A Columbus case in which a doctor has been accused of over-prescribing drugs to 34 hospital patients who later died has Ohio medical boards and hospitals here watching closely to see what went wrong.
Prosecutors are investigating Dr. William Husel after the Mount Carmel Health System in Columbus reported it found evidence that Husel ordered “significantly excessive” doses of painkillers for 34 patients over the past five years. All 34 died, though the hospital said for six of them, the drug orders went beyond providing comfort but were likely not the cause of death.
The hospital announced its allegations publicly in January and the state of Ohio has since suspended Husel’s medical license. So far at least eight lawsuits have been filed by family members of the deceased. Mount Carmel said it has placed 23 employees on leave, including six pharmacists and 14 nurses.
“You had four failures, basically. The pharmacy failure, the nursing failure, the rogue doctor and then you’ve got an institutional failure for safeguards that are being followed or not,” said attorney David Shroyer, who is representing the family of deceased patient Jeremia “Sue” Hodge, in a lawsuit against Mount Carmel, Husel and others.
Hodge was a 57-year-old grandmother who arrived by ambulance at Mount Carmel West Hospital in Columbus on Easter Sunday, feeling short of breath. By nightfall she had died after receiving a fatal dose of fentanyl ordered by Husel, according to a lawsuit filed last week.
“Every hospital administrator in the country should be going to their board and saying ‘Could this happen at our hospital?’ and the answer is going to be it probably could,” Shroyer said this week.
Attorney James McGovern said in an email that neither he nor his client, Husel, would comment on the allegations against the doctor. Husel has not been charged with a crime in the cases.
The explosive accusations have hospitals in the Miami Valley watching because hospitals have procedures around drug administration which are meant to keep patients safe and avoid just such an incident.
“We are certainly interested in learning the details of this situation – and others – to see what lessons can be gleaned,” said Premier Health spokesman Ben Sutherly. “This case has already prompted us to review our processes out of an abundance of caution.”
Premier Health has a medication safety officer tasked with monitoring safety events that happen at other health institutions and looks for ways to enhance safety within the health network, he said. The employee is currently evaluating the Mount Carmel incident, as well as others.
Administrators will continue to monitor the situation as the event unfolds and if the details about the investigation indicate that hospitals across Ohio should change any policies, Premier will do so, Sutherly said.
Kettering Health Network constantly reviews processes and procedures to ensure safety and best practice across the network, said spokeswoman Elizabeth Long.
Administrators with Premier, Kettering Health Network and Mercy Health say they use both human judgment and technology to alert personnel of doses that seem outside of normal parameters. At all hospitals the order must go through a doctor, pharmacist and nurse. Some have further checks and balances to keep patients safe.
“When a doctor places an order for medication, the pharmacy receives the order,” Mercy Health spokeswoman Nanette Bentley said. “A pharmacist reviews the order, pulling up an individualized patient profile to ensure the medication is safe for the patient, based on the patient’s age, weight, kidney function, etc. This helps ensure that medications and doses are appropriate.”
From there a nurse will administer the drug.
Most inpatient orders are reviewed again when medical teams check charts in their daily rounds at Kettering Health Network hospitals, said Doug Lukens, Kettering Health’s director of pharmacy.
The hospitals each also have their own technology with alert systems that tell care givers when dosages seem inappropriate. At Premier, a software system designed by EPIC issues safety warnings that “require the action of clinical decision making and verification across more than a single discipline prior to administration,” Lukens said.
Premier had already made some safety precaution updates before the Mount Carmel news came to light. In late 2018, Premier upgraded its electronic medical records system, which added “hard stops” where flags are thrown up when dosages meet a certain threshold. The hard stops require all three parties — doctors, pharmacists and nurses — to take additional, concrete action.
The accusations against Husel are very rare. Ohio last saw a case of the same scale three decades ago when hospital orderly Donald Harvey admitted to poisoning to death 24 patients at Cincinnati’s Drake Hospital in 1986 and 1987. Harvey was beaten to death in a state prison in March 2017.
Ohio Hospital Association spokesman John Palmer said safeguards exist to protect patients, including state licensing regulations, professional codes of conduct and hospital protocols to ensure standards are followed. The Mount Carmel investigation may eventually be used as a case study for determining how to strengthen patient protections, he said.
“It’s very unfortunate in a health care setting. It is devastating to know that this occurred,” Palmer said.
After receiving three formal complaints related to Husel’s care, Mount Carmel removed him from patient care on Nov. 21 and fired him Dec. 5. The hospital system also notified the State Medical Board, Ohio Board of Pharmacy, Ohio Nursing Board and Franklin County Prosecutor Ron O’Brien within days of Husel’s dismissal, the hospital said.
“Our integrated team is identifying immediate root causes as well as steps we can take to ensure this never happens again,” said Mt. Carmel spokeswoman Samantha Irons. “So far, these include a new escalation policy for increases in pain medication dosing and a new approval process for pain medication at high doses during similar situations.”
Pharmacists and physicians share responsibility for patient prescriptions, said Ohio Board of Pharmacy spokesman Cameron McNamee. Pharmacists have a duty to use professional judgment to determine the prescription is in the patient’s best interest and is a legal script — and if it’s not, pharmacists are expected to decline to fill the prescription, he said.
McNamee noted that the board of pharmacy is investigating those involved in the Mount Carmel case. He declined to release the pharmacist names or documents, citing the ongoing investigation.
The board operates a powerful database, Ohio Automated Rx Reporting System, that was established in 2006 to guard against misuse of prescription painkillers and other drugs. Pharmacists and doctors check OARRS when filling or writing prescriptions for controlled drugs to prevent patients from “doctor shopping” or acquiring powerful painkillers from multiple sources.
But OARRS does not capture prescriptions written for hospital patients who are admitted. Instead, those prescriptions are expected to be monitored internally by hospitals, McNamee and Palmer both said.
Shroyer, the attorney representing Hodge and two other families in lawsuits against Mount Carmel, said hospital electronic records systems should be set to throw red flags when lethal doses are ordered. He also said nurses have a legal duty of care to their patients and hospital culture should encourage nurses to stand up to orders they believe aren’t in a patient’s best interest.
The proper handling of these types of drugs is a focus for health care institutions. Premier Health received Magnet recognition from the American Nurses Credentialing Center earlier this month. There are 20 other hospital systems that hold the distinction in the United States. Magnet-recognized organizations “embrace a culture that empowers nurses and other staff to identify and bring forth concerns without fear of retribution,” Premier said.
Nurses at Kettering Health are also encouraged to contact their unit’s leadership if they are uncomfortable, concerned or if there is an issue in their patient care, said Julie Vincent, chief nursing officer at Kettering Health Network.
Any complaints received through patients and their families are screened by Premier’s quality department and sent through peer review. There’s also an internal reporting process.
Kettering Health Network recommends non-opioid, non-addictive medication whenever possible. If opioids are used as the treatment, the hospitals recommends the lowest dose, for the shortest time period, and take into consideration age, chronic disease and history of use disorder, said Nancy Pook, the medical director of emergency at Kettering Health Network.
The Husel case has triggered at least eight lawsuits and multiple investigations. “Regardless of the reasons these actions were taken, we take responsibility for the fact that the processes in place were not sufficient to prevent these actions from happening,” Mount Carmel Chief Executive Ed Lamb said in a video released by the hospital system. “We are doing everything to understand how this happened and what we need to do to ensure it never happens again.”
Staff writer Parker Perry contributed to this report.