By Gretchen Schuldt
The state Supreme Court will hear arguments Tuesday in a case that could have a profound impact on how hospitals and doctors treat patients and the degree of control patients have over their medical care.
At issue is whether patients or their representatives can demand treatment that their caregivers believe is below an adequate standard of care.
The Court of Appeals, in a 2-1 decision, ruled in May that Aurora Health Care did not have to administer ivermectin to John Zingsheim, a COVID-19 patient. Ivermectin, promoted by some as a COVID treatment, is primarily used as an anti-parasitic in farm animals and is given to humans to treat some parasites and scabies. It has not been approved by the FDA for COVID-19 treatment.
Aurora declined to administer the drug, requested by Zingsheim’s representative, Allen Gahl, who is the plaintiff in the appeal. Waukesha County Circuit Judge Lloyd Carter first ordered Aurora to administer ivermectin, then said Gahl should find a physician willing to administer the drug and to whom Aurora could grant credentials to practice in its hospital. Once credentialed, that doctor would have permission to go to the hospital and administer the ivermectin to Zingsheim.
Aurora appealed and won. Then-Appellate Judge Lori Kornblum wrote that Gahl “failed to identify any law, claim, or recognized cause of action under Wisconsin law by which a patient may compel a health care professional to administer a course of treatment contrary to that medical professional’s judgment,” so the lower court “erroneously exercised its discretion in granting Gahl injunctive relief.”
Appellate Judge Shelley A. Grogan, in dissent, said Carter ruled reasonably when he issued the injunction directing Aurora to credential a doctor willing to give the treatment to Zingsheim.
Aurora, in its brief to the Wisconsin Supreme Court, agreed that Gahl failed to meet legal standards to be granted the relief he sought. In addition, it argued, “There is no authority that would give hospital patients a legal right to demand a specific treatment against the medical judgment of their providers.”
Aurora is represented by attorneysJason J. Franckowiak, Michael L. Johnson, and Randall R. Guse.
Karen Mueller, the lawyer representing Gahl, said in her appeal brief that “It has been established in the record that the hospital relies heavily on the CDC and the FDA for directions on what drugs to give and what drugs to withhold from their patients.”
Mueller accused Aurora of “strict and blind adherence to unconstitutional edicts, guidelines and administrative rules of federal agencies who had loftier goals than keeping John Zingsheim and many other Wisconsin citizens alive.”
Both parties have allies in the case. The Wisconsin Medical Society and the American Medical Association filed a joint amicus brief supporting Aurora. Two groups, the Front Line COVID-19 Critical Care Alliance and the Association of American Physicians and Surgeons, are weighing in on behalf of Gahl.
The AMA and Medical Society said reversing the appellate decision would mean that doctors will be forced “to choose between the law and their ethical duties, potentially exposing patients to harm and physicians to liability.”
Ivermectin is not-an FDA-approved COVID treatment, attorneys Patricia Epstein Putney and Melita M. Mullen wrote.
“To the contrary, the FDA cautions that taking ivermectin – even in amounts approved for human consumption – can interfere with other medications” and cause a variety of reactions ranging from nausea to “seizures, coma, and even death,” they wrote.
Doctors can administer off-label prescriptions if they minimize risk, the treatment is backed by evidence and clinical experience, and the treatment is shown to improve patient outcomes, they said.
“Novel treatments do not become part of the standard of care simply because they are ethically attempted, however,” they said. “And physicians do not breach ethical or legal duties by declining to administer them. Consequently, even if a physician could ethically treat COVID-19 with ivermectin, patients have no legal or ethical entitlement to that care.”
The Physicians and Surgeons group, in supporting Gahl, said Grogan’s dissent was right and that Wisconsin law “does fully recognize the right of a patient ‘to request and receive medically viable alternative treatments.’ That right would be meaningless if a powerful, revenue-maximizing business such as Aurora could interfere with access to treatment without judicial review, as the panel majority decision mistakenly establishes.”
The FDA found “decades ago” that ivermectin is safe, attorneys Rory E. O’Sullivan and Andrew L. Schlafly wrote in the brief. Many physicians have prescribed it for countless COVID-19 patients, they said.
“Yet Aurora blocked access to that physician-prescribed medication by patients trapped in its hospital,” they said. “Aurora never disclosed to the public that patients who admit themselves to that hospital will be automatically denied this medical care that is widely available outside of its hospital. As Aurora benefits enormously from its nonprofit tax status in purportedly serving the public, it can hardly hide behind its private status now to evade judicial review for how it senselessly blocked access to medication by all the patients hospitalized there for COVID-19.”
Attorney Joseph W. Voiland, writing for the Critical Care Alliance, said overturning the Court of Appeals decision would “preserve the equitable and statutory authority…of trial judges to grant temporary injunctive relief, particularly in matters where a patient is on their deathbed without many, if any, other option.”
Mueller, Schlafly, and Voiland have represented and advocated for conservative causes in the past, such as arguing that the 2020 presidential election was “stolen” (Mueller), filing suit to challenge the Affordable Care Act (Schlafly), or submitting an amicus brief for Sen. Ron Johnson in Wisconsin’s ballot-box case (Voiland).
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