"Absolute systemic failure": Employee addresses fentanyl deaths at Mount Carmel

File Photo - Mount Carmel West Hospital (AP Photo/Andrew Welsh Huggins)
Mount Carmel employee speaks about fentanyl death investigation
Mount Carmel employee calls scandal a systemic issue
Dr Husel admits criminal history in medical license application

COLUMBUS -- A Mount Carmel employee is speaking out in wake of the scandal at the hospital system where 34 patients are believed to have received potentially fatal doses of painkillers.

To date, most patients identified by the hospital were believed to have been given excessive doses of the powerful synthetic opiate, Fentanyl.

“It is absolutely a systemic failure. Most importantly because we did not anticipate it coming,” the employee told 10 Investigates.

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In a wide-ranging interview, the person spoke to 10 Investigates on a condition of anonymity because he fears reprisal from the hospital.

He told 10 Investigates that the problem centers around several issues.

Among them, that the hospital lacked clear policies with regard to how much medication could be given to palliative care patients who are being removed from ventilators.

He also said that nurses lacked the proper specific training in those instances to challenge a doctor’s orders, and that the hospital’s pharmacy was sometimes unaware that Dr. William Husel was ordering large doses of medications for patients who were about to be removed from life support.

Nine wrongful death lawsuits have been filed against Husel, Mount Carmel Health System and several caregivers and more are pending, lawyers tell 10 Investigates.

In several of the cases, attorneys have alleged that Husel was able to avoid pharmacy approval before administering large doses of fentanyl to the patients.

When asked directly by 10 Investigates’ Bennett Haeberle: “So in other words, you wouldn’t have to tell the pharmacy that you were doing a ventilator withdrawal?”

The employee said: “That’s exactly right.”

10 Investigates: “So you could just say I need 1,000 micrograms of fentanyl?

The employee: “That’s exactly right.”

The hospital has confirmed it has since changed that policy and now requires that nurses and doctors receive pharmacy approval before administering drugs during the removal of a ventilator.

“Clearly I believe Dr. Husel is responsible for what he did. He is the one who decided on the dose and an order to be given,” the employee said.

Dr. William Husel was fired by the hospital in December after questions were raised about his care. His medical license has been suspended along with his provider agreement with the state department of Medicaid, which accused him of fraud of billing for “medically unnecessary services involving grossly inappropriate amounts of fentanyl.”

Husel and his attorneys have declined to comment in the past to 10 Investigates.

Twenty-three caregivers – including 14 nurses, 6 pharmacists along with three other employees including managers – have been placed on administrative leave.

The employee we spoke to is well aware of the hospital’s internal investigation.

He also said he believes some of the caregivers placed on leave should not shoulder the same amount of blame as Husel or the hospital.

“To hold individual practitioners responsible for doing the best they could is not appropriate,” he said.

Late last week, the Centers for Medicare and Medicaid Services notified Mount Carmel that it was not in compliance with the Medicare Conditions of Participation related to pharmaceutical services. A letter went on to state that the deficiencies “are so serious that they constitute an immediate threat to patient health and safety.”

The hospital has five days to submit its plan of correction. Another site visit by the Ohio Department of Health, which had been conducting a survey on behalf of CMS, is very likely. A spokesman for the state department of health could not say when that would occur.

Late Friday, a spokeswoman for the hospital released this statement:

“We continue to cooperate fully with the Ohio Department of Health, the federal Centers for Medicare & Medicaid Services (CMS), and other regulators to investigate Dr. Husel’s actions and how we can ensure a tragedy like that never happens again. As a result of the Ohio Department of Health’s recent review, Mount Carmel West has been asked, and we anticipate Mount Carmel St. Ann’s will be asked, to submit action plans to improve pharmacy processes.

Mount Carmel West has been (and we expect Mount Carmel St. Ann’s to be) placed in what is referred to as “immediate jeopardy” status for continued participation in Medicare & Medicaid. As is standard for this status, we will work through corrective action plans with CMS. If CMS is confident that our corrective action plans are sufficient, immediate jeopardy status will be removed. In the meantime, nothing changes our ability to treat patients covered by Medicare or Medicaid.

We will submit Mount Carmel West’s action plan next week and have already taken steps to implement the plan. We will follow the same process for Mount Carmel St. Ann’s.

We remain committed to doing everything in our power to address root causes and implement meaningful change. Already, we have increased education on standards and practices regarding end-of-life care, we added a new protocol to set maximum appropriate doses for pain medication in our electronic medical record system, we have a new escalation policy for deviations in our pain medication protocols, and we have implemented numerous other initiatives to ensure patient medication safety. We also have engaged independent experts who are assisting us with this process.

Providing safe, compassionate, people-centered care remains our highest priority throughout this process. We continue to learn from this, and we will do better – our patients and their families deserve nothing less.”

Thirty-three of the 34 patients were at Mount Carmel West. One of them who died was at Mount Carmel St. Ann’s in Westerville.

The hospital has said that 28 of the patients received fatal doses of fentanyl and that the remaining six received doses that “went beyond providing comfort” but that they liked died of other causes.

The employee interviewed by 10 Investigates said that there is still a feeling of uneasiness inside the hospital.

“The feeling is among employees is that they are very much afraid that the hospital is going to use these employees on leave as scapegoats. I would say the morale among employee is very, very low,” he said.

10 Investigates also obtained a copy of responses that Husel provided to the state medical board regarding his misdemeanor conviction in 1996 involving a pipe bomb case. Husel admitted to the board that he pleaded guilty to improperly storing a destructive device or pipe bomb. Details surrounding the incident are spelled out in more than 100 pages of documents that were provided to 10 Investigates by the state medical board as part of an open records request.

In the documents, Husel details how he fell into trouble as a student at Wheeling Jesuit College in the mid-1990s.

In his addendum to his application to the state medical board in 2013, Husel states that he was trained in anesthesia and critical care at the Cleveland Clinic where “I am attending faculty.” It’s the same year he would become employed by Mount Carmel Health System.

In his address to the board in 2013, Husel again tries to make amends for his past behavior, noting that at age 37 in 2013, his arrest was more than 20 years ago and that “my passion is taking care of sick patients in the ICU. Please give me the opportunity to practice what I love doing.”