Former Mount Carmel employees and fired doctor William Husel have filed lawsuits against the hospital system over the last few weeks. In an exclusive interview with WOSU, three nurses defend their actions – and Husel’s – in providing what the hospital called "excessive and potentially fatal" doses of pain medications to patients.
From the very beginning, Husel's case has revolved around doses of pain medication. Almost a year ago, Mount Carmel CEO Ed Lamb announced that the hospital had fired Husel, a night shift doctor who worked in the ICU.
"During the five years he worked here," Lamb said in a video statement, "this doctor ordered significantly excessive and potentially fatal doses of pain medications for at least 27 patients who were near death."
Mount Carmel has since updated that total to 35 patients, all of whom died after receiving the medication. The hospital later claimed some of the patients may have survived.
When the news about Husel came out, Attorney General Dave Yost called for his medical license to be suspended. The Ohio Medical Board soon did exactly that.
"It looks like we may have a serial killer on the loose with a medical license and access to fentanyl," Yost said last January.
Then in June, Franklin County authorities charged Husel with 25 counts of murder. Prosecutor Ron O'Brien argued that Husel's doses "hastened" death of those patients.
“The expert witnesses we talked to said with certainty that a dosage at that level could not support any legitimate medical purpose, and a dosage at that level would cause someone’s death,” O'Brien said while announcing the indictment.
"Days And Days Fighting Death"
Through all of that, Husel has maintained that he was trying to provide comfort care, not kill anyone. He pleaded not guilty to all charges.
Now, for the first time, the doctor has back up: 10 former Mount Carmel employees came forward in a lawsuit last month saying that neither Husel nor his colleagues intended to cause harm to patients.
Timeline: The Mount Carmel Scandal So Far
"It’s really kind of hurtful, obviously, to hear these stories and then people think, ‘Why are they doing this at Mount Carmel?’ Well, we’re not," says former nurse Beth Macioce Quinn. "That’s the craziest thing I’ve heard of, is that you’d get a group of health care workers who dedicated their lives to helping people to collude to such atrocities."
Macioce Quinn worked as a nurse at Mount Carmel West for 25 years. She is one of six former night shift nurses – along with a nursing supervisor, a clinical educator, a pharmacist and an additional ICU nurse – who sued the hospital system for defamation and wrongful termination.
Nurses say the hospital’s statements in the wake of Husel's firing were false, and stoked a media frenzy that made it impossible to get work in the field.
Statements like those in Lamb's internal video for employees, obtained by WOSU: "Some of our colleagues did not meet our standard of care. The actions that created this tragedy were instigated by this physician and carried out by a small number of good people who made poor decisions. They ignored the safeguards we had in place."
In addition to firing Husel, Mount Carmel reported 48 hospital employees to the state boards of nursing and pharmacy. In July, the hospital terminated 23 employees, including five members of management teams, while Lamb himself resigned.
None of the nurses that WOSU interviewed were cited by the Ohio Board of Nursing or named in any wrongful death lawsuit.
In each of the cases identified by the hospital, Husel's ICU patients were on a ventilator to help them breathe. The families asked for life saving measures to be stopped, and for the tube to be removed.
It is common to give pain medication like fentanyl during that procedure, which is called a palliative ventilator withdrawal or terminal extubation. Without it, patients can panic and gasp for air while their loved ones look on.
But fentanyl itself has a potential side effect of slowing or even stopping breath, depending on the dose.
"We spent days and days fighting death for every single one of our patients," says former nurse and clinical educator Rebecca McNeil. "You don’t turn around then and try and kill someone."
McNeil worked for Mount Carmel for nearly 19 years, and part of her job duties including training staffers on things like medication dosing.
"I taught the staff that – as I was taught by Mount Carmel’s lawyers – that it was about intent," McNeil says. "And I firmly believe that every single nurse that I worked shoulder to shoulder with would never intend to cause death. Our goal was to stop the pain and allow what we could consider a good death."
How High Is Too High?
At the time of Husel's employment, the health system did not have any guidelines or a cap on pain medication during palliative ventilator withdrawals. Mount Carmel updated its guidelines in January 2019, after firing Husel.
The nurses allege that those new policies endanger patients and delay care.
Most hospitals don’t have a policy for palliative ventilator withdrawal because there is no agreed-upon maximum dose, experts say.
"There are no absolute limits to the doses of medication that we give," says Richard Leiter, a palliative care doctor at Dana Farber Cancer Institute and teacher at Harvard Medical School.
Leiter explains there’s no cap so the physician has discretion when providing comfort care, and can tailor treatment to the specific needs of the patient.
"Our goal is to make sure the patient is as comfortable as possible for the short time they have left," he says.
Despite that, Mount Carmel officials and the Franklin County Prosecutor’s Office argue that any dose of fentanyl higher than 500 micrograms is grounds for murder.
"500 sounds extremely high to me," Leiter says. "Although I could imagine there being situations where it could be appropriate."
Prosecutor Ron O'Brien declined to interview for this story, but wrote in an email, "We have found no one in America after a diligent search who sanctions the administration of a 500+ single dose use of fentanyl for any reason on any patient outside an operating room."
Jared Rubenstein, a palliative care doctor at Texas Children's Hospital, says a large factor in determining the appropriate dose is opioid tolerance: if a person has been taking opioids for pain management, or even recreational use, they may require a higher dose to achieve the same pain management. He compares it to building up a tolerance to coffee.
"A dose of 500 micrograms to help someone be comfortable as part of a palliative extubation, who has demonstrated tolerance to fentanyl, would not be an unheard-of dose," Rubenstein says.
The nurse’s lawsuit alleges that the highest doses ordered by Husel were for patients who were opioid tolerant – in one case, the patient had been taking morphine for pain for years. In another, the patient came to the hospital after overdosing on opioids.
In both these cases, patients received 2,000 micrograms of fentanyl.
"2,000 is a lot… I’ve never personally seen that," says Mark Zhang, a palliative care doctor at the Dana-Farber Cancer Institute in Boston. "Every individual has a unique set of tolerance levels. Is it out of the realm of possibilities? I guess not… but I personally have never seen that."
Zhang says he would not start with a dose that high. Instead, Zhang says he chooses to use smaller doses and increase if necessary.
Former nurse Brandi Wells says she often advocated for that approach with Husel.
"When I have before questioned Dr. Husel on pain medication, being administered to a patient who wasn’t being withdrawn on, he decreased it for me," she says. "Lo and behold, he was right, and an hour later I had to give the dose he wanted to give in the first place."
In a written statement, a Mount Carmel spokeswoman said the claims made by the nurses have no merit.
“We thoroughly investigated these events and stand by our decisions," the statement reads. "Mount Carmel’s focus continues to be on caring for our community."
"It Was The Nurses Who Gave Them A Good Death"
Dozens of wrongful death lawsuits have been filed by patients' families against Husel and Mount Carmel. Many of those suits also name nurses and pharmacists as defendants.
McNeil argues the nurses' focus was always on the patients and their families.
"I would ask them to remember the last moments in the room, when the weight on their shoulder was the nurse's hand, because the nurse sat there with them, cried with them, prayed with them, sang 'Amazing Grace,'" McNeil says through tears.
"It was the nurse who lifted that loved one over so that the family member could crawl in bed and hold them for the last time," she continues. "It was the nurse who got the box of Kleenexes for them. It was the nurse who went through that with them. It was never the nurse who hastened death. It was the nurse who gave them a good death."
Husel filed his own lawsuit in late December accusing Mount Carmel of defamation and breach of contract. His complaint mirrors that same argument, claiming that the hospital falsely accused him of murdering patients when he was trying to provide appropriate end of life care.
"It would not be an exaggeration to state that Dr. Husel has suffered perhaps the most egregious case of defamation in Ohio's recent history," the lawsuit reads.
The hospital calls those allegations unfounded.
A criminal trial for Husel is scheduled for June 2020. Hearings for 25 nurses cited by the Ohio Board of Nursing are set to begin in February, but for now, the nurses' licenses remain active.
If you have information to share about the Mount Carmel investigation, please contact WOSU at paige.pfleger@wosu.org.
