A former Ohio hospital physician on trial in the deaths of critically ill patients was portrayed Monday in closing arguments as a "terrible doctor" with no medically justifiable reason for his actions and as a "caring man" easing the pain of those dying.
The jury, which was expected to begin deliberations Tuesday, is tasked with determining whether William Husel, 46, committed murder by purposefully hastening 14 patients' deaths when, prosecutors say, he ordered excessive doses of fentanyl, a powerful opioid used to blunt pain, while he was employed at Mount Carmel Health System in Columbus.
Husel, whose medical license was suspended in January 2019, faces life in prison with no chance of parole for 15 years if he's found guilty of even one count of murder. The jury can also consider a lesser charge of attempted murder, which carries a sentence of several years in prison.
Assistant Franklin County Prosecutor David Zeyen argued that it was Husel's intention to hasten or cause the deaths of 14 patients and that it didn't matter whether they were already ill or near death.
"It's a crime to kill a dying person — it's not a defense," Zeyen said.
The patients, who were treated from 2015 to 2018, were rushed to the hospital with a variety of ailments, including cancer, pneumonia and organ failure.
"Even if their death is assured as the sun is going to rise in the morning, if you hasten that along, you caused their death in the eyes of the law," Zeyen said.
He said Husel's late-night shift gave him authority and cover to order 10 times the amount of fentanyl that expert witnesses said was the norm in nonsurgical settings and that nurses under him were "enthralled" by working with someone like Husel, who completed a residency in critical care at the prestigious Cleveland Clinic.
Prosecutors mounted a rigorous case when testimony opened seven weeks ago, calling more than 50 witnesses, including medical experts, family members of the patients who died and Husel's former colleagues.
Husel's defense team, led by the high-profile attorney Jose Baez, called just one witness — an intensive care specialist from Emory University in Atlanta who testified why there are no maximum dosing limits and said doctors must be careful not to give inadequate doses of painkillers.
The jury didn't hear from Husel, who hasn't spoken publicly or given media interviews since the allegations first arose in a series of lawsuits families filed in early 2019.
Closing arguments began after a week of delay when Baez filed a request with the Ohio Supreme Court to have Franklin County Common Pleas Judge Michael Holbrook disqualified from the case. The reason for the request, which was denied, hasn't been made public.
Baez reiterated to the jury Monday that the burden of proof is on the state, which he said had failed to show evidence of how much longer any of Husel's patients would have lived had they not been given the amounts of painkillers he ordered.
"Where is it that he intended on killing people? Where did you hear that evidence?" asked Baez, whose clients have included NFL player Aaron Hernandez, Florida mother Casey Anthony and Hollywood mogul Harvey Weinstein.
"This is not a murder case. It never was. It never will be," Baez said.
At the center of the trial has been whether Husel was acting as permitted under the law when, prosecutors say, he ordered high levels of fentanyl and other painkillers for patients in the intensive care unit. Most were in their 70s and 80s and needed help breathing on ventilators, although a few were as young as their late 30s.
Ohio law declares that physicians who say they were motivated by a "good faith" standard shouldn't be held liable even when a "medical procedure, treatment, intervention, or other measure may appear to hasten or increase the risk" of death.
Throughout the trial, defense attorneys have argued that Husel never intended for his actions to result in a "bad outcome," saying he sought to alleviate the patients' suffering and provide end-of-life comfort care.
Prosecutors early on highlighted the amount of fentanyl in each case to argue that Husel was an outlier among his colleagues and that the doses they say he authorized were unnecessarily large.
Dr. Wes Ely, an intensive care doctor from Vanderbilt University in Nashville, Tennessee, testified for the prosecution that the 1,000 micrograms of fentanyl given to Husel's patients was enough "to take out an elephant." Medical experts have said a typical dose might be around 50 to 100 micrograms.
"This is like driving 250 miles per hour through a school zone while people are crossing the street," Ely testified.
Family members also said they would have expected Husel to do everything in his power to keep their loved ones alive.
Husel "killed my husband," said Christine Allison, whose spouse, Troy Allison, 44, received a 1,000-microgram dose of fentanyl before he died in July 2018 while suffering from multisystem organ failure.
During closing arguments, prosecutors revisited each of the patients for the jurors and said some of them might have survived if not for the potentially lethal doses of painkillers.
"If you're asking yourself, 'Why are we here talking for weeks and weeks and weeks and hours and hours and hours about sick dying people — what is the point of all of this?'" Zeyen told the jury, "Troy Allison, along with all of the other ones, could have lived. That's the point."
Baez told the jury that there are no maximum doses of fentanyl that are considered illegal under state law.
"When it comes to palliative care, there are no maximum ranges. It's for the doctor at bedside to make that determination," he said.
Baez also questioned how workers in the hospital's internal pharmacy repeatedly approved the doses of painkillers to be taken out in each case and said pharmacists couldn't have been surprised by what Husel was doing, as was suggested during the trial.
For effect, he played the jury a scene from the classic 1942 movie "Casablanca," in which a character claims to be "shocked" by illegal behavior.
Baez also criticized Columbus police for how they handled the initial investigation, which he said was "at best pathetic," and he said Husel was a "caring man" guided by a sense of compassion.
"He's dedicated his life to taking care of the ill, to taking care of patients, to saving lives — not to taking them," Baez said, pointing to Husel. "And to sit here and accuse him of something else is just nothing short of absurd absent any real evidence. You don't have a shred of evidence to his intent."
Ric Simmons, a former prosecutor who teaches criminal law at Ohio State University, said the dearth of defense witnesses could signal that Husel's lawyers were unable to secure the right experts.
"A weak expert or poorly credentialed expert is worse than no expert at all," Simmons said.
Meanwhile, putting Husel on the stand would have subjected him to cross-examination, which would also be risky, Simmons said.
The defense could have another strategy in mind when it presents a truncated case, he said, by reasserting that the burden of proof is on the prosecution.
That was the point the defense made in closing arguments.
"It forces the jury instead to focus completely on the prosecution's case and determine whether they have proven all the elements beyond a reasonable doubt," Simmons said. "And in this case, the defense has done a pretty good job making their points on cross-examination."