Since Mount Carmel Health System announced the firing of a doctor over "excessive" pain medication dosing, hospital executives and family members of patients have given their perspectives. But largely out of fear for losing their jobs, employees who worked alongside him remained silent - until now.

Dr. William Husel joined Mount Carmel Health System in 2013 as an intensive care physician trained in anesthesiology and critical care. From the time Husel started at Mount Carmel, one medical professional at the hospital says he noticed Husel used high doses of pain medication.

“In general, I would say anesthesiologists tend to be more liberal on sedatives,” he says. “And when he first came, that’s sort of the pattern we saw. He did use larger doses of sedatives than a typical internal medicine trained doctor would do. But we generally consider that’s part of his training.”

WOSU spoke with a nurse and pharmacist who worked the night shift with Husel. We’re not disclosing their names because they fear they will lose their jobs for speaking publicly.

“When you’re introduced or they talk about Husel, they let you know his background,” another employee says. “Say you didn’t know him, you came in, they’d be like Husel, that's our nightshift doctor. He’s good. If nobody can do it, Husel can do it. He is very looked up to. So then you have that trust that they have.”

Both Mount Carmel employees say it was common for Husel to be the only doctor in the ICU during the night shift. He often was the only person on duty with expertise in anesthesiology and sedation for patients.

So when Husel ordered higher-than-usual doses of pain medication, the employees say they deferred to him.

“The doctor is our expert, and you have that trust that they’re guiding the care in the right direction,” the employee said. “We have the ability to speak up because we have a license and I understand that, but our doctor is our expert and they’re guiding the care.”

Ohio law states that pharmacists and nurses both have a legal responsibility to the patient, and can use their professional judgement to question the prescriber.

One of the employees says he did just that by directly questioning Husel about high doses.

“When I spoke to him about medication doses, he would give a very reasonable answer that convinced me a certain dose or indication is appropriate,” the employee said.

In the end, he deferred to the doctor. He says he never brought his concerns to hospital management.

Timeline: The Mount Carmel Scandal So Far

Husel was removed from patient care duty on November 21, 2018, and fired on December 5. The hospital says that Husel gave "excessive" doses of painkillers to at least 34 patients who died after being administered the drugs.

Since Husel’s firing was made public on January 14, families of patients have filed eight wrongful death lawsuits against Husel, the hospital, and several nurses and pharmacists. In many of the suits, families report Husel said their loved one could not be saved.

Family members say they requested their loved ones be taken off life support and made comfortable during their remaining time.

“The whole area of how much pain medicine to give, how to manage someone who you are going to allow to die, is very grey,” says Arthur Caplan, a medical ethicist at New York University.

“There's not like clear-cut rules or clear-cut standards about what to do," Caplan continues. "So challenging, asking questions, that's very appropriate. But if you get answers that you think make sense or at least quiet down your questions, that's certainly common and would be happening at many hospitals.”

Caplan says when cases like this come up, the medical community looks at what is considered common practice.

“And amazingly, you find out that some people use a lot of drugs,” Caplan says.

Mount Carmel officials say they are still investigating whether Husel exhausted all life-saving measures before ordering the drugs. The hospital has also put more strict guidelines in place when it comes to medication management, acknowledging it did not have “sufficient safeguards.”

“Some of our colleagues did not meet our standard of care,” Mount Carmel CEO Ed Lamb said in a video for employees. “The actions that created this tragedy were instigated by this physician and carried out by a small number of good people who made poor decisions. They ignored the safeguards we had in place.”

Following Husel’s firing, the hospital suspended 23 pharmacists and nurses, as well as “members of the management team.” Neither of the employees WOSU spoke to are currently on administrative leave.

“When it all came out, I’m like, it could have easily been me. Easily,” one employee says. “Now there’s a fear that you could do something wrong when you’re given an order from a doctor, you know?”

Both employees agree: Mount Carmel’s policies were not sufficient to justify punishing staff members who carried out a doctor’s orders.

“They are pinning a systemic problem on individuals,” one employee says. “The general feeling is that Trinity and Mount Carmel is singling out people as scapegoats to lessen their responsibility. In my opinion, it’s the system that failed. From the very top, to the very bottom. Everybody is responsible.”

“It’s not an individual issue,” the other employee added. “When it’s that many people involved, the system failed. And I don’t understand why it’s not okay to say the system failed?”

Mount Carmel said in a statement that they continue to examine whether they could have caught Husel’s practices sooner.

Husel's medical license was suspended last week by the State Medical Board, barring him from practicing medicine in Ohio pending a full investigation.

If you are a Mount Carmel staffer who has information to share, or you believe your loved one or family member was impacted by this case, contact WOSU at paige.pfleger@wosu.org.