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Federal health agency accepts plan of correction at Mount Carmel hospitals

COLUMBUS – The Centers for Medicare and Medicaid Services has accepted plans of correction for Mount Carmel West and St. Ann’s hospitals, 10 Investigates has learned.

But the documents released in association with this announcement reveal damning details about what may have transpired inside the Mount Carmel Health System where 34 patients are believed to have received excessive doses of pain medications – 28 of which received potentially fatal doses.

Site inspectors from the state department of health – investigating on behalf of CMS – determined that “the hospital failed to ensure a system was in place to monitor and prevent large doses of central nervous system medications from being accessed from the automated medication dispensing system by overriding the warnings and prior approval of the pharmacist. This affected 27 patients at the hospital.”

A 10 Investigates review of the records show that in 24 of the 27 patient cases reviewed by state health inspectors – Dr. William Husel overrode the hospital’s internal system to gain access to pain medications prior to pharmacy approval.

One of those patients who was administered fentanyl through a system override was 67-year old Sanders Young Jr. His records show that the he was given 400 micrograms of fentanyl in July of 2016. The records do not show that the pharmacy approved the dose.

His family became the latest to file a wrongful death lawsuit against Mount Carmel Health System, Dr. Husel, its nurses and pharmacists. They spoke to 10 Investigates.

“I don’t really have a message for them. I just want somebody held accountable for it,” said Booker Young, Sanders’ son.

His daughter, Tieshia Young, told 10 Investigates: “It’s unnerving it’s like I don’t understand how somebody could be see callous.”

The failure to prevent patients like Young and others from receiving a large dose of CNS medications resulted in a determination of immediate jeopardy by CMS, the document said.

Sources had told 10 Investigates that Dr. William Husel had used go-arounds to avoid receiving pharmacy approval while ordering drugs for patients. In some cases, he’s accused of declaring emergent situations, the sources have alleged. In others, a Mount Carmel employee told 10 Investigates that sometimes the pharmacy was unaware that the patients were being removed from the ventilator.

One of Mount Carmel’s new policies includes requiring that nurses and doctors receive pharmacy approval before administering drugs used when ventilators are being removed. Another change includes stating that the use override to obtain medication is not to be used during palliative ventilator withdrawal. The use of an override can be used, however, in unplanned emergencies – like intubating a patient.

A review of Mount Carmel policy titled “Physician Orders” revealed that verbal and telephone orders are to be limited to:

  • Emergent situations
  • When clinical situations make it impractical for orders to be entered into the Electronic Health Record or written on the appropriate form
  • Situations when the physicians do not have access to remote computer devices or the patient’s chart

Another physician listed as “physician B” said there was no current “lock out” on the AMDS machine to prevent staff from continuing to override the system to obtain medications.

Inspectors also noted that fentanyl was not listed as a medication to use for palliative ventilator withdrawal, according to the inspectors review of the “Palliative Ventilator Withdrawal – Powerplan Medication Reference Document” which was updated 12/14/18.

Other findings included: that the usual adult dose of fentanyl was 25 to 100 micrograms; Dilaudid was one half to four miligrams; and Versed, was one to four miligrams. All the patients named in the wrongful death lawsuits filed thus far received at least one of these medications.

News that CMS has accepted the plans of correction could likely indicate that Mount Carmel West and St. Ann’s are temporarily no longer in jeopardy of losing its federal funding, but follow-up visits by site inspectors are expected, 10 Investigates has learned.

A spokesman for the Ohio Department of Health told 10 Investigates: “CMS has indeed approved the Plans of Correction for both Mount Carmel West and Mount Carmel St. Ann’s (both plans attached), and directed the Ohio Department of Health (ODH) to conduct follow up surveys/inspections to ensure that each hospital is implementing its respective plan. ODH conducted a follow-up survey of Mount Carmel West yesterday and is at Mount Carmel St. Ann’s today. ODH will communicate its findings to CMS which will make the final determination about whether any/all deficiencies have been sufficiently addressed (Note – it will be up to CMS to determine whether the “Immediate Jeopardy” citation is removed).”

The hospitals’ Medicare funding was in jeopardy of being terminated unless Mount Carmel could prove to the state health department and the federal overseers at CMS that they could make corrections in wake of the scandal there.

To date, 34 patients have been identified by the hospital as receiving excessive or potentially fatal doses of pain medications.

Thirty-three of the patients who received the excessive doses were at Mount Carmel West; one of the patients was attending Mount Carmel St. Ann’s in Westerville.

Of that total figure, 28 of the patients are believed to have received potentially fatal doses, the hospital has said. The six others received doses that went “beyond providing comfort” but were likely not the causes of their deaths, the hospital said.

In letters sent to the hospitals late last month, CMS warned that Mount Carmel West “was in not in compliance” with the Medicare conditions of participations because of “pharmaceutical services.”

“We have determined that the deficiencies are so serious they constitute an immediate threat to patient health and safety,” the January 30th letter from CMS read.

That same letter stated that “if you believe your hospital will be able to come into compliance, you should submit an allegation of compliance and plan of correction that addresses all the deficiencies cited at the survey…”

It went on to state, “if (CMS) accept(s) your allegation of compliance, we will authorize the ODH to conduct a revisit to verify necessary corrections.”

A similar letter was sent to Mount Carmel St. Ann’s.

The hospital said it first received a “formal report” concerning allegations about Dr. William Husel’s patient care on October 25. Three more patients died between that date and Nov. 21, 2018 – when the hospital said it received additional information and removed Dr. Husel from patient care.

Husel was fired by the hospital on December 5.

He has been named in several wrongful death lawsuits. The Ohio medical board suspended his medical license last month and the Ohio Department of Medicaid suspended his provider agreement and accused him of fraud – alleging that he conducted “medically unnecessary procedures that involved grossly inappropriate amounts of fentanyl,” according to a department spokesman.

Husel and his attorneys have declined to comment.