 So if he was making pipe bombs, he was clearly smart enough to be a physician, right? Let's fast forward a little bit. This doctor was charged with murdering 34 of his patients. Welcome back to the channel, everybody. For those of you who are new around here, my name is Michael, aka Dr. Chalini, and I'm a board certified diagnostic and interventional radiologist in New Jersey. Since I've recently been doing some deep dives on some high profile medical cases, I was left no choice but to do yet another deep dive on this case involving Dr. William Hussle, which you may or may have not heard of. Full disclosure here, I personally did not know about this case until a few people mentioned it in the comments of my prior videos, which if you haven't seen them, link up here. You should go check them out after this video. Now, a quick Google search of Dr. William Hussle's name showed numerous articles accusing him of killing at least 34 of his own patients. That obviously got me a little curious. So let's go ahead and do another deep dive on this particular case. Let's go. Okay, so let's get straight into the case. Who is Dr. William Hussle? And I hope I'm saying his name right. Well, he is a 45 year old intensive care physician based in Ohio. A quick look into his past while doing some research showed some pretty interesting things. However, they aren't really applicable to this current case, but they're good enough to share, so I'm going to share them. Allegedly, while attending college in West Virginia, he built a pipe bomb and stored it until he used it to explode a trash can near a health and recreation center on the college campus in 1994. Apparently after this whole thing went down, he tried to frame another student by planting bomb material or bomb making material in that person's car. And I'll read his charges here. He was charged with malicious damage by means of explosive device, possession of an unregistered explosive device, and unlawful mating of an explosive device, and was sentenced to six months to serve in community confinement center, along with one year of supervision, whatever that means. So if he was making pipe bombs, he was clearly smart enough to be a physician, right? Let's fast forward a little bit. He then went on to medical school and residency and started working as a critical care physician in 2013 at Mount Caramel Hospital in Columbus, Ohio. So now that we know who William Husell is, let's go ahead and talk about the timeline on how all this went down. Well, we know that Dr. William Husell started working at Mount Caramel Health System in 2013. In February, 2015, according to the Medical Board of Ohio, was the first time Husell provided substandard care and jeopardized the safety of critically ill patients. February 10th of 2015, a patient dies at Mount Caramel Hospital after they were giving 400 micrograms of fentanyl, which is quite a bit. And for those of you who don't know what fentanyl is, it's a very potent synthetic opioid that's about 50 to 100 times more potent than morphine. Just as an example, for my procedures that require moderate sedation, we usually start with a 50 microgram dose and the patients are usually in La La Land. So that was February 10th, let's go to February 11th, 2015, where another patient dies. And then March 1st, another patient dies, followed by March 4th, another patient dying, March 10th, another patient. And the next patient dies on April 3rd, 2017, followed by seven other patients that year, all while on his watch, followed by 10 more patients in 2018, which prompted a formal report by the Mount Caramel Health System regarding Husell's care, which was in late October of 2018. Fast forward a month later to November of 2018, two more patients died. This was followed by the passing of two more patients, which prompted a third report and ultimately removal of Dr. Husell from duty. And in December of 2018, Mount Caramel Health System fires Dr. William Husell. They notify the state medical board of Ohio, who met with the Franklin County prosecutors. As of that date, 24 patients were thought to have been given excessive doses of opioids by Dr. William Husell. And in December 28th of 2018, the investigation expands, finding three additional patients that have passed under his care, bringing the total to 27 and prompting at least 28 lawsuits from families. All said and done, June 5th of 2019, he was charged with 25 counts of murder and turned himself in. And he ultimately pled not guilty to those 25 charges. The trial was then delayed because of the pandemic and then three years into the case, 11 of the 25 charges of murder were dropped and the 14 remaining patients were given some of the highest doses of fentanyl. Okay, so now we have the timeline taken care of. Let's talk about what actually happened to these patients under Dr. William Husell's care. For the court documents, Dr. William Husell was a night shift ICU doctor. Husell allegedly ordered multiple fentanyl doses that were well over the recommended dose, along with other drugs for multiple different patients. Some reports even stated that he ordered 1,000 micrograms of fentanyl on multiple patients or 10 times the usual dose per patients. One of the patients even received 2,000 micrograms of fentanyl, which is 20 vials all at once. Now I tried for a while to find some medical records on these patients so that I could analyze the charts and see what actually was going on here. But it turns out they aren't really public data, I guess, or at least I couldn't find them. I did find a small amount of information on one particular patient who the prosecution expert physician witness mentioned. I'll read it off here. It was a 69 year old with CKD or chronic kidney disease, pneumonia, septic shock, and lung cancer. And just for education purposes here, someone who is in septic shock is extremely sick. So sick in fact that oftentimes they can't maintain their own blood pressure and have to have a constant infusion of medications to keep their blood pressure within a normal range. We call those drugs pressers in the business, which is short for vasopressers. Norepinephrine, epinephrine, phenolephrine, and vasopressin are all examples of those drugs. All right, so back to the 69 year old patient. According to the expert physician witness, their pain was being treated well over the two and a half week hospitalization, which was why he argued that the decision to remove that patient from life support was premature because death wasn't imminent. Furthermore, he stated that if he didn't give such a high dose of fentanyl, maybe she would have lived longer and not have died minutes later. It seems to me that this was the common argument for a lot of these patients. And per Ohio law, they do not allow physicians to be involved in medically assisted death. And like I said, this was the basis for a lot of the prosecuting arguments. I did read, however, that most of these high doses of fentanyl were given at the time of palliative extubation. In a case you have no idea what palliative extubation is, don't worry, here is the definition right here. Palliative extubation, also known as compassionate extubation, is the removal of an endotracheal tube from a patient who is not expected to sustain independent respirations while easing the patient's suffering. The procedure is intended to provide a patient with comfort and freedom from the ventilator with the understanding that the goal is quality of life, not quantity of life. I think that pretty much sums it up. All right, now that we got that all out of the way, what are my thoughts on this case? That's what we came here for, right? Well, at first glance, I think a lot of people died under his watch, which makes you really stretch your head and be like, what is this guy doing? However, you do have to take a step back and look at it from a different perspective. After all, he is a critical care physician. He's taken care of the sickest patients in the hospital, a lot of whom would not be alive without modern medicine. It is also not uncommon on an ICU floor to have multiple patients die per week or even daily. So you can see now that over the course of many years, it really isn't that shocking. It just seems shocking when you read that fancy headline, 34 patients died under doctor's care. Another thought about this case was, why did the pharmacy and hospital and nurses not question these extraordinarily high medication doses? I did read, however, that some of the nurses and staff were allegedly enthralled with Dr. Hussle and they would pretty much be complicit with what he was doing. However, there were 25 nurses that faced disciplinary action from the nursing board because of these actions. And 10 of those nurses filed their own lawsuits against the hospital, claiming the hospital was creating a false narrative as some sort of image saving campaign. Now, this whole image saving campaign is sounding very familiar to the last two cases, I just did videos on, link up here. Somehow the hospital and healthcare system always skate by unaffected. And like I mentioned prior, I did a lot of dating on this case and couldn't really find exact examples of what he was doing in the patient's conditions that he was treating, et cetera, et cetera. I did, however, read between the lines and it sounds like most of those patients, including the 14 patients who received the highest dose of fentanyl were all given those high doses at the time of palliative extubation. And you can rewind the video a little bit if you wanna see the definition of that again. And I do wanna reiterate here, this is not factual data, this is just me reading between the lines and coming up with my own conclusion. It may not be true, it may be true, we'll never know. But as you probably gain from the definition of palliative extubation, it is reserved for patients who are critically ill. And by critically ill, I mean patients with little or no chance of survival. Together, the family and physicians can ultimately decide to end all life-preserving measures and extubate the patient, aka remove the breathing tube. Upon removing the breathing tube, the patient will eventually pass over a certain period of time, which could be any amount of time. Five minutes, a day, 12 hours, you never know. And there's a fine line between providing comfort measures and expediting death during palliative extubation, which I've come to realize was essentially the basis for this entire case. They were trying to see if you overstepped that line as a physician. And this is what makes palliative care so difficult and so necessary at the same time. There is a huge fear surrounding death because it's unknown and scary. And trying to convey a critically ill patient's prognosis to the family can be very difficult. But as physicians and especially ICU physicians, they see and deal with this all the time. And with their knowledge base, experience, and modern medicine, they can help the family to decide the most appropriate thing to do for the patient. It does seem, by reading between the lines again, that he was trying to provide comfort for his patients, rather than them being extubated in an agonizing or painful manner. And if you've ever seen a loved one or patient pass from palliative extubation, you know what I mean. And I really hope what I'm talking about here does not come across insensitive because that's not my intention whatsoever. It's hard to talk about this stuff and I'm trying to do it because I'm trying to keep an open dialogue. So hopefully you all bear with me through all this and don't think I'm being insensitive. I'm just trying to be pragmatic. I'm simply trying to take myself out of the equation and think about it from the ICU doctor's perspective. Do I think the doses of fentanyl were excessive? Probably. I don't think they need 2,000 micrograms to not feel pain. And if he didn't give his patients such high doses, I don't think he would be in this predicament. If he just ordered the usual dose, I don't think any red flags would be raised. Now, to be clear, I'm not a critical care physician and I do not deal with end-of-life care. But after a little bit of reading, I did find that there were some standard protocols recommended during palliative extubation, none of which require excessive amounts of fentanyl. Also, I did read about a few things where he allegedly told patients, family members, that their loved one was brain dead when they may not have been brain dead, which may have been intentional to expedite end-of-life management. This may or may not have been true, but I think it's important to talk about, at least from an educational standpoint. Brain death is a clinical diagnosis made by a physician, sometimes requiring two separate physicians. It means that there's permanent and complete loss of brain function in both the cerebrum and brainstem. It can be diagnosed clinically by the presence of three conditions, persistent coma, absence of brainstem reflexes, and lack of ability to breathe independently. And here is a nice chart from the New England Journal of Medicine listing criteria for brain death. Coma, absence of motor responses, absence of pupillary responses to light and pupils at mid-position with respect to dilatation, four to six millimeters, absence of corneal reflexes, absence of gad reflex, absence of respiratory drive. I'm not gonna go through all of these, obviously, but just thought I'd throw this up here so you could see them. And by the way, since I am a radiologist, brain death can also be diagnosed by nuclear imaging. If you look right here, this is a cerebral perfusion study. Notice there is no flow to the brain and there is increased flow or uptake in the area of the nose. This is called hot nose sign, which is caused by increased perfusion to the external trotid artery that supplies the face because there is no flow going through the internal trotid artery that supplies the brain. The reason brain death diagnosis is so important is because it essentially means that life support is futile. If he inadvertently told patients' family members that their loved one was brain dead and they weren't, just to expedite the inevitable, that is wrong on so many different levels. However, that really didn't seem to matter that much in this case because of the ultimate outcome, which, while we're speaking of outcome, I didn't really mention it yet, so now that he's not guilty, what's next for Dr. Hussle? Well, I think he's got a lot more in store for him. He's been acquitted of these 14 murder charges, but multiple civil lawsuits are allegedly being filed by the families. Also, his license is currently suspended and allegedly he's going to try to get it reinstated, although I feel like his reputation may be a tad bit tarnished at this point, even though the outcome was in his favor. But he definitely has an uphill battle going forward. So that's officially it. I'm curious to know what you all think of this case, especially my ICU physicians, nurses, PAs, NPs, et cetera. Comment below and let's have a civil discussion because this is something we need to talk about. Do you think he did anything wrong? Do you agree with medically assisted death? Is it ethical? These are all tough questions that I don't really know if anybody has the answer to. So thanks again for watching, everybody. Subscribe to my channel. Hit that little subscribe button. Follow me on Instagram and TikTok if you don't already. And as always, I'll see you all on the next video. Bye.