, said the initial results of their investigation into the way he prescribed drugs while he was there found his actions "consistent with appropriate care provided to patients in the intensive care unit."
According to the Centers for Disease Control and Prevention, “Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine.” The Drug Enforcement Administration adds, “Overdose may result in stupor, changes in pupillary size, cold and clammy skin, cyanosis, coma, and respiratory failure leading to death. The presence of triad of symptoms such as coma, pinpoint pupils, and respiratory depression are strongly suggestive of opioid poisoning.”
The DEA also notes of fentanyl, “Oral transmucosal lozenges and effervescent buccal tablets are used for the management of breakthrough cancer pain in patients who are already receiving opioid medication for their underlying persistent pain. Transdermal patches are used in the management of chronic pain in patients who require continuous opioid analgesia. … Because of a concern about deaths and overdoses resulting from fentanyl transdermal patches … on July 15, 2005, the Food and Drug Administration issued safety warnings and reiterated the importance of strict adherence to the guidelines for the proper use of these products.”