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Ohio Doctor Charged with 25 counts of Murder

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  • Avatar Tim 
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    #219623 Reply
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    Avatar pulmdoc 
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    This sort of case makes me very queasy as an ICU doc. The reporting so far does not give a lot of details but the impression I am getting is that these are all “withdrawal of life support” situations, not “angel of death” situations. I routinely give opiates and benzodiazepines, both anticipatory and PRN, to patients when life support measures are withdrawn to treat pain, anxiety, air hunger etc and if there is a legal risk that I could be charged with murder as a result that’s the end of my ICU career-I am FI and don’t do it for the money.

    Questions unanswered/ambiguous:

    1) Were family/POA in agreement with the decision to withdraw? Obviously, if he is withdrawing life support with a fentanyl chaser on patients over family objections and without ethics backup, he’s on legally thin ice already.

    2) Were these huge amounts of narcotics single doses, or total dosage? I’ve had patients with extreme narcotic tolerance who required 250-300mcg/dose to have any effect, so needing several doses could get someone into this cumulative range. Obviously, starting with 2000mcg of fentanyl as the initial dose is harder to justify without documentation of tolerance.

    #219629 Reply
    Zaphod Zaphod 
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    Yeah that all needs to be clarified, but theres a difference between putting people on a drip and letting them go slowly and peacefully with full buy in from the family and just guillotining them with a lethal injection dose. Ultimately there is no difference, but it doesnt lead to a good perception and that matters a lot. Did he just not have patience to wait 15 mins? Not a good look either. These cases have as much to do with perception as reality, more of course.

    Functionally, reality wise, theres no difference, but the doses might have been unnecessarily large and at least look bad (agree if cumulative, well who cares, but as a push of course not a good look). Have to have family buy in and tell them what to expect.

    Hard to know more from the reporting. Just from the vignettes which of course will be from the record which could have been painted more or less grim (and to family as well) given what the doctor wanted to do. Theres a lot of power in these positions, worth looking into of course. A couple of the vignettes didnt look so great.

    #219631 Reply
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    Avatar pulmdoc 
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    The “hook” of a story like this isn’t going to be “he was trying to help patients at the end of life and the overzealous DA charged him with murder” but “bad doctor plays God, murders 2 dozen patients.” Quite different prejudices involved in those types of stories.

    #219654 Reply
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    ENT Doc ENT Doc 
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    The “hook” of a story like this isn’t going to be “he was trying to help patients at the end of life and the overzealous DA charged him with murder” but “bad doctor plays God, murders 2 dozen patients.” Quite different prejudices involved in those types of stories.

    Click to expand…

    Agreed.  People like to think the situation is much more grave than it really is – makes for better gossip.  Not excusing this guy at all, but when I tried to explain to family members that, based on the current info, he’s not a “serial killer” and was overzealous/unethical with his dosing of narcotics and decision making to end someone’s life faster when it was a sure thing anyway.  It’s not murder when someone is falling from a skyscraper and you knock them out as they start to fall.  Some facts may have changed since, but it was amazing to see how people refused to let go of the narrative that there was a serial killer out there.

    #219669 Reply
    Avatar Tim 
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    @ENT Doc,
    I confess, many times I was completely justified in making decisions I was convinced were 100% right, until someone nicely showed me how mistaken I was.
    Totally agree, news stories aren’t sufficient for any conclusion. I certainly don’t believe he was intentionally knocking people off for kicks. It seems lines were crossed, the motives or situation is probably a little different in each case. The technique he used for compassionate care is really unusual. From your premise, I would hate to be on a jury if his intentions were clearly intended to be in the best interest of the patients.

    #219682 Reply
    Zaphod Zaphod 
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    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.

    Click to expand…

    I think the overall gestalt just shows an extreme lack of judgement that begs these questions. I agree in the black/white of if theyre done theyre done, and its perception after that. But when you see these doses stated as given full on at once and a couple of those pts (as much as can be gleaned from 2 sentences) looking on shaky grounds…it invites questions as to that drs whole process.

    Were these cases trumped up in the chart and presented to the family as such? You can make a family believe anything and theyll trust and go along with you because of your position.

    That is why perception and making sure you’re doing things right and by current methods, whether or not same end is achieved is so important. To not invite this kind of scrutiny or questions at all. End of life is just going to be fraught with issues no matter what, you dont go out of your way to make it worse. These all could have been fine candidates, but the style that it was handled in has put the drs ethics in question and eroded trust.

    I definitely do not envy critical care guys, did enough in residency for me.

    #219685 Reply
    ENT Doc ENT Doc 
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    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.

    Click to expand…

    I think the overall gestalt just shows an extreme lack of judgement that begs these questions. I agree in the black/white of if theyre done theyre done, and its perception after that. But when you see these doses stated as given full on at once and a couple of those pts (as much as can be gleaned from 2 sentences) looking on shaky grounds…it invites questions as to that drs whole process.

    Were these cases trumped up in the chart and presented to the family as such? You can make a family believe anything and theyll trust and go along with you because of your position.

    That is why perception and making sure you’re doing things right and by current methods, whether or not same end is achieved is so important. To not invite this kind of scrutiny or questions at all. End of life is just going to be fraught with issues no matter what, you dont go out of your way to make it worse. These all could have been fine candidates, but the style that it was handled in has put the drs ethics in question and eroded trust.

    I definitely do not envy critical care guys, did enough in residency for me.

    Click to expand…

    Totally agree.

    #219691 Reply
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    ENT Doc ENT Doc 
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    @ENT Doc,
    I confess, many times I was completely justified in making decisions I was convinced were 100% right, until someone nicely showed me how mistaken I was.
    Totally agree, news stories aren’t sufficient for any conclusion. I certainly don’t believe he was intentionally knocking people off for kicks. It seems lines were crossed, the motives or situation is probably a little different in each case. The technique he used for compassionate care is really unusual. From your premise, I would hate to be on a jury if his intentions were clearly intended to be in the best interest of the patients.

    Click to expand…

    Yeah, it’s going to be very interesting to watch this unfold.  This is a bizarre gray area that I would want no part of.  If the patients would still be dead, and in extremely close proximity to the Fentanyl dosing, then can it really be called “murder”?  What if someone is alive, not on any vent, in hospice, and clearly going to die in the next day, and someone shoots that person in the head?  Seems like murder in that situation, but it’s effectively the same as the Fentanyl situation, no?  Likening it to the skyscraper analogy, is it really murder to shoot and kill someone as they are falling to their death from a skyscraper?  Did John Snow murder Mance Rader?  Did Hawkeye (Daniel Day Lewis) murder Duncan in Last of the Mohicans?  …

    #219692 Reply
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    Avatar Tim 
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    Splash Refinancing Bonus

    I agree. Personally, giving the instruction to cease feeding through a feeding tube felt like I was “ordering “
    a slow death. Only one result without nutrition and water. Was there a more compassionate way? Don’t think using a bullet would have made me feel better, nor 2000 msg.
    My justification was, it’s best not to prolong a miserable situation, making the decision for him.
    Damn, I told them to legally kill him. Guess what, he was ready to go. That’s why he hand a Healthcare power of attorney. Someone that would make tough decisions for him.
    That certainly wasn’t the physician that had know idea when or how he wanted to quit. Sometimes the family isn’t ready. Ethically, it’s not his choice. Stop when your told. That’s my bottom line for the physician. Guide the family (easier said than done). It’s on paper. Same as a will. Some want to fight for one more day. Let them.

    #219712 Reply
    Avatar Dont_know_mind 
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    Murder is a legal term. So is manslaughter. If you give your friend a lethal shot of heroin, that is different to him giving it to himself, even if in both cases he dies in front of you.

    The elements of common law murder are :
    Unlawful killing
    through criminal act or omission
    of a human
    by another human
    with malice aforethought.

    Note the term ‘unlawful killing’. Some types of killing are not unlawful. In the medical area it is might be a grey area without euthanasia legislation.

    The most prolific serial murderer was Harold Shipman who was a medical practitioner. So there are some bad eggs amongst us – as in any group of people in society. Medical practitioners are probably less likely to be serial murderers, but they have more capacity to kill people than average due to their role in health care.
    https://en.m.wikipedia.org/wiki/Harold_Shipman

    #219796 Reply
    Avatar jacoavlu 
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    “State health inspectors – acting on behalf of CMS – found that Husel used an override function to bypass the hospital’s pharmacy and gain access to large doses of fentanyl and other medications.

    State health inspectors found that in 24 of the 27 patient cases they reviewed, Husel used an override function to gain access to the medications.“

    Interesting.

    The Finance Buff's solo 401k contribution spreadsheet: https://goo.gl/6cZKVA

    #220342 Reply
    Avatar pulmdoc 
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    The “double effect” doctrine is a key part of end of life ethics. Performing an action that knowingly hastens a patient’s death (such as withdrawing a ventilator or giving IV narcotics) is permissible when the same action also has a beneficial effect such as relieving pain or anxiety. Implicit in this is that the action taken is proportionate to the desirable effect. Yes, 2000mcg of fentanyl IVP will produce pain relief, but if 100mcg fentanyl IVP would also produce pain relief the other 1900mcg fentanyl are impermissible.

    My gut suspicion for why a CC doctor would use massive doses of narcotics is that he had a withdrawal of life support go badly, where the patient was in obvious suffering, air hunger etc. Those are extremely traumatizing experiences for everyone involved, and can lead to a feeling of “I’m never going to let that happen again no matter what” especially if procedural roadblocks prevented him from “doing the right thing” to help end suffering. This is 100% speculation on my part, but having had withdrawals of life support go badly early in my career I can empathize with the temptation.

    #220406 Reply
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    Avatar Panscan 
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    “State health inspectors – acting on behalf of CMS – found that Husel used an override function to bypass the hospital’s pharmacy and gain access to large doses of fentanyl and other medications.

    State health inspectors found that in 24 of the 27 patient cases they reviewed, Husel used an override function to gain access to the medications.“

    Interesting.

    Click to expand…

    what about the other 3? I’d assume the pharmacy would still be notified if they are being bypassed or someone is aware? Sounds like a cop out to me.

    #220438 Reply

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