Ohio Board of Nursing believes 25 nurses violated law by failing to question the medication orders of ex-Mount Carmel physician Dr. William Husel

The Ohio Board of Nursing sent notices on Thursday telling 25 Mount Carmel Health System nurses that they could lose their licenses for their roles in the care of critically ill patients who died after receiving inappropriate doses of pain medications.

Also Thursday, a 25th wrongful-death lawsuit naming Mount Carmel and Dr. William Husel was filed in Franklin County Common Pleas Court. It says that 37-year-old Brandy McDonald of London, Ohio, died at Mount Carmel West on Jan. 14, 2018, after receiving a lethal dose of fentanyl ordered by Husel.

The state nursing board said the nurses receiving notices were involved in administering drugs ordered by Husel, who has been accused by the health system of overdosing 35 intensive-care patients, with dosages high enough to be potentially fatal for 29.

Letters released by the board say the nurses violated state law and reference 31 patients who received care at Mount Carmel West hospital in Franklinton and one at Mount Carmel St. Ann's hospital in Westerville from September 2014 to November of last year. Nurses, the letters say, knew or should have known that the drugs would be harmful and that there is no documentation that they questioned orders or consulted with others involved in patient care.

The nurses face disciplinary action that could include anything from reprimands to permanent license revocations or fines of up to $500 per violation.

Most of the 25 nurses are being called into question regarding the care of a single patient. However, some nurses face discipline over two to five patients, according to the letters. Each nurse has 30 days to request a hearing.

Attorney General Dave Yost said his office will handle any such hearings on behalf of the nursing board.

“Nurses are professionals who have a duty to exercise their best judgment, and tens of thousands of them do, every single day,” Yost said in a statement. “These nurses didn’t. They should have questioned the orders to administer such a high dose of painkillers.”

Husel was fired by Mount Carmel in December, and his license has been suspended by the State Medical Board of Ohio, before which he faces a July hearing on possible further action. Medical board documents in the matter reference eight patients, seven of whom received 1,000-microgram doses of the opioid fentanyl and one who received a 2,000-microgram dose.

A recent Ohio Department of Health inspection at Mount Carmel West found that a policy updated after Husel’s firing says the usual adult dose of fentanyl is 25 to 100 micrograms.

Most patients referenced in the nursing board letters received single doses of fentanyl ranging from 200 micrograms to 2,000 micrograms, along with other drugs.

In three patient cases, the board also questions the use of paralytics, twice with no documentation of a need for such drugs and once listed as necessary for a CT scan. One nurse was said to have failed to question the removal of a breathing tube after administration of a paralytic, which could cause respiration to stop.

Many of the now 25 wrongful-death lawsuits filed in the matter have named nurses and pharmacists, but attorney Craig Tuttle of the Leeseberg & Valentine firm said Mount Carmel has agreed to accept liability for the employees, so they will be dropped from the several suits filed by that firm.

>>Complete coverage: Find out more about this on-going investigation at Mount Carmel

Mount Carmel on Wednesday said it had reported 48 pharmacists and nurses to licensing boards regarding their involvement in the care of the 35 patients.

Thirty of the reported nurses and pharmacists have been placed on paid leave, and 18 have left the health system, some a number of years ago. Five managers also are on paid leave.

In a statement Thursday, Mount Carmel said it is cooperating with the nursing board and other authorities.

"We respect the actions taken by the Board of Nursing today and its role in ensuring that all nurses follow the expected standards of professional practice in our community," the statement said. "... Out of an abundance of caution, we placed all nurses who were associated with medication administration for an impacted patient on paid administrative leave until ongoing investigations provide a complete understanding of individual nurses' actions."

Husel, 48, of Liberty Township near Dublin, also is under investigation by law enforcement.

One of his lawyers has said the doctor did not intend to kill anyone.

jviviano@dispatch.com

@JoAnneViviano