New medication guidelines distributed to Mount Carmel staff members highlight the internal processes the hospital is re-examining in the wake of an ongoing scandal. The hospital announced earlier this month that at least 27 patients were given “excessive” and "potentially fatal" doses of fentanyl by Dr. William Husel.
The guidelines, timestamped Janaury 2019 and obtained this week by WOSU, examine ICU sedation processes, medication orders, pain management standards and more.
Husel was an overnight doctor in Mount Carmel West’s Intensive Care Unit. He is an anesthesiologist, and was seen as an expert in the hospital in sedation management in the ICU. The new guidelines provide a checklist for sedation management in the ICU.
The pamphlet shows the process of medication overrides in a system the hospital uses called Pyxis, which is an automated medication dispensing system.
Standards require that pharmacists review all medication orders, but there are two exceptions to that: when a Licensed Independent Practioner controls the ordering, or when a delay would harm the patient due to an emergency.
"Mount Carmel provides ongoing education about our hospital’s policies and best practices throughout the year," said a hospital spokesperson in a written statement. "For many of our professionals, we distribute quick-reference guides that summarize certain policies. The document you sent me is one of those quick-reference guides that is updated regularly with any changes from the hospital, the Joint Commission, or regulatory authorities. We know that Dr. Husel didn’t follow our policies and best practices."
The hospital has put six pharmacists on administrative leave since Husel was fired December 5. Husel's firing was not announced until more than a month later, on January 14. Since then, four lawsuits have been launched by the families of Husel's patients, the most recent being filed Tuesday night. The lawsuits all target Husel and Mount Carmel, and some also name other employees involved.
Last week, the Ohio Department of Health announced it launched an investigation into the Mount Carmel Health System.
WOSU also obtained a video distributed to Mount Carmel employees in the wake of the news. The video, which WOSU has republished below, begins with a statement released to the public in which CEO Ed Lamb apologizes for the incidents.
"Regardless of the reasons the actions were taken, we take responsibility for the fact that the processes in place were not sufficient to prevent these actions from happening," Lamb says.
Lamb goes on to address internal employees. He praises the colleague that verbally reported Husel in October, which spurred an investigation and Husel’s eventual firing.
“Part of this journey includes finding and fixing problems,” Lamb says in the video. “As these investigations continue, it’s possible that we will uncover more things along the way.”
Lamb urged employees to be truthful when talking to the media and internal investigators, and asked they not speculate about the incidents. He also said that, while Mount Carmel seeks to be transparent, the hospital will likely not share everything it knows with employees.
Mount Carmel stated that all patients involved were near-death and their families had requested that lifesaving measures be stopped, meaning life support be withdrawn. The guidelines highlight Palliative Ventilator Withdrawal policies, which demand that orders cannot be verbal, and that medications cannot be administered without verification from the pharmacy.
The pamphlet also highlights pain management policies. In some of the lawsuits, the patients were unconscious, making it difficult to assess pain levels.
The guidelines highlight that for adult intensive care patients, physicians should use the Critical Care Pain Observation Tool. This tool rates a patient's facial expressions, body movements, and muscle tension to determine an overall pain score.
View Mount Carmel's new medication guidelines below.
This article will be updated with more information as the story develops.
If you are a Mount Carmel staffer who has information to share or you believe your loved one or family member was impacted by this case, contact WOSU at firstname.lastname@example.org.