William Husel is a free man after a jury in Ohio failed to convict him on 14 counts of murder last Wednesday. The ex-doctor was accused of ordering and administering excessive amounts of painkillers to patients, many of whom later died. But the defense was able to cast doubt on the idea that the drugs were ultimately responsible for the deaths. The outcome raises questions about when it’s appropriate to use opioids in end-of-life care.
Poking Holes in the Case
Husel was charged with 14 counts of murder for administering large doses of fentanyl to patients, sometimes as much as 500 milligrams at one time, during his time at the Mount Carmel Health System.
Each charge was punishable by up to 15 years in prison, but the weekslong murder trial failed to result in a conviction. Many doctors have faced charges for illegally prescribing opioids since the start of epidemic. The case against Husel shows how difficult it can be for prosecutors to prove that the provider acted with malicious intent.
The prosecution called 53 witnesses over the course of the trial, including dozens of medical experts, former co-workers and patients that testified on their behalf. They argued that ordering such a high dosage of opioids for non-surgical purposes meant that that Husel intended to end lives.
Dr. Wes Ely, a physician and professor of medicine at Vanderbilt University, said Husel administered enough opioids to some patients to “kill an elephant.”
The defense called just one witness, a medical expert from Emory University that cast doubt on the notion that the painkillers were to blame for the patients’ deaths. Instead, the witness said the patients died of underlying medical causes. The ages of the patients raged from 37 to 82.
Husel was fired from his job as a hospital physician after the error came to light. The Mount Carmel Health System accused him of ordering excessive painkillers for about three dozen patients who died over several years.
The hospital has reached settlements with the patients’ families and loved ones, totalling over $16.7 million thus far.
Experts say Husel got off due to a lack of standards on how and when to administer highly powerful painkillers and that it’s rare for prosecutors to charge a single doctor with murder in the middle of the ongoing opioid epidemic.
“A textbook can be written on this case,” said Dr. Ziv Cohen, a clinical assistant professor at Cornell University and forensic psychiatrist. “Was there really enough evidence? In general, we can’t regulate medicine through the criminal courts because we have to think about the public health consequences of doing so. It doesn’t mean doctors in some cases are not criminally liable, but they should reserve charges for the most serious.”
But records show some of Husel’s patients were given ten times the average amount of fentanyl used for non-surgical patients. In some cases, patients were given 20 times the normal amount.
Several of Husel’s colleagues even shared their concerns with hospital administrators, the local police, and the patients’ families.
Prosecutors argued that even if the painkillers weren’t the direct cause of death, it is illegal for providers to administer such large amounts of fentanyl as this increases their chances of death.
“Even though they were very critically ill, and perhaps some of them were on a trajectory to die very soon anyways, you cannot hasten their death, you cannot quickly, painlessly cause the death of a dying person,” said Assistant Franklin County Prosecutor David Zeyen. “Can’t do it — not in the state of Ohio.”
But the burden of proof was on the prosecution and proving the intention to kill can be difficult.
“The prosecution’s case on intent hinged on the circumstantial evidence that the amount of fentanyl administered was so high that the only possible explanation was that Husel intended to kill the patients,” said Ric Simmons, a former prosecutor who teaches criminal law at Ohio State University.
“This is a reasonable inference to make, and it was reasonable for the prosecutor to rely on this inference, especially since there was no other evidence of intent,” Simmons added.
But many palliative care providers know that fentanyl dosage levels can change over time as patients start to build up resistance.
With Husel, “it’s important to understand that the fact that he was found not guilty doesn’t mean he was practicing good medicine or that his actions were medically justifiable,” Cohen said. “It really means that there wasn’t enough evidence beyond a reasonable doubt that his intent was to commit murder. That is, to hasten their deaths without any legitimate medical purpose.”