Hospitals reeling from surging Covid-19 cases are facing a new pandemic battle: lawsuits from guardians of patients on ventilators demanding treatment with ivermectin.
The string of suits, brought by New York attorney Ralph Lorigo, relies on a national network of internal medicine doctors called the Front Line Covid-19 Critical Care Alliance, which advocates for using the anti-parasitic ivermectin as one part of a treatment protocol for Covid-19 ICU patients. Lorigo has scored a handful of victories, including in Buffalo, where his firm is located, and in Cincinnati, where a judge last week ordered West Chester Hospital to give the drug prescribed by an outside physician to a 51-year-old man on a ventilator.
The trend is unnerving health lawyers who worry court orders overriding medical guidance could lead to a slippery slope in health systems already strained by the pandemic. Meanwhile, a social media frenzy over ivermectin is riding a wave of conservative skepticism over the Covid-19 vaccines, leading people to consume the more potent animal form of the drug as a home remedy or prophylactic and contributing to a sharp increase in poison control calls in the southern U.S.
“When non-clinicians are actually determining the standards for the practice of medicine, it just raises concerns among the medical community as to whether the patients are receiving the gold standard of care,” Richard Roberson, general counsel and vice president for policy and state advocacy for the Mississippi Hospital Association, said in an interview. “You don’t want to violate the judge’s orders, but you also don’t want to render care that has not been approved by the scientific community and accepted as the appropriate treatment option.”
The Centers for Disease Control and Prevention, World Health Organization, the Food and Drug Administration, and the drug’s inventor
Proponents of the medication point to the National Institutes for Health rating the drug as “neutral”—not recommended or discouraged—for Covid-19 treatment because there isn’t enough study of its impact on the disease, and research is ongoing. But hospital associations have warned their members to steer clear of off-label use of the drug due to potential liability and the possibility for misuse.
The courts are telling hospitals, “if there’s somebody on your medical staff who will do it, we order you to let that happen,” said Patrick Souter, a health-care attorney for Gray Reed.
Souter advises hospital clients to make a court order the treatment rather than agreeing to administer the drug voluntarily. That stance could afford a facility some protection in the chance that a patient’s family later alleges the hospital “deviated from the appropriate standards of care.”
For hospitals, the order then creates the possibility for a “damned if you do, damned if you don’t,” scenario, Roberson said. And right now, the demand for ivermectin treatment to help patients recover from Covid-19 is lower than the demand for treating patients who have misused the drug in Mississippi, he added.
In January, Lorigo brought and won his first case in which a court ordered a Buffalo hospital to allow an 80-year-old woman on a ventilator to receive ivermectin. She recovered and was discharged.
Since then Lorigo, chairman of the Erie County Conservative Party, said he receives “nonstop” calls from patients around the globe seeking to alter hospital treatment as a last resort.
“For the kind of people that are contacting me, there’s no real alternative, the hospital is out of bullets,” he said. Lorigo didn’t respond to questions about who is paying for the suits, how successful his cases have been, or how many he has brought. Bloomberg Law is aware of litigation in New York, Ohio, Illinois, and Mississippi.
Dr. Pierre Kory, a Madison, Wisconsin, internal medicine doctor and president of the Front Line Covid-19 Critical Care Alliance, said his group has urged hospitals to include ivermectin—formulated as a tablet and given to humans around the world to treat parasitic infection—in Covid-19 treatment protocols since last year. The group helps Lorigo by providing studies and affidavits for these legal complaints because they believe hospitals are being too restrictive. “During the pandemic, every hospital system suddenly wanted order,” Kory said in an interview, and this creates a dynamic where health systems limit the ability of doctors to practice medicine freely.
Hospitals Push Back
On Thursday, attorneys for West Chester Hospital in Cincinnati will argue in court to prevent a preliminary injunction requiring the treatment.
Similarly, a hospital in Elmhurst, Illinois, fought a court order, arguing that no physicians in the organization were comfortable administering the drug. A state court of appeals upheld the lower court order requiring treatment.
Souter said these pandemic-era lawsuits are unlikely to set a precedent for non-pandemic times because courts traditionally defer to health-care providers.