Internationally regarded as a brilliant researcher, David Boothman helped pioneer a promising approach to fighting cancer by turning diseased cells against themselves in a process he dubbed the Kiss of Death.

The work helped draw Boothman to Indiana in 2017 to serve as the inaugural Sid and Lois Eskenazi Chair in Cancer Research at the Indiana University School of Medicine and Associate Director of Translational Research at the Simon Cancer Center.

His hire was a significant coup for the school. But Boothman will never get the opportunity to see if his research translates into saving lives.

Boothman died after a nurse at the Sid and Lois Eskenazi Hospital in Indianapolis mistakenly administered a massive dose of fentanyl a synthetic opioid nearly 100 time stronger than morphine instead of a benign hydrating solution as he recovered from a stroke.

The 61-year-old molecular biologists death on Nov. 1, 2019, came a week after the medication error. The fentanyl depressed his blood pressure, causing brain damage that pushed Boothman into an irreversible coma. An autopsy revealed he died from respiratory failure following the fentanyl overdose. The coroner ruled his death an accident.

For the last 10 months, his widow, Dr. Sue Strickfaden, has been locked in a malpractice dispute with the hospital, the flagship of the public Health & Hospital Corp. of Marion County. Officials acknowledged the medical error but denied the mistake caused Boothmans death, according to her attorney, Michael J. Woody of Findling Park Conyers Woody & Sniderman.

But last week the hospital proposed a settlement with Strickfaden. The offer came after IndyStar interviewed Woody, Strickfaden and others and then reached out to HHC with questions about Boothmans death. The confidential settlement, which has not been finalized, prohibits the parties from discussing this case. This story is based on those prior interviews.

Boothmans death culminated what Woody called a tragic circus of errors that occurred during his two-week stay at Eskenazi last October.

Strickfaden was seeking compensation for the loss of the love, care, affection and support of her husband, Woody said. But her ultimate goal is broader: She wants the hospital to be held accountable so no one else dies from a mistake like the one that killed her husband, he said.

The main issue is how lethal and dangerous fentanyl is as a medication, not just on the streets but even in the hospitals, and how little the very people that are in the hospital handling it actually seem to have been trained, Strickfaden said. I think and I hope that that certainly will change.

An Eskenazi Health spokesperson said in a written statement Oct. 21 that they can not talk about the case because of privacy laws and the litigation.

We can, however, state, unequivocally, that Eskenazi Health is committed to high quality patient care, and never wants a medical error to occur, said Michelle OKeefe. In the unfortunate and infrequent circumstance when a medical error does occur, we immediately conduct a thorough review to determine the cause of the event, learn everything that we can from the situation, and develop specific action plans to reduce risk and further improve patient safety.

Coup for med school

Officials at the medical school and cancer center declined to comment for this story, but luring a researcher of Boothmans prowess to IU was a coup, according to Lindsey Mayo, an associate professor at IU who worked with Boothman.

He was starting a whole new group to work on a specific area, which we didnt have at IU, and he was pivotal, because he has such an infectious personality, in getting a lot of these junior people to come here, said Mayo.

A molecular biologist, Boothman came to IU with a distinguished track record of innovation and a knack for securing grants to further research, including his Kiss of Death approach to attacking lung and pancreatic cancer cells. After more than a decade of research, he had found a way to trick the cancer cells into producing a self-defeating toxin that didnt affect other cells.

Boothmans groundbreaking work had the potential to jumpstart the medical schools aspiration of becoming one of the nations preeminent medical schools, according to a memorandum of understanding detailing his role and expectations. A copy provided by Woody and dated Aug. 2, 2017, said the goals included aiming toward developing cures for at least one cancer and a childhood disease in the next decade.

The memorandum said school officials believed Boothman was the kind of researcher to make this happen.

In my opinion, Dave was a superstar, said Marc Mendonca, Director of Radiation and Cancer Biology and Associate Vice Chancellor for Research in the IUPUI Departments of Radiation Oncology & Medical and Molecular Genetics. He had known Boothman for years and worked with him at IU.

In the last few years he hit the big time. He published major papers. But he worked many, many years to get there. And then, suddenly, all the grants came and, you know, he was rocking.

Strickfaden said he was involved in research projects that attracted more than $20 million in grants.

There was no roadmap for their pancreatic cancer research, Mendonca said, and Boothman was doing stuff that many other people were not even thinking about.

Prior to being recruited to Indiana, Boothman had been Associate Director of Translational Research at the University of Texas Southwestern Medical Center and Co-Director of Experimental Therapeutics at the schools Simmons Comprehensive Cancer Center in Dallas.

Boothman grew up in the Detroit area, where his father operated an auto body shop. Boothman and his siblings often helped at the family business. Thats where they learned about work ethic, Strickfaden said.

He graduated from the University of Michigan-Ann Arbor, then received his Ph.D in microbiology and immunology at the University of Miami Medical School. Boothman did postdoctoral research at the Dana-Farber Cancer Institute of Harvard Medical School before taking a position at his alma mater. Thats where he met Strickfaden, who was working as a lab assistant before leaving to attend chiropractic school in Texas.

Their friendship turned to romance in 1996 after Boothman moved on to the University of Wisconsin-Madison and then Case Western Reserve University in Cleveland. They were reunited geographically when Boothman went to UT Southwestern Texas in 2005.

The couple married in 2007. Away from their work, Strickfaden said they lived a quiet life, going to movies, gardening and traveling.

Boothmans real passion, however, revolved around his work and colleagues.

Mad scientist in shorts, sandals

Circus of errors

Last October, Boothman and Strickfaden had just celebrated their 12th wedding anniversary and were preparing to close on a house. It was a busy time. They were selling a home in Texas, and Boothman had presentations coming up in Baltimore and London. He also was reviewing grant applications for the National Institutes of Health.

On Oct. 17, he complained about fatigue and balance problems to Strickfaden, who had returned to Texas to handle the home sale there. It wasnt like him to complain, so she asked one of his Indianapolis colleagues to take him to the doctor.

The friend arrived at Boothmans home the next day. Boothman had fallen. He wasnt able to get him up and they called an ambulance that took him to Eskenazi.

Over the next two days, Boothmans condition stabilized. He began speech, physical and occupational therapies, according to Woody, the attorney representing Strickfaden. As he continued to improve, his diet was advanced on Oct. 20 to solid foods.

A photo of Boothman taken by Strickfaden that day shows him reclining in a hospital bed. He is smiling and holding a foam cup. A plate with remnants of the omelet and fruit hed had for breakfast sits on a tray in front of him.

While Boothman likely faced an extensive rehabilitation regime, Woody said he was expected to survive the stroke. Plans were being made for his move to a rehab facility when his condition took a turn for the worse two days later. Boothman failed a swallowing test.

That marked the start, Woody said, of the tragic circus of errors that would culminate in Boothmans death.

On Oct. 23, Boothmans breathing became labored. The next day, a feeding tube was inserted due to his difficulty swallowing. During the procedure, Boothman aspirated a large piece of food from his stomach. It lodged in his airway. He suffered acute respiratory arrest and was placed on a ventilator.

To sedate Boothman while he was on the ventilator, records show he was given four small doses of fentanyl, ranging from 18 to 59 micrograms, on Oct 24 and Oct. 25. Still, he was responsive. Medical records show he was following simple commands and moving all limbs spontaneously. Woody said neurology progress notes indicated he was expected to come off the ventilator by Oct. 26.

But a little after 11 p.m. on Oct. 25, a nurse covering for Boothmans primary nurse responded to an alarm going off on a medication pump next to Boothmans bed. An IV bag of Lactated Ringers solution, a common hydrating fluid, needed to be replaced.

Nurses fatal mistake

The nurse obtained a new bag of the solution and hung it on the pole along with other medications also attached to the pump. One of those bags contained the fentanyl, which had been discontinued earlier in the day.

The nurse said in a deposition that she scanned the solution and a barcode that came up on the pump before restarting it at 11:24 p.m. The steps were part of a confirmation procedure intended to track medications and catch errors. But there was a gap in the fail-safe system.

She had attached the hydrating solution to one channel on the pump, but mistakenly pushed the start button for another channel the one attached to a bag of fentanyl. The pouch holding the drug he had been off of since earlier in the day remained attached to the pump nearly 12 hours later.

As soon as she pushed the start button on the module that was actually going to give the fentanyl the alarm went off. And instead of checking the alarm and reading the alarm code, the nurse just hit a silence button, Woody said.

A few minutes later, another nurse who checked the pump also missed the error.

If the nurses would have looked at the drip chamber, they would have seen that the bag of Lactated Ringers wasnt running, he said.

Because the mix-up went unnoticed, over the next 69 minutes Boothman received 1119.4 mcg of fentanyl. That was nearly 20 times the largest dose he had received for sedation before it had been discontinued. A doctor in Ohio was charged with murder last year after prescribing patients 500 mcg of the drug.

The error was finally discovered at 12:33 p.m. Oct. 26. But Boothman wasnt given Narcan, which can counter the effects of opioid overdoses. A doctor didnt come to his bedside until 2 a.m., according to the chart. Even then, no Narcan was administered as Boothmans blood pressure plummeted to a level too low to provide an adequate oxygen supply to his brain and other organs.

Its unclear whether the reversal agent would have been able to help after that huge dose of fentanyl, Woody said. But by not doing that it took away any chance that he would have had.

Boothman never regained consciousness. He was removed from life support Nov. 1. It was All Saints Day, a Christian holiday celebrating a believer who has entered heaven. Strickfaden said the timing offered a small measure of solace to her and Boothmans mother, a devout Catholic.

Error nearlyoverlooked

The medical error that killed Boothman could easily have escaped detection, Woody said. When reviewing records from the hospital he found no indication Boothman had received the massive dose of fentanyl.

A medication log from that night showed Boothman had, however, received the Lactated Ringers solution as ordered. But there was a note from the critical care doctor in the chart from the next morning. It mentioned a one milligram fentanyl bolus that was consistent with Dr. Boothmans state of not being responsive.

Details of what really happened came out after the malpractice complaint was filed in January and Woody began taking testimony from hospital officials. I asked what was this doctor talking about when she said there was a one milligram dose of fentanyl ... Where is that in the records? And so then they produce the records and said, Well, its under Lactated Ringers, Woody said.

Woody said hospital officials refused to admit the medication error was below the standard of care or constituted malpractice.

Theyre claiming that his underlying stroke was the cause of this event that he had an underlying stroke that just kept getting worse and that was the cause of his death, Woody said.

But two independent doctors who reviewed the case dispute that claim, Woody said. They include Dr. Max Wintermark, Chief of Neuroradiology at Stanford University and Medical Center, who said Boothmans stroke is not the type Eskenazi claims it was in the hospitals defense.

Dave was expected to recover, Woody said. Up until after the fentanyl overdose, theres nothing to suggest that anybody felt that this was a terminal condition.

Widow suffered in silence

The cause of Boothmans death has not been previously made public. Most everyone has no idea what really happened to my husband in that hospital, Strickfaden told IndyStar.

Even though I did know, I had to suffer in silence so to be as strong as I could be for everyone else. And while the time I should have been able to grieve, instead I needed to immediately direct my attention to this case in hopes it will bring the much needed awareness and a wake-up call about the incredible deadly danger of fentanyl.

On a personal note, she is also devastated that Boothmans wedding ring which he hadnt taken off since they were married went missing at the hospital.

Strickfaden said she hopes that speaking about the tragedy increases awareness about the danger of fentanyl, even in a hospital setting, and what she believes were inexcusable gaps in her husbands care.

Her attorney, Woody, added the role of a medical malpractice lawyer is to hold hospitals and healthcare providers accountable when basic safety violations result in serious injury or death. If accountability in this case creates necessary safety changes that help prevent a fatal medication error from happening to someone elses loved one, then Ive done my job and our malpractice law has served its primary purpose of promoting patient safety, he said.

OKeefe, the Eskenazi spokesperson, said the hospital promotes a culture of safety by encouraging our providers and staff to report errors and near misses to continuously improve our processes and ensure the same medical errors do not happen again.

She did not disclose what, if any, changes were made in response to Boothmans death.

Excerpt from:
Cancer researcher dead after Indianapolis hospital gave him fentanyl rather than fluids - South Bend Tribune