This month we look at a case which you may have seen in the mainstream media involving the drug ivermectin. During the COVID-19 pandemic, as fear and uncertainty hit a peak, desperation caused some people to seek alternative ‘treatments’ and ‘cures’ for the virus. The one that has received the most attention is ivermectin, an antiparasitic, which despite not being proven effective or being approved by the FDA for this purpose, has been touted by some as a treatment for COVID-19.
Several cases have gone to court over this issue. These cases often begin when a patient seeks an injunction to legally ‘force’ a hospital to administer the medication. For the most part, these cases have generally failed, but they provide a fascinating window into the intersection of medication regulation, patient self-autonomy, and the physicians’ oath to ‘do no harm.’
Facts of the Case
In mid-September 2021, the patient, Mr Z, contracted COVID-19, and 3 days later he was admitted to the hospital’s intensive care unit. He was not doing well and by early October he was intubated and placed on a ventilator. Mr Z’s nephew, Mr G, held a health care power of attorney for his uncle. After his uncle was intubated, Mr G began doing internet research and concluded that an alternative treatment, ivermectin, would save the patient.
He found a physician (who was not credentialed at the hospital) who agreed to write a prescription for the medication based on a discussion with Mr G about his uncle’s condition. Mr G filled the prescription and brought it to the hospital and asked them to administer it. The hospital refused, based on the staff’s conclusion that providing the medication would fall below the standard of care. Mr G then filed a petition in court seeking an injunction that would force the hospital to administer the proposed treatment.
The Lower Court Decides
The hospital opposed the nephew’s petition, arguing that there was no legal authority in the state that would authorize a court to compel a licensed health care provider “to render treatment or to administer a medication that the provider reasonably believes would be below the standard of care.” Furthermore, the hospital argued, the physician who wrote the prescription for the patient was not the patient’s physician and, in fact, had never met or examined the patient.
The physician was not credentialed by the hospital, nor did he have privileges there. The hospital also introduced affidavits by medical experts pointing out the dangers of the proposed treatment and noting that guidance from the medical community (including the CDC, FDA, American Medical Association, and American Pharmacists Association) warned against the use of ivermectin to treat COVID-19.
After a hearing on the issue, the lower court signed an order compelling the hospital to administer the proposed treatment to the patient. The hospital immediately appealed, pointing out that the prescription did not indicate how the tablets are to be administered to a patient who is intubated and sedated, and that the patient was showing signs of improvement and had now tested negative for COVID-19. After considering the arguments, the lower court amended its order, and held that Mr G would have to provide or identify a physician that the hospital could review and pass through its credentialing process to administer the proposed treatment. The hospital appealed, and the case moved up the ladder to the Court of Appeals.