An Ohio Department of Health inspection found that, in 24 of 27 patient records reviewed, a former physician at Columbus-based Mount Carmel Health System could access powerful pain medications using overrides over warnings, The Columbus Dispatch reports.
Details of the Jan. 18 findings are contained in a correction plan Mount Carmel Health System prepared for CMS after firing William Husel, MD, an intensive-care physician accused of ordering excessive painkiller doses for 34 near-death patients. The doses were at fatal levels for 28 of the patients.
Mount Carmel said it reviewed and revised policies and increased education efforts after the physician's Dec. 5 firing.
Documents on the investigation released Feb. 12 provide details for the two Ohio hospitals involved — Mount Carmel West in Columbus and Mount Carmel St. Ann's in Westerville.
The inspection reports, which looked at 27 cases dating to 2015, say the hospitals did not ensure a system was in place to prevent large doses of medications from being accessed by override.
Medication ordered by a physician is typically approved by a pharmacist and released electronically, letting nurses access it through a cabinet. Overrides to access the cabinet are allowed for certain medications in certain emergency situations.
The health department reports, which repeatedly refer to "Physician A," found pharmacists verified medications in some of the override cases.
In one case, the cabinet was accessed by override multiple times to get 2,000 micrograms of fentanyl. In two other cases, 1,000-microgram doses of fentanyl, along with high doses of Versed, were dispersed by override even before the physician's order, the report said.
In its correction plan, Mount Carmel officials said they placed limits on what medications are available on an emergency-order basis; further defined when emergency orders are permitted; implemented a plan for daily pharmacist review of emergency medication orders; and revised a policy to set parameters on the amount of pain medication used for patients being removed from breathing machines.
CMS accepted Mount Carmel's plans, according to a spokesperson from the Ohio Health Department, which conducted investigations on behalf of CMS.