https://www.dispatch.com/news/20190605/husel-charged-with-murder-in-25-mount-carmel-deaths

He ordered up to 2,000 micrograms of fentanyl for some patients, allegedly in an effort to hasten their deaths.

I'm not usually in favor of healthcare workers being charged when patients die in their care, but good God. Is there any legitimate medical purpose for administering that much fentanyl?

Let the free market decide. I'm sure he won't get any more patients and everything will work out.

I don't remember the size of the total bag but it's possible a fentanyl drip contains that amount at some hospitals.

First thing that popped in my head was how many vials it would take to administer that much

According to the prosecutor, the minimum amount most of these people received was 500mcg. That is an incredibly high dose, especially if given all at once.

However, there is something fishy here to me about how so many nurses and pharmacists seemed okay with these high doses. The way medications work in the hospital is that a doctor prescribes the medication, the order goes to the pharmacist who double checks the dose, route, allergies, contraindications, etc. Once the pharmacist approves the medication, the order gets sent through the system where a nurse can pull the medication out of the computerized med cart. The nurse is also supposed to have an extensive knowledge of the medications and provide a third check for safety.

According to the report, many of the meds were overridden from the system before pharmacy approval, but I assume that at least some of these orders reached the pharmacists before administration. No reasonable pharmacist or nurse for that matter would be willing to administer that much fentanyl at once to one patient without questioning the order. At least none than I know. I have a really hard time believing these doses were given all at once.

Dr. Not Yet Dr. Ag said:

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It is common practice to provide opioids and benzodiazepines in terminal patients for pain control, anxiolysis, and to prevent air hunger with the knowledge that it will likely expedite their death, and the families are made aware of this possibility. Oftentimes these patients might require several large doses of opioids in order to make them comfortable.

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I agree, but I'm not sure that's what happened here. Some of these people were allegedly brain dead. Would there be a need to give a brain dead person so much fentanyl? There is a fine line between withdrawing care while keeping someone comfortable, and acting specifically to hasten someone's death.

What I'm also afraid of is that healthcare will turn into the next big thing for overzealous prosecutors to exploit. The more these stories get out in the media the more pressure will be put on prosecutors by families to charge doctors and nurses when errors occur. Defensive medicine is already bad enough, just wait until this starts happening more frequently.

Most hospitals I've worked at have a palliative extubation protocol (the process of pulling the breathing tube when the family has decided to cease efforts at attempting to resuscitate and instead focusing on comfort). I do this once in awhile in the ER. Most protocols, even for comatose patients is to give something like 2-4mg of morphine and 1-2mg of Ativan prior to pulling the tube. I've not given meds before in someone that clearly was not going to require any, but it is still fairly routine in comatose patients. Now giving 500mcg at a single time is not routine. Who knows what the truth is, but I imagine it wasn't as egregious as the claims made in the article, but also was likely still very questionable otherwise we wouldn't be hearing about it.

Air hunger?

The only truth in this is that lawyers and the designated hitter are both scummy.

LEJ said:

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The only truth in this is that lawyers and the designated hitter are both scummy.

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I'd never vote a DH for President.