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Ohio Doctor Charged with 25 counts of Murder

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  • Zaphod Zaphod 
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    What were the hospital pharmacists doing? I feel like you couldnt even do this in most hospitals even if you tried. I mean there’s clinical judgment if you want to give someone 150 of fentanyl but not 2000

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    agree. many places wouldnt let this go through the emr period.

     

    OMG. What an epic failure mount carmel was. Notified and investigated but still on staff for four weeks after, during which 3 more people died. WTH.

    Mount Carmel shouldnt be the kind of place where they had so many terminal pts, Im not familiar with them per se, but theyre only 10 mins from Ohio State/Grant and pretty the majority of serious stuff was there. Any time there is this level of issues, you have to rule out some kind of mental issue first. Maybe he thought the first couple were indicated, but something happened and couldnt stop.

    Almost 50 people fired and reported.

    #219484 Reply
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    CordMcNally CordMcNally 
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    I’m surprised about it getting through pharmacy, too. I can’t even give IV clindamycin unless I talk with pharmacy 3 times and get both chambers of Congress on board.

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    wonka31 wonka31 
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    I’m surprised about it getting through pharmacy, too. I can’t even give IV clindamycin unless I talk with pharmacy 3 times and get both chambers of Congress on board.

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    What I don’t understand is that it got through pharmacy and nurses. I mean, it doesn’t sound like he order a morphine drip, went rogue and drew out of the bag with a syringe and pushed it himself. I mean, how many times would this have to happen before it’s the talk of the unit and, in turn, the entire hospital (Answer: Almost once, which wouldn’t happen because any sane nurse or pharmacist would halt this immediately)? Clearly the physician is the main culprit, but there had to be a bunch of people that either a) knew it was wrong and let it happen or b) simply looked the other way.

    #219534 Reply
    ENT Doc ENT Doc 
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    So apparently more has come out since I last looked into this. Bad stuff. And apparently the new hospital has had a dozen people contract Legionnaires Disease. Ugh.

    #219537 Reply
    Avatar jacoavlu 
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    Shocked here as well. Anything can happen once. But then usually incident reports, sentinel event, quality committee peer review stuff happens. And it went on for “years”?

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    hatton1 hatton1 
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    Where was JCAHO?  CMO?  Quality review?  How could this of not been noticed?

    #219567 Reply
    Lordosis Lordosis 
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    If the meds came from a PCA pump then he could sneak a high dose past the pharmacist who checked the order for routine PCA amounts.  However they should have noticed that he was churning through Fentanyl at an alarming rate.  I guess he could have been documenting “disposing” of it and covering his tracks but that should be hard to do.  People must have had suspicions and just turned a blind eye.  It is really terrible that someone can get away with this.

    “Never let your sense of morals prevent you from doing what is right.”

    #219580 Reply
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    Avatar hightower 
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    What were the hospital pharmacists doing? I feel like you couldnt even do this in most hospitals even if you tried. I mean there’s clinical judgment if you want to give someone 150 of fentanyl but not 2000

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    I think you’re absolutely correct.  Even in my tiny little Midwestern town hospital, our pharmd’s are quite pushy and I’m certain they would not follow my order if I tried to order that much fentanyl.

    #219581 Reply
    Avatar okayplayer 
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    https://www.dispatch.com/news/20190605/here-are-victims-in-mount-carmel-criminal-case

    Will be an interesting trial/precedent. I’m not an intensivist but generous doses of opiate for “air hunger” in patients who have been extubated/made comfort care is not unique to this guy (obviously the doses he is giving are absurdly high).

    #219582 Reply
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    Avatar hightower 
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    So, what freaked me out about this initially was the thought that maybe he was just ordering routine hospice type meds for very sick patients who were DNR/Comfort Care.  Sounds like that wasn’t the case with what limited info we have.  BUT, it still brings to light the question of if we could be accused of trying to hasten someone’s death with some of the more routine orders we write for palliative care purposes.

    I mean, our inpatient hospice order set has orders you can click that are pretty hefty…Roxanol 10mg-20mg PO q2prn or Intensol PO 0.5mg q1prn.  I remember we had an old school ICU attending when I was in residency that would write for fairly large doses of IV morphine q10 mins prn on hospice patients who were coming off a vent or whatever.  It always feels like we’re walking a thin line between trying to provide comfort to someone who is actively dying vs helping that process along.  But, at the same time, I felt that if I were in that patient’s condition, I would want the doctors and nurses to have the ability to snow me with medication too.

    There’s no right or wrong answer here or clear guidelines as to exactly what is ok to order.  If we leave it open to the doctors interpretation, then how can we accuse them of trying to kill someone if they may simply have a difference of opinion?  I guess it will be an interesting trial.

    #219584 Reply
    Avatar hightower 
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    https://www.dispatch.com/news/20190605/here-are-victims-in-mount-carmel-criminal-case

    Will be an interesting trial/precedent. I’m not an intensivist but generous doses of opiate for “air hunger” in patients who have been extubated/made comfort care is not unique to this guy (obviously the doses he is giving are absurdly high).

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    Thanks for finding that.  So, wow, I’m not so certain these are clear cut criminal acts.  Sounds like most of those patients were withdrawing care and/or had arrived in cardiac arrest, septic shock, brain swelling, etc.  I mean, his doses are massive and way more than I would ever even consider ordering, but to call it murder?  I don’t know I would go that far.  It’s clear he was hastening the inevitable, but does that define him as a murderer?

    #219587 Reply
    Avatar G 
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    It’s clear he was hastening the inevitable, but does that define him as a murderer?

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    Whatever the outcome of this specific doctor, I hope it doesn’t lead to the lack of compassionate end of life care for all.

    That said, this one reads like an execution:

    James Nickolas Timmons, 39, of Hilliard, who went by Nick, arrived at the hospital on Oct. 22, 2018 with an altered mental status due to drug abuse. On Oct. 24, he was given 1,000 micrograms of fentanyl and10 mg of Versed at 3 a.m. and 10 mg of hydromorphone and 10 mg of Versed after that. He died at 3:13.

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    ENT Doc ENT Doc 
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    It’s clear he was hastening the inevitable, but does that define him as a murderer? 

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    Whatever the outcome of this specific doctor, I hope it doesn’t lead to the lack of compassionate end of life care for all.

    That said, this one reads like an execution:

    James Nickolas Timmons, 39, of Hilliard, who went by Nick, arrived at the hospital on Oct. 22, 2018 with an altered mental status due to drug abuse. On Oct. 24, he was given 1,000 micrograms of fentanyl and10 mg of Versed at 3 a.m. and 10 mg of hydromorphone and 10 mg of Versed after that. He died at 3:13.

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    So the reporting from Columbus is that initially all victims were said to have been end-of-life.  This was then walked back to state that 5 victims *may* have been able to recover to have some kind of quality of life.  Personally, I see zero problem with giving mega doses of Fentanyl to me, my loved one, or any patient who is coming off the vent in an end-of-life situation.  But again, the problem here was that he didn’t involve the family in that decision, and lack of general oversight.  He was the late-night shift doctor with often times no other physician involved in the consulting process.  Then of course you now have the “did he take it to the next level” questions and hasten the demise of people he alone thought weren’t going to make it.  Will be interesting to watch what happens.

    #219607 Reply
    Avatar Tim 
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    @g,
    “Whatever the outcome of this specific doctor, I hope it doesn’t lead to the lack of compassionate end of life care for all. That said, this one reads like an execution.”

    End of life decisions (which we had one this year) are a moral dilemma.
    a) Killing me softly (hospice-pain and sedation but feeding, medication, and liquids removed). The disease runs it’s course with a victim that is defenseless.
    b) Provide drugs to accelerate the process.

    I wish I could have opted for b) in some ways. I do carry some “guilt” for the 7 days a) required. In both cases, we made the choice.
    This decision was made by the family with quasi knowledge of the patient. Under NO circumstances should a physician make the choice independently. It’s not like this guy was trying to keep someone alive. He was playing God. “Your time is up”. Simply my impression and recent experience.

    #219612 Reply
    Craigy Craigy 
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    Isn’t this the premise of a medical thriller novel?  I swear I read something like this in the past.  If I am remembering correctly the doctor was the antagonist and was killing off patients for nefarious reasons.

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    @lordosis Maybe you’re thinking about the doctor who was accused of mercy type killing surrounding hurricane Katrina when resources were low?

     

    Some of these ethical dilemmas are indirect reasons as to why I chose radiology.

     

    John Oliver sort of addressed the “first do no harm” idea a few weeks ago in regards to the death penalty. Dr. Gawande addresses that idea in “Better.”

    As much as I believe a patient has a choice to die and should be allowed to make that choice, it’s not where we are from medico-legal (and to some people, ethical) standpoint.

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    This is the story I remember:

    https://www.newsweek.com/2014/12/26/angel-death-one-worlds-most-prolific-serial-killers-292388.html

     

     

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