Nurses, pharmacists should have known fentanyl doses were excessive

Dr. Hans Schweiger, an anesthesiologist at Tampa General Hospital, says fentanyl has been commonly used in hospital intensive care units for 25 years.

Schweiger, hired as an expert witness by a plaintiffs attorney in one of the lawsuits filed recently against Mount Carmel Health System and Dr. William Husel, says nurses and pharmacists are very familiar with the benefits and the risks of fentanyl as a pain medication. 

“The standard dose would be to give somewhere in the order of 50 to 100 micrograms initially,” Schweiger said. “Even relatively novice ICU nurses know that its a respiratory depressant.”

Mount Carmel has said at least 34 patients of Dr. Husel received excessive doses of pain medication including 28 who received potentially fatal doses.
One of the patients was at Mount Carmel St Ann’s Hospital in Westerville. All of the others were patients at Mount Carmel West Hospital.

Dr. Schweiger says a typical dose for a patient in comfort care would be 50 to 100 micrograms. He says larger doses can be delivered through an IV drip over an hour’s time to a patient being supported by a ventilator.

Lawsuits filed on behalf of some of the Mount Carmel patients who died cite medical records showing that Husel ordered excessive doses of fentanyl ranging from 500 micrograms to 2,000 micrograms. In many of the cases, the fentanyl was delivered by injection after the patients were removed from a ventilator.

Schweiger says the nurses and pharmacists had to have known what would happen. “In the ICU we do a lot of education from physician to nurse but also from pharmacy to nurse perspective to know that patients who are going to be taken off a ventilator are at risk for respiratory pressure,” Schweiger said. “So I  think that would be a very unusual situation where a nurse might say… she or he didn’t know that this was a potentially toxic dose of fentanyl.”

Husel was fired by Mount Carmel and 23 employees including nurses and pharmacists were suspended. Husel’s medical license was suspended by the state medical board. No word yet of any suspensions from the State Nursing Board or the Ohio Board of Pharmacy.