The Line Between Comfort Care and Murder Physician Accused of Murdering 14 Patients Found Not Guilty

5 thoughts on “The Line Between Comfort Care and Murder Physician Accused of Murdering 14 Patients Found Not Guilty”

1. The legal focus is on such minutia. Palliative extubation = the patient is expected to die. The patient is NOT expected to live. Recovery is not the intention. By remaining intubated, only the patient’s death is expected to be prolonged, so if it to be hastened by withdrawing respiratory support, why should hastening it by any other means (especially by further mitigating discomfort) be looked upon any differently? The distinction between withholding care and actively causing death is made just to make us feel better about the former. Under other circumstances, withholding care can be construed as torture, so legalities are defined by situation and intent. The intent was clear as soon as the extubation was planned, so proving it further is pointless, except to make someone responsible. It is all a symptom of how we love to lay blame on someone for everything. Story: G-d was assigning duties to the angels and asked for a volunteer to be the Angel of Death. Of course no one wanted the job, so He was forced to select one at random. Afterwards, G-d is explaining the job to the angel, how to transport the soul and care for it until it reaches its final resting place… The angel looks miserable about his new responsibility, so G-d puts His arm around the angel and says, “Look, this job isn’t so bad, because no matter WHAT happens, people are going to be willing to blame everything but you.”

2. This is a peculiar case since there are SO many people involved over a long period. Frankly, I’m surprised CMS hasn’t sent Husel a special award for saving Mount Carmel St. Ann’s Hospital in Westerville the most money in ICU care history. Maybe he applied for the Czar of Death Panels at CMS, and they thought he was just a bit too aggressive. Very peculiar case.

3. I will be very interested to learn Husel’s side in his deposition scheduled Monday (I suppose in the defamation and wrongful termination case against Mt Carmel by him and other terminated employees? Or in one of the cases brought against him?)
   The initial motivation of the hospital was first to clear beds for the following day— otherwise why would they be doing these “palliative extubations” at night? After the fact, it was obviously to exonerate themselves, and regain their CMS certification.
   The motivation of the prosecutor (50 witnesses? Come on!) is almost certainly political in OH.
   The motivation of the patients’ families (all of whom knew the patients were moribund and either they, or the patients themselves via Advance Directives gave consent to “Palliative Extubation”—which is specifically intended to end suffering and hasten death) is clearly $$$. (Gee, I wonder if they did/will claim damages for Pain and Suffering.)
   The motivation of the medical board in OHIO was clearly to C(Its)A.

   Did anyone there care a whit about the desires or feeling of the patients themselves?
   No, they were mere bit players in this monetarily driven melodrama of litigants.

4. Ever since Hitchens, Dawkins and Krauss wrote their fabulously successful books extolling atheism, with the “goal of promoting reason over superstition,” Western Societies have been confused by death. I don’t blame these rich authors for their success because at one time I too was monumentally confused about God and the Holocaust. I still am but have reached a kind of “detente” with God.

   We now demand our physicians “make up” for that same confusion that has split our society almost exactly in half. This is what happened to Dr. Husel. Because of his choice of employing respiratory depressants for dying patients, he essentially ended his carrier and faced criminal charges that almost put him away et eternal.

   Every terminal care physician needs to create a kind of “sliding scale” for evaluating terminal use of respiratory depressants. The guide above is not enough because it lacks specificity for each patient. I have thought over the years that a kind of numerical sliding schedule that would be filled out each day by nurses and other care operatives could be used as a template. But it would be INDIVIDUALIZED for each patient, each day. That individualized history is what protects you best legally.

   I have wondered about the best way to create this document. I am still thinking about it. But should it be up to an old retired DPM to come up with it? Almost anything would have at least protected Dr. Husel from his personal hell. The key is INDIVIDUALIZED DAILY METROLOGY, combining the status of the patient with their Sp02 and some other kinds of objective clinical pain measurements. Any metrology is better than nothing.

   If you do terminal care, you need to create a metrology form for respiratory depressants and fill it out each day. If you are interested in developing one, contact me through Medical Justice. I know what you’re thinking: “How can an old retired DPM come up with anything?” Actually, I have created numerical chart audit systems, unlikely as that sounds. But if you do terminal care, almost anything is better than nothing. Start out with your chart notes. Ultimately, they defend you best.

   Michael M. Rosenblatt, DPM

5. Given my most recent posting above, in case you are interested, here is an “example” of a Digital Chart Audit (TM) Worksheet I am describing. You are permitted to use it or any permutation of it you choose, but you must specify it is “Digital Chart Audit (TM). ”

   The form I have on MSWORD prints out better as a single page.

   Example of Digital Chart Audit (TM) for terminal care:

   Terminal Care Fill-in Sheet-Digital Chart Audit™
   Disclaimer: This Form contains PHI. This is regulated by Government. Special handling is required. No guarantees, warrantees or promises are made concerning outcome of audit, prosecution, fines, effectiveness of treatment or any other effects of the use of this form. This is not legal advice. If you have any questions, contact a licensed attorney.

   Name: Enter name here Date:Click or tap to enter a date. Motor Responses and Features of Final Days:
   Localization to Noxious ☐ Stimulation
   Fixation of Pupils ☐
   Reaching with hands ☐

   Flexion Withdrawal ☐
   No facial expression ☐
   Speaking to unknown persons ☐
   Speaking to unseen persons ☐

   Abnormal Posturing ☐
   Grimace ☐
   Request by patient to notify ☐

   None/Flaccid Verbal Response
   ☐
   Oral Reflexive movements
   ☐
   Depressive facial features
   ☐

   Verbalization (un) intelligible
   ☐
   Startle Response ☐
   No Startle Response☐
   Overt Anger ☐
   Overt Fear ☐
   Acceptance ☐

   Vocalization ☐
   Frequent shifting in bed ☐
   Request for sharing ☐
   Request for Clergy ☐ By family ☐

   Groaning ☐
   Scratching/itching ☐
   Combative ☐

   No Visual Response ☐
   Obvious dyspnea and struggling ☐
   Massive pain response ☐
   Un-focused Movements ☐
   Contortions/flexion contractures
   ☐

   Enter total point values for Motor Responses (+1 points for each) here: Click or tap here to enter text.

   Present Dose/Name of Narcotic(s) Enter Text here Click or tap here to enter text.
   ☐ Family Request for “better” pain control Enter text here
   Expectation of death within 24 hrs. Enter Text here
   Restlessness and depth of coma deepening Enter text here
   Enter more text:
   Cheyne-Stokes Respiration ☐ Click or tap here to enter text.
   Conscious contact with deceased relatives Enter text here
   Pain from disease ☐ Worsening ☐ Lessening ☐ Not responding as expected
   Kidney Function ☐ Anuria ☐ Urine flow increasing ☐ Urine flow decreasing
   Jaundice ☐ Sclerae only ☐ Total ☐ Jaundice meter measurement
   Enter Total point values for bold features (+1 point for each) here: Click here to enter point value

   Identification of unexpected patterns: Enter text here
   Enter more text here
   Decision ☐ Admit to hospice ☐ Remove from hospice ☐ Reactivate curative treatment ☐ No Change
   Time factors ☐ Floor time ☐ Counsel family ☐ Counsel patient ☐ Chart review
   Decision ☐ Increase narcotics ☐ Decrease narcotics ☐ Change to different narcotic ☐ Alternative care
   History of narcotic abuse ☐ Enter text here
   Enter more text here
   Comments: Enter text here Enter more here:

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