An appeals court ruling last week blocked a court order that could have compelled a hospital to go against its own protocols and provide a COVID-19 patient with widely discredited and ineffective treatment.
But the fact that the original prescription was ever issued indicates a remarkable development at the intersection of law, medicine and politics: a growing attitude in some quarters that elevates patients’ wishes above professional knowledge and judgment. health care providers.
“There’s this idea that whatever a patient wants, they should get,” says Pilar Ossorio, professor of bioethical law at the University of Wisconsin Law School and ethics researcher at the Morgridge Institute for Research. .
The court case took place in Waukesha County. The drug involved is ivermectin, an antiparasitic drug that has been used in both animals and humans. Medical studies as well as documents from World Health Organization (WHO), the Centers for Disaster Control and Prevention (CDC) and the National Institutes of Health (NIH) all concluded that ivermectin does not help patients with COVID-19.
“There’s a very strong consensus, an overwhelming consensus, that ivermectin is ineffective,” says Dr. Rob Hoffman, a Madison physician who specializes in hospital care.
Despite the evidence, the drug has been embraced by some enthusiasts as an alternative treatment. Among the ivermectin recalls are skeptics of the COVID-19 vaccine.
“It’s a really amazing and really new phenomenon,” says Hoffman, who has had COVID-19 patients request the drug, sometimes getting angry or threatening legal action when he refuses the request. “Somewhere along the line, a significant portion of the population has become convinced that any COVID treatment is a political issue.”
The Waukesha case is yet another case in which the COVID-19 pandemic has been politicized.
“Provider responsibilities and patient rights are no longer necessarily confined to the private realm,” says political scientist Philip Rocco of Marquette University.
Medical advice on the Internet
On September 19, 2021, Waukesha County resident John Zingsheim was admitted to Aurora Medical Center-Summit after being diagnosed with COVID-19 three days prior. Two weeks later, on October 3, he was intubated and put on a ventilator. At the hospital, Zingsheim was treated with a steroid and three other drugs, while he was refused the antiviral drug remdesivir, the appeals court ruled.
Zingsheim’s nephew, Allen Gahl, holds power of attorney for his uncle’s health care. According to the appeals court ruling, Gahl became aware of the use of ivermectin for COVID-19 through an internet search. Gahl spoke with a doctor from Wisconsin who recommended ivermectin. The doctor wrote a prescription for Zingsheim without seeing him, based on Gahl’s information.
Aurora doctors denied the request for ivermectin, saying it would be “below the standard of care” for patients with COVID-19, according to the appeals court ruling.
Gahl filed a motion with the Waukesha County Circuit Court on Oct. 7, asking a judge to order the hospital to honor the ivermectin prescription. After a hearing on October 12, Judge Lloyd Carter issued an order directing the hospital to administer the order. At a follow-up hearing the next day, the judge varied the order, saying it would be up to Gahl to supply the ivermectin and provide a physician “who meets hospital approval” to administer the ivermectin. prescription.
Aurora appealed the judge’s order to the state’s District II Court of Appeals, which stayed the order. The Wisconsin Supreme Court denied a motion by Gahl asking the High Court to take the case directly.
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In a May 25 opinion, the appeals court overturned the judge’s order by a 2-to-1 vote. The opinion was written by Judge Lori Kornblum and joined by Judge Lisa Neubauer.
“We don’t decide the medical question of what the standard of care should be. We are not doctors,” the notice reads. But for legal reasons, he concludes, “we find that the circuit court had no legal authority to compel Aurora, a private health care provider, to provide care below its standard of care. We further believe that the court had no legal authority to compel Aurora to certify an outside provider to provide substandard care.
In a dissenting opinion, Judge Shelley Grogan insisted the lower court “did not improperly exercise its discretion” in granting the order and that it should remain in place.
‘It’s my body’
Ossorio, a UW law school professor, says it’s rare for the courts to interfere with medical decisions, especially overturning a health care provider’s decision.
When that happens, it’s more likely to be a life-or-death situation and a proposed treatment with an ambiguous expected outcome, she says. In other situations, it may be an order to continue life-saving treatment that doctors believe is no longer effective but family members do not want to stop.
None of these apply to ivermectin, however, Ossorio observes: “One of the things about ivermectin is that there was never any evidence that it was an effective treatment.”
She compares cases like Waukesha’s to the campaign that passed the “Right to Try Act” in 2018, intended to give patients easier access to unapproved drugs in some cases.
“There’s a political movement behind it — ‘It’s my body. We don’t care what our doctors think about ivermectin,” Ossorio says, paraphrasing the view of patients who might request such drugs without heeding the advice of medical professionals. “It comes from the same intellectual and political position that doesn’t really recognize that it’s not just me [the patient] is to make the decision.
The courts have a role to play in encouraging professionals to self-monitor, including medical professionals, she says. But she finds “troubling” a judge’s willingness to overrule a medical professional’s judgment of an appropriate standard of care.
“It’s really bad for the medical profession and for all of us who want the health care system to succeed so that patients can take these kinds of cases to court and win,” Ossorio says. “It can incentivize the healthcare system to provide not just unnecessary care, but dangerous care.”
Rocco, who has studied political polarization in health care and public health policy, notes that Karen Mueller, the attorney representing the nephew in the Waukesha case, is running in the Republican primary for attorney general. State on a platform opposing COVID-19 vaccines and challenging hospitals in their treatment of COVID-19 patients.
The appeals court’s decision to overturn the ivermectin order is unlikely to settle the dispute. “Because every aspect of the pandemic has been politicized, you now see real challenges to the judgment of medical providers,” says Rocco. “And whether or not they have a future in the courts of Wisconsin, that’s absolutely something we could expect to see in the race for the Attorney General.”
Hoffman says that even if ivermectin was an effective antiviral drug — which research hasn’t shown — using it after about the first week of illness doesn’t make sense. Antiviral drugs are used only in this early phase of the disease.
In the weeks that follow, the disease is inflammatory, “where the damage to the body actually comes from the immune system spiraling out of control.”
For Hoffman, the Waukesha case adds to the alarm he has already felt when patients refuse recommended treatment for COVID-19 and demand ineffective remedies.
“The idea that the courts are going to decide what the appropriate medical therapy is is pretty scary,” he says. “It doesn’t seem to me that a judge is qualified to render this judgment on behalf of the patient. These medical decisions are extremely complicated, which is why people go through years and years of training.