Due to its lethal potency, the synthetic opioid named fentanyl has claimed hundreds of Hoosiers’ lives in recent years.
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 Sidney 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.
Dr. David Boothman (Photo: WFAA)
Boothman died after a nurse at the Sidney & 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 biologist’s 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 Boothman’s death, according to her attorney, Michael J. Woody of Findling Park Conyers Woody & Sniderman.
But this 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 Boothman’s death. The confidential settlement, which has not been finalized, prohibits the parties from discussing this case. This story is based on those prior interviews.
Boothman’s 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 she contends 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 cannot 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 O’Keefe. “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.”
‘A coup’ for medical school
Officials at the medical school and cancer center declined to comment for this story, but luring a researcher of Boothman’s 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 didn’t 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 didn’t affect other cells.
Boothman’s groundbreaking work had the potential to jumpstart the medical school’s aspiration of “becoming one of the nation’s 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 school’s Simmons Comprehensive Cancer Center in Dallas.
Boothman grew up in the Detroit area, where his father operated an auto body shop. Boothman and his brother often helped at the family business. “That’s 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. That’s where he met Strickfaden, who was working as a research assistant in a different lab before leaving to attend chiropractic school in Texas.
They were engaged in 1996 and married in 2007 after Boothman moved to UT Southwestern Texas. Away from their work, Strickfaden said they lived a quiet life, going to movies, gardening and traveling.
Boothman’s real passion, however, revolved around his work and colleagues.
A ‘mad scientist’ in shorts, sandals
“Dave did have a little bit of the mad scientist thing going for him,” said Dr. Shaalan Beg, director for Gastrointestinal Medical Oncology at UT Southwestern.
“By that I just meant his demeanor, like his hair, and his you know, him gesticulating while he talks very graphically. So it made the conversations more interesting — but always in a very human and sort of mission-driven way.”
Boothman’s standard wardrobe at UT added to the persona. “He would always be in the office wearing sandals and shorts and a polo shirt,” Beg explained. “That was sort of his uniform at work.” Beg said there was another side to Boothman, which isn’t always found in scientists.
“When you talk to the really hardcore scientists, they don’t always connect with you at a personal level. That wasn’t him,” said Beg, who continued to collaborate on clinical trials for the Kiss of Death after Bootman moved to Indiana. “He was able to turn it on or off pretty much at will, which again, is the sign of someone who’s smart and self-aware and really able to be empathic in understanding where other people in the room are coming from.”
Beg said that showed in Boothman’s love of teaching and his commitment to mentoring students and those in his lab. “He really looked out for all of us,” he said, “both at work and outside of work.”
Tracy Criswell was one of many students whose lives were inspired by Boothman. She was impressed by her first visit to Boothman’s lab and chose him to be her Ph.D. mentor at Case Western Reserve University.
“I knew immediately that’s what I wanted to do,” said Criswell, now an assistant professor and research scientist at Wake Forest University. “He fostered collaboration within the lab. He was the type of mentor that was always available.”
Criswell said Boothman’s labs had a family atmosphere that extended to amusement park outings and a group trip to catch the premier of the Lord of the Rings movie.
Even after their professional paths diverged, she said Boothman remained a friend. “I would email him and he would read my grants and give me feedback,” Criswell said.
When Criswell learned Boothman was hospitalized and was not likely to survive, she dropped what she was doing and made the 8-hour drive from North Carolina to say good-bye — and one last “thank you.” It was Oct. 31, 2019 — the day before he was taken off life support. Others former students and colleagues traveled from Michigan, Ohio, Wisconsin and Florida.
“To watch them come by, and to honor him, and respect him was — it was so great to see for me, because he deserved it,” Strickfaden said. “But Dave never, never would have thought he meant that much to so many people.”
‘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 wasn’t like him to complain, so she she asked one of his Indianapolis colleagues to take him to the doctor.
The friend arrived at Boothman’s home the next day. Boothman had fallen. He wasn’t able to get him up and they called an ambulance that took him to Eskenazi.
Over the next two days, Boothman’s 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 he’d 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 Boothman’s death.
On Oct. 23, Boothman’s 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 25 to 75 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 Boothman’s primary nurse responded to an alarm going off on a medication pump next to Boothman’s bed. An IV bag of Lactated Ringer’s solution, a common hydrating fluid, needed to be replaced.
A nurse’s 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 Ringer’s wasn’t 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 a.m. Oct. 26. But Boothman wasn’t given Narcan, which can counter the effects of opioid overdoses. A doctor didn’t come to his bedside until 2 a.m., according to the chart. Even then, no Narcan was administered as Boothman’s blood pressure plummeted to a level too low to provide an adequate oxygen supply to his brain and other organs.
“It’s 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 Boothman’s mother, a devout Catholic.
Error nearly overlooked
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 Ringer’s 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. Boothman’s 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, it’s under Lactated Ringer’s,'” Woody said.
Woody said hospital officials refused to admit the medication error was below the standard of care or constituted malpractice.
“They’re 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 Boothman’s stroke is not the type Eskenazi claims it was in the hospital’s defense.
“Dave was expected to recover,” Woody said. “Up until after the fentanyl overdose, there’s nothing to suggest that anybody felt that this was a terminal condition.”
Widow suffered in silence
The cause of Boothman’s 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 Boothman’s wedding ring — which he hadn’t 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 husband’s care.
Her attorney, Woody, added the role of a medical malpractice lawyer is to hold hospitals and health care 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 else’s loved one, then I’ve done my job and our malpractice law has served its primary purpose of promoting patient safety,” he said.
O’Keefe, 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 Boothman’s death.
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