With the trial of former Mount Carmel doctor William Husel quickly approaching, ABC6/FOX28 is looking into the doses the men and women received before their deaths.
Husel has pleaded not guilty, with attorneys claiming it was comfort care.
“I’ve been a prosecutor for 22 years and I have not seen a 25-count murder indictment," said Prosecutor Ron O'Brien when Husel was indicted in June.
With the criminal trial set to begin in June, we are also asking experts about what a jury will likely have to answer: are these doses deadly like prosecutors claim or medically necessary like some of Husel's attorneys argue?
"We are anxious to scream it from the mountain tops: this is an innocent man," said Husel's attorney Jose Baez.
ABC6/FOX28 took questions all the way to the University of Pittsburgh to get some clarity from a critical care doctor, who says so much of this comes down to the individual patient.
"There’s not really a set protocol for how to dose this," said Dr. Douglas White with the University of Pittsburgh.
White spends his time caring for patients in the intensive care unit, training others and researching ways to improve end of life care in ICUs.
His work is on a national stage, published in some of the most respected medical journals.
Husel's legal team cited some of White's research in a civil lawsuit, where they argue the former Mt. Carmel doctor is being defamed.
"Fentanyl is an opioid pain medicine. We use it in intensive care units to try to alleviate the pain and stress that can come up during the dying process. The difficulty or the challenge with fentanyl is it can also hasten death, which is something that medical ethics disallows in the United States," said White.
Of the 25 murder charges, Husel is accused of, doses of fentanyl range from 500 to 2000 micrograms.
"For example, if a patient is having a little bit of distress and had not been on, for example, fentanyl before, it would be quite concerning to give for example 500 micrograms or 700 micrograms. However, if the patient had been chronically in the ICU on 500 micrograms an hour on fentanyl, it might be quite appropriate if they are having a lot of pain to give...500 micrograms or more," he said.
As for each patient's tolerance, that's up to lawyers and medical experts to argue.
Reports by state inspectors revealed that much of the medication Dr. Husel ordered was obtained by overriding the system.
"2,000 micrograms is a very large dose. It would be an unusual circumstance for that to be the appropriate amount for a patient in an intensive care unit, but not unheard of," said White.
ABC6/FOX28 reached out to Prosecutor O'Brien ahead of the trial. He said because it is a pending case, he can't comment at this time. But, he did have this to say when Husel was indicted in June:
“I have found no one, nowhere that says 500 micrograms of fentanyl is an appropriate use of fentanyl for treatment of somebody being taken off a ventilator," he said.
To learn more about what arguments a jury could hear, ABC6/FOX28 spoke with former Franklin County Prosecutor Mike Miller.
"The prosecution is going to argue that due to the amounts of the drugs that were given, they caused the deaths of the patients. And the defense is going to say it wasn't done for that purpose," he said.
ABC6/FOX28 asked just how difficult it could be to present all the medical information.
"There will be masses of medical records and so forth, but each side will make it clear what these records mean, at least in their opinion. I don't really think it is going to be as complicated as it sounds," said Miller.
He thinks much of the case boils down to one factor.
"Intent is basically everything," he said. "I think that is basically the whole case."
White believes this could be an important question for the jury:
"Was it the kind of dose that any reasonable physician would look at and say: 'That is way too big a dose'?" said White.
Mt. Carmel has apologized, saying they've implemented many changes to make sure this never happens again.
Husel has pleaded not guilty.