CINCINNATI, Ohio – Rebecca Walls went to the hospital because her primary care physician recommended it. The 75-year-old had been lightheaded and short of breath for about a month, so on Nov. 13, 2018, she went to Mount Carmel West Hospital in Columbus, Ohio, and checked herself in.

Six days later, things seemed to be going downhill, and Walls’ status was changed to “do not resuscitate.”

The doctor in charge of her care ordered a large dose of painkiller. A nurse administered the dose. And minutes later, Walls was dead.

Seven months after that, her doctor, William Husel, was charged with murder for using excessive doses of pain medication to kill Walls and 24 other patients over a span of three and a half years.

Husel, 43, is out on bond awaiting trial. He pleaded not guilty to 25 counts of murder and hired Florida attorney Jose Baez, who has represented high-profile clients like Casey Anthony and NFL star Aaron Hernandez.

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Husel’s medical license has been suspended, but the case raises larger questions about doctors, hospitals and the trust patients put in them.

When you’re sick, you don’t have any answers. You trust the doctors, with years of training and experience, to cure you. You put your faith in the nurses, believing they have your best interests at heart. You believe a hospital is a place of healing.

But what if that’s not always true?

Twenty-five victims

The victims range in age from 37 to 85. There was 39-year-old Ryan Hayes, who suffered a heart attack; 70-year-old Larry Brigner, a Vietnam veteran battling brain cancer; and 85-year-old Norma Welch, brought to the hospital after a fall.

Husel is accused of ordering nurses to administer excessive doses of fentanyl, a painkiller at least 50 times more powerful than morphine, to dozens of patients, either quickening or causing their deaths.

According to court records, Husel ordered between 500 and 2,000 micrograms of fentanyl for each victim, sometimes paired with a paralytic.

A normal dose of fentanyl is between 25 and 100 micrograms.

“I have found no one, nowhere that says 500 micrograms of fentanyl is an appropriate use of fentanyl for treatment of someone being taken off a ventilator,” said Franklin County Prosecutor Ron O’Brien.

Some of the victims were frail and failing and might have died anyway.

But some, like Walls, might have lived.

Attorney Timothy Mahler is representing Walls’ estate in a civil suit against Husel, the hospital and a host of nurses and administrators. Mahler told The Cincinnati Enquirer earlier this year that Walls’ friend, who was in charge of medical decisions, was led to believe Walls was going to die no matter what and was asked in the middle of the night to change Walls’ status to “do not resuscitate.”

The friend agreed because she didn’t want Walls to suffer, Mahler said. She thought she had no choice.

Walls was one of three patients who died after Mount Carmel West Hospital was given “formal notice” of what Husel was doing, Mahler said.

Perhaps even worse, he said, she’s one of five patients the hospital admits “could have survived had she received proper medical care.”

“The oversight, or lack of oversight, just blows your mind,” Mahler said. “The only purpose to administer this medication would be to kill a person.”

‘A system failure’

Mount Carmel had safeguards in place to stop doctors from ordering excessive doses, but none of them stopped Husel. Nurses and pharmacists often had to override flags in the hospital’s medication-dispensing cabinet, called Pyxis, to access the amount of fentanyl Husel requested.

The hospital had a policy: No one overrides the cabinet except in rare circumstances, such as an emergency when delaying medication could harm the patient. But that wasn’t what happened with Husel’s patients.

Instead, nurses “routinely” performed overrides, according to the Ohio Board of Pharmacy, which could level fines against the hospital and three pharmacists. 

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The high doses did raise some eyebrows among the third-shift nurses, but Husel explained away the questions by reminding the nurses he had completed a residency in anesthesiology at the Cleveland Clinic, the state’s most prestigious hospital, O’Brien, the prosecutor, told reporters.

At least at the time, that seemed to be enough, O’Brien said.

“They failed to kick it up the chain of command,” he said.

But then, at least one staff member formally reported concerns about the high dosage given to a 39-year-old on Oct. 24, 2018.

James Nickolas Timmons was brought to Mount Carmel with “altered mental status and hypothermia.” Within days, doctors informed Timmons’ brother that his sibling was “brain dead.” The brother changed Timmons’ status to “do not resuscitate.” Husel ordered the dose of fentanyl, and Timmons was dead 13 minutes later.

It’s not clear exactly what prompted the staff member to report Timmons’ death on Oct. 25. It might have been Timmons’ age or the fact he was alert and responsive before his death.

It’s also not clear how far the employee’s concerns were taken. There’s no record that Husel was reprimanded or asked to leave. In fact, he would be linked to at least three more deaths before he was shown the door.

Husel’s final patient was Melissa Ann Penix, 82, who died on Nov. 20 – just four minutes after receiving a 2,000-microgram dose of fentanyl following two paralytics. A nurse administered the drugs even though Penix’s record showed no need for a paralytic, according to nursing board records.

That high dose prompted a pharmacist to report Penix’s death to hospital officials. Husel was escorted from the hospital the next day. On Dec. 5, Mount Carmel fired Husel and called the county prosecutor.

“From the outset, it’s appeared to be a system failure, from top to bottom,” said attorney Anne Valentine, who is representing victims’ relatives in several lawsuits against Mount Carmel. 

No nurse or pharmacist will face criminal charges for what happened to Husel’s patients, but many have already faced professional consequences. Several were named in civil lawsuits brought by relatives of those given fentanyl. Twenty-five nurses were cited by the Ohio Board of Nursing. Mount Carmel’s CEO Ed Lamb resigned in July, following Husel’s arrest, and the hospital fired 23 employees.

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An Ohio Board of Pharmacy review found the hospital didn’t require investigations of overrides to determine if they were done properly.

“What was done by way of an audit or an immediate look back to verify that in fact, there was a legitimate emergency justifying the override exception?” asked attorney Gerald Leeseberg, Valentine’s colleague. “The answer to that is nothing.”

Mount Carmel’s investigation into Husel wasn’t done in a timely manner, the pharmacy board review found. 

Since Husel’s dismissal, Mount Carmel has limited when overrides can occur, according to corrective plans submitted to the U.S. Centers for Medicare and Medicaid Services.

“There is nothing more important to Mount Carmel than the safety of our patients and their trust in us,” reads a hospital statement. “We continue to learn from these events, and we are confident that we have processes in place to ensure the safety of our patients and their families.”

‘A second chance’

Twenty-five years before he would be charged with murder, Husel – then a young college student in Wheeling, West Virginia – found himself facing federal charges. 

It started with a string of car break-ins. Husel and a friend had been breaking into cars on and around campus, stealing stereo equipment, according to court records. When students confronted them about the thefts, Husel and his friend concocted a plan to build a pipe bomb and detonate it under the vehicle of one of the students.

They ended up setting off the bomb in a trash bin on campus, but the explosion destroyed the bin and damaged a nearby building.

Then, to throw suspicion off himself, Husel planted bomb parts in another student’s car and made an anonymous call to police, trying to frame the other student.

Husel ended up pleading guilty to the thefts from cars. He was fined $250, put on probation for a year and ordered to pay restitution.

He signed a plea deal in the pipe-bomb case where he pleaded guilty to a lesser charge of improperly storing a destructive device. He was sentenced to six months in a halfway house and put on probation for a year.

He also lost his basketball scholarship and was kicked out of school. 

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After that, Husel seemed to turn his life around. He moved back to Ohio and got a job to pay for classes at Ohio State University, graduating in 2000. Eight years later, he earned his doctorate of osteopathy from Ohio University’s College of Osteopathic Medicine.

In letters to the medical board, explaining his criminal past, Husel said he was an “immature and irresponsible teenager” who got in with the wrong crowd.

He felt out of sorts being away from home for the first time, he wrote.

“At this new school I was just another unknown student and no one respected my athletic ability,” he wrote. “I now felt like a small fish in a big pond.”

Husel asked the medical board for a second chance.

“I was 19 years old when I was arrested,” he wrote. “That night I made a promise to myself that I will never again act so irresponsible. I was given a second chance to correct a wrong and have made every attempt to demonstrate that I learned my lesson and will never make those types of mistakes again.”

After graduation, Husel worked at the Cleveland Clinic until 2013, specializing in anesthesiology and critical care. While there, he was never disciplined or placed on probation. His instructors reported no negative behavior, according to records in his state medical board file.

In 2013, he started work at Mount Carmel West Hospital in a lower-income Columbus neighborhood.

He was one of about 10 doctors working as an intensive care physician for the hospital. He worked the night shift and was often the only doctor on duty with the authority to order sedatives, a nurse and pharmacist told Columbus’ WOSU.

Nurses and pharmacists have a duty under Ohio law to advocate for their patients. But Husel was the doctor, after all.

It was his call.

What choice was there but to trust him?

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