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Court explains denial of hospitalized patient’s request for ivermectin

On The Docket

David B. Brushwood, BSPharm, JD

The Scales of Justice.

Many hospitalized COVID-19 patients have requested ivermectin to treat their condition, and some patients have sought an injunction to legally force their hospital to obtain and administer the drug.

A court in Delaware recently provided an in-depth explanation for its refusal to order a hospital to provide ivermectin to a patient. The court’s rationale has significant implications beyond this particular scenario regarding ivermectin. The court case addresses the duty of any health care professional to provide treatment that is consistent with that professional’s standard of care.

Factual background

A patient was admitted to the defendant hospital with a diagnosis of COVID-19. The patient was transferred to the ICU and was treated in accordance with the hospital’s treatment guidelines for COVID-19. Nevertheless, he was diagnosed with “severe hypoxic respiratory failure and was on the brink of requiring intubation with mechanical ventilation.”

The patient contacted his wife by phone and requested that she obtain ivermectin for him. The wife was able to get a prescription for ivermectin from a physician who had never treated the patient, had not examined the patient, and did not have admitting privileges at the hospital. A community pharmacy filled the prescription. The hospital refused to administer the medication.

The patient was discharged to his home against medical advice, and his wife administered “one ‘large’ dose of the prescribed ivermectin.” Within hours, the patient experienced what his wife described as “a catastrophic equipment failure” when the patient’s oxygen mask broke in her hands. The wife called 911, requesting that the patient be transported to a different hospital. Because the other hospital had no ICU beds available, the patient was readmitted to the defendant hospital’s ICU.

The wife filed a motion in court for an injunction that would force the hospital to “abide by the Patient/Physician contract and [its] Hippocratic Oath to ‘Do No Harm’ ” and to administer ivermectin to the patient.

Rationale

The court held a hearing, at which time a naturopathic physician testified that ivermectin would “very likely” be beneficial for the patient, and that it was “certainly worth a shot.” The naturopathic physician had never treated a critically ill COVID-19 patient, and he had never spoken with critical care teams or pulmonologists at hospitals that treat COVID-19 patients.

The hospital presented testimony of the defendant hospital’s Department of Medicine chair, who described the hospital’s treatment guidelines for COVID-19 patients and how those guidelines were developed. The hospital chair cited a position statement by AMA, APhA, and ASHP that these organizations “strongly oppose the ordering, prescribing, or dispensing of ivermectin to prevent or treat COVID-19 outside of a clinical trial.”

The court reasoned that “under the present standard of care, healthcare providers have no duty to administer ivermectin to a COVID-19 patient.” The court noted that “compelling defendant to provide a treatment outside the standard of care … risks substantial harm to defendant and the health care system at large.” Moreover, “granting plaintiff’s injunction would be detrimental to the public policy of allowing and compelling a healthcare provider to deliver the standard of care based on prevailing scientific and ethical norms and regulations.”

The court concluded that “compelling a provider to operate outside the standard of care would improperly and imprudently move health care treatment decisionmaking [sic] from the patient’s bedside to a judge’s bench.”

The injunction was denied.

Discussion

The COVID-19 pandemic has clarified many rights and responsibilities in health care. This case explains that although patients have a right to refuse medications that are within the standard of care, patients do not have the right to receive medications that are not within the standard of care.

Health care professionals have a responsibility to deliver evidence-based treatment. They must offer their patients those treatments that may be beneficial and avoid providing treatments that are detrimental. The principles of the Delaware case are fundamental and apply to all health care professionals and to all medical treatments.