Murder by Opioid: The Case of the Ohio Doctor Charged With 25 Counts of Murder

Lin Rice

October 01, 2019

The Impact on Patients and Doctors

Despite the well-intentioned goal of allowing physicians to individualize care, some healthcare providers say that care is being impeded for many patients dealing with serious pain, many of whom resort to seeking relief on the black market, or who take similarly drastic (and potentially tragic) steps.

"You're not affecting the number of deaths by pain pills, but rather shifting them to heroin," said Dr Mark Malinowski, vice president of the Ohio Society of Interventional Pain Physicians.

Given the huge attention generated by the opioid crisis—on the part of patients, clinicians, and government—the whole subject "of opioids is a big taboo, and certainly it affects the care we provide," Malinowski says. "Many times now, patients will get just a couple of pain pills and have to learn to survive without them for the rest of their illness." Prescribers are "darned if they do and darned if they don't." It can be a Solomonic decision—treat pain adequately and run the risk for addiction, or allow patients to suffer. And it's all done under the glare of enhanced scrutiny.

"Opioids probably were overutilized in the past. I think that's now turned around, but it could be to the point where we've gone too far the other direction," says Dr Rick Buenaventura, president of the Ohio Society of Interventional Pain Physicians. Buenaventura says that in many cases, the additional regulatory hoops that small providers have to jump through have a big impact on the time and resources they have to treat their patients. At the same time, prescribers who don't already specialize in pain treatment may be looking over their shoulders, he says.

"Internal medicine practitioners and family practice doctors not only don't want to prescribe opioids, they don't want to prescribe antidepressants and antiseizure medications that could help with pain as well. There's this misconception that only pain doctors can prescribe any kind of medicine for pain, which of course isn't right. But that limits access to care, and patients have to go to a second doctor to get that care, and of course pay another copay or deductible; that pain doctor might not have time to see them. So it hurts the patients and gums up the medical system, causing more delays."

Anecdotal stories abound of patients with legitimate pain management needs slipping through the cracks, along with above-board prescribers finding themselves under aggressive investigation for routine treatment decisions.

Moving Forward

State representative Liston contends that the state's efforts have shifted from regulation to creating better support infrastructure.

"I don't see much movement right now (in the Ohio legislature) in terms of further regulations on prescribing practices. I think a lot of that is because we've really made a dent in those prescribing patterns. Now we're working to develop better treatment infrastructure to manage the addiction and get people therapy. And I think that's a space for improvement."

Liston said that addressing an uncommon situation like that at Mount Carmel with legislation is complicated.

"I think there are bad actors in every field, and having the ability to identify when that is occurring is what's needed. But most physicians are not in those spaces; most physicians are working to do the best for their patients and the individual need in front of them" Liston says, making it "very difficult to create a one-size-fits-all law or regulation."

Buenaventura suggests that the climate may be improving for nonopioid pain management options, along with increased calls for the alternatives to be covered by insurance providers and Medicare.

"We're trying to let (the public and legislators) know that we're the good guys," he says. "We're trying a full spectrum of accepted treatment that they will cover, namely physical therapy, injection therapy, surgery, psychological counseling, and non-narcotic medication."

With a trial not until 2020, Husel's case will continue to garner attention. And although the gravity of the loss of life resulting from Husel's actions cannot be overstated, it can provide the hospital an opportunity to improve its checks and balances, Malinowski says.

"No matter how hard we try in healthcare, sometimes it takes a tragedy to improve processes," Malinowski says. "This emphasizes the need for critical checks and balances in any healthcare setting."

Mount Carmel St. Ann's hospital.

Along with changing leadership in its intensive care unit and the hospital as a whole, Mount Carmel announced several policy changes aimed at preventing similar situations. Some of these changes include setting maximum appropriate doses for pain medication in their electronic medical record system and putting in place a new escalation policy for deviations from pain medication protocols.

"It's no time to celebrate. We're encouraged, but we're still losing way too many people to this epidemic, so our work isn't done," Hurst says. "And as new, proven, successful interventions become available, we need to make sure those become available to the community as well. Evidence-based and effective treatments are really the core of what we're doing and need to continue to do."

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Lin Rice is a freelance journalist based in Columbus, Ohio.

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