Disclosures: Oregon K. Hunter, Jr., MD: No financial relationships or conflicts of interest

Case Diagnosis: Pain management provided for end of life care was targeted by an overzealous prosecutor.

Case Description: An anesthesiologist/pain specialist, Dr Husel, managed palliative extubation in terminally ill patients in an ICU from 2015-18. He prescribed Fentanyl to opioid tolerant DNR actively dying terminally ill patients. His use of Fentanyl for palliative extubation was to prevent suffering and “bad death,” remained unquestioned by the pharmacy, medical staff, and hospital for three years. When the hospital involved found pharmacy patient safety concerns, investigation was initiated. Bypassing standard peer review process, the hospital reported Dr Husel to law enforcement. He was charged with twenty-five counts of murder, later reduced to fourteen. A Franklin County jury acquitted him on all counts.

Setting: Community Hospital.

Assessment/Results: Publicly available trial records were reviewed. Dr Husel treated his patients ethically, compassionately, within standard of care, yet, he was charged with the crime of murder. A pro-bono defense team of lawyers and doctors assisted Dr Husel in achieving a favorable verdict.

Discussion: Doctors who provide pain management for end-of-life care may become targets of overzealous prosecutors. Risk reduction suggestions are identified.

Conclusion: Pain specialists may become prosecution targets. Suggested strategies may reduce risk.

1. Transparency in documenting care decisions. 2. Document pain levels. 3. Support decisions with medical literature. 4. Ask colleague(s) for a second opinion. 5. Document your communications with family. 6. Be kind and respectful to staff and colleagues, you need their support. 7. Consider medical ethicist consult.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prosecutor-targets-pain-management-doctor-a-case-report/