Legislators accuse Board of Medicine of violating Constitution

Legislators accuse Board of Medicine of violating Constitution

By Morgan Hughes

Casper Star-Tribune

Via Wyoming News Exchange

CASPER — Several state lawmakers have charged the Wyoming Board of Medicine with violating the state’s Constitution because of a statement that board published in March regarding the prescribing of hydroxychloroquine for COVID-19.

The specific accusations are outlined in a House Joint Resolution, HJ2, sponsored by newly elected Rep. John Bear, R-Gillette, and co-sponsored by nine additional lawmakers. The resolution claims the board’s statement violates the Constitution in three ways: by “improperly banning or prohibiting an otherwise legal medical treatment,” “improperly limiting Wyoming physicians from exploring possible prescription options for the treatment of COVID-19,” and “failing, as an agency of the state of Wyoming, in its affirmative duty to defend the health care freedom of Wyoming citizens as required by the Wyoming constitution.”

But the Board of Medicine asserts all the statement did was reiterate the standard of “good medicine” and in no way violated state law.

The statement in question, published by the board March 26, reads: “The Wyoming Board of Medicine supports the American Medical Association’s call for a stop to inappropriate prescribing and ordering of medications, including but not limited to chloroquine and hydroxychloroquine, in response to COVID-19. This includes, but is not limited to, the prescribing of medications to patients who are asymptomatic at the time of the writing of the prescription.”

The board updated its position Friday with a clarification: “Some therapies originally hoped to be effective against COVID-19 have been shown in scientific studies to have limited or no benefit. … As scientific and medical knowledge about COVID-19 continues to rapidly evolve, the Board takes no position on any specific medications or treatments; however, the Board urges physicians and physician assistants to adhere to the applicable standard of care, as required by the Wyoming Medical Practice Act.”

Despite the revision, Bear said he will still move forward with the resolution “as this behavior of taking the right to try away from Wyoming citizens must never be tried again and there needs to be a record of how the Wyoming State Legislature interprets the Wyoming Constitution.”

The section of the constitution being referenced is Article 1, Section 38, which states “each competent adult shall have the right to make his or her own health care decisions.”

Hydroxychloroquine is an antimalarial drug also used to treat symptoms of certain autoimmune and rheumatic disorders, such as lupus. When the pandemic first emerged, a small French study of just 20 individuals suggested the drug combined with the antibiotic azithromycin reduced the viral load in COVID-19 patients. Much larger subsequent studies have disproven that claim.

A study conducted by the UK government this summer tested hydroxychloroquine on more than 1,500 COVID-19 patients. The study showed the drug had “no beneficial effect” on treating COVID-19 patients.

But after President Donald Trump touted the French research as “one of the biggest game changers in the history of medicine,” controversy exploded around the medication. Demand for the unproven and later debunked treatment skyrocketed, leading to global shortages. A study published in November by the American College of Rheumatology concluded many patients who needed hydroxychloroquine for non-coronavirus related illnesses had trouble filling prescriptions because demand for the drug was so high.

The American Medical Association in March issued a statement saying physicians were prescribing the drug to themselves and their family and friends as a preventative treatment, and that other entities were stockpiling supplies.

“We strongly oppose these actions that can lead to supply disruptions for patients who need these medicines for chronic conditions,” the association wrote.

Kevin Bonenblust, director of the Wyoming Board of Medicine, said this is ultimately why the body took action as well.

“There were suddenly shortages,” Bonenblust said. “This was a very, very serious kind of hoarding.”

Moreover, he said physicians in Wyoming were also prescribing the drug to themselves and their family members, though he said those physicians were never investigated because the board was informed of the situation by pharmacists who declined to fill the prescriptions.

He added that combining hydroxychloroquine and azithromycin can be dangerous and has been known to affect some people’s heart rhythms. The U.S. Food and Drug Administration issued a warning to this effect in July, cautioning physicians not to prescribe the drug to COVID-19 patients outside of hospital or clinical trial settings because of reports of “serious heart rhythm problems and other safety issues, including blood and lymph system disorders, kidney injuries, and liver problems and failure.”

But Bonenblust stressed the board did not ban the use of the drug and has not investigated a single physician for prescribing it since that March statement was published.

Bear said via email that while the statement may not have been an outright ban, it had “far reaching effects” and that “during the last year no Wyoming citizen could have a prescription for Hydroxychloroquine filled, as no pharmacist was willing to cross that line drawn by the Wyoming Board of Medicine.”

A call and email to the Wyoming Pharmacy Association seeking to verify that claim was not returned by press time.

Bonenblust did say he was aware of pharmacists declining to fill prescriptions for hydroxychloroquine for those intending to use it as a COVID-19 prophylactic.

The issue became even more convoluted when right-wing commentator Rush Limbaugh inaccurately said on his show that the American Medical Association had changed its stance on hydroxychloroquine and now supported its use to treat and prevent COVID-19.

The statement was entirely false, which multiple fact-checkers and the association itself have said. A resolution was submitted to reverse the American Medical Association’s stance, but it was never adopted.

Bear referenced that decision in his reasoning for submitting the resolution, saying it was “disappointing” it took the Wyoming Board of Medicine so long to adjust its stance after that resolution had been submitted to the American Medical Association.

Bonenblust, who is not a physician but serves on the board in an administrative role, said he had not been approached by Bear or the resolution’s co-sponsors. Bear did say he consulted physicians before filing the resolution, but did not specify how many or who they were.

“Those doctors who were well versed on off label use of other treatments were very disappointed in the Wyoming Board of Medicine’s stance,” Bear said. “Some felt that lives may have been lost due to the board’s and the AMA’s politicization of the issue.”

Clinical studies have shown no benefit to COVID-19 patients who used the drug.

Bear acknowledged that members of the Board of Medicine, which seats five physicians, one physician’s assistant and two laypeople, likely had more expertise than members of the Legislature without medical degrees. But he said limiting an individual’s right to have those conversations with their doctor was a step too far.

“I do not believe that the members of the legislature who do not hold medical degrees have more medical expertise than the members of the board,” he said. “What I do believe is that the AMA and the Wyoming Board of Medicine, by following the AMA’s guidelines, have trampled on the rights of Wyoming citizens, and have ignored the Wyoming Constitution.”

Other state lawmakers have chastised Gov. Mark Gordon for not promoting the drug’s use. Wyoming state Sen. Anthony Bouchard, R-Cheyenne, who recently announced a primary campaign against U.S. Rep. Liz Cheney, publicly argued the drug is effective for COVID-19 patients because his daughter was given the treatment four years ago for sepsis, an entirely different illness than COVID-19. Bouchard, who is a realtor, made the statement at a protest held outside the state capitol Jan. 4 against the state’s public health orders.

But Bonenblust encouraged residents to discuss options with their doctors to determine what was best for them and reiterated the Board of Medicine took no position on the use of hydroxychloroquine, but expected doctors to prescribe it “responsibly” and in line with the accepted standard of care.

“I respect that legislators are doing what they feel is best for their constituents,” Bonenblust said. “I’d like to think people in general are intelligent and will weigh the information they get and make good choices.”

He added: “Talk with your provider … come to the best conclusion for you as a patient.”

The resolution was received in the House for introduction Thursday and will be heard sometime during the session tentatively planned for March. If supported by a majority vote in both chambers, Bear said the resolution could lead to legal action against the board.

“The resolution gives the Speaker of the House and the President of the Senate authority to take whatever means are necessary to remedy the situation. That could include suing the executive branch and letting the courts decide” if the board’s letter violated the state constitution, he said.

A date has not been set for the resolution’s first reading.