Do no harm

Who watches the watchmen?

Last Monday, January 30, 2023, Representative Tamara Trujillo (R-Cheyenne) asked the director of Wyoming’s State Board of Nursing (WSBN), Lori Hart, “Do you believe that there is enough ‘evidence-based safety’ for those who have prescribed and given the COVID shot?” Hart did not answer the question, but replied, “We certainly are not providing disciplinary action either way.”

Trujillo doubled down, “I just wanted to know if there was enough ‘evidence-based safety’ to prescribe that medication to people.” Chairman Dan Zwonitzer (R-Cheyenne) concurred: “In your professional opinion, in the Board of Nursing, do you agree that there is enough scientific data out there for people to feel comfortable?”

“I am sorry not to give a ‘yes,’ or ‘no,’ answer, here,” replied Dr. Hart, “. . .I don't feel that I've got that evidence to be able to do that.” After nurses administered more than 778,000 COVID-19 injections in Wyoming, the nursing board will not comment on its “evidence-based safety.”

In spite of this, the WSBN’s website, says that nursing students “should be vaccinated . . . [for COVID-19, and that] Nursing education programs should reach out to students who are vaccine-hesitant and counsel the students about the benefit of the vaccine and the need for it.” If she still refuses the shot she “may be disenrolled from the institution/nursing program.” That surely sounds like disciplinary action.

This remarkable exchange perfectly illustrates the problem that the hearing was convened to address. The House Judiciary Committee was discussing HB 119 Medical prescriptions-off label purposes. It is a bill intended to give freedom to patients and prescribers to follow the evidence even when state boards and professional associations are enforcing rules based on something else.

For almost an hour and a half, the Pharmacy program manager for Medicaid joined the directors of the Wyoming State boards of Pharmacy, Nursing, and Medicine, together with lobbyists from the Wyoming Hospital Association, the Wyoming Medical Society, the Wyoming Trial Lawyers Association, and the Wyoming Dental Association to impede this common-sense clarification.

They took turns criticizing the bill’s provision that “a prescriber or pharmacist shall not face any adverse action from a health related licensing board or employer, including disciplinary action, loss of employment, hospital privileges or credentials, solely on the basis that a prescriber prescribed a . . . drug for off label indication.” This was interpreted to hamper the ability of state boards and medical associations to punish wrongdoers without any reference to its qualifier, “solely.”

Finally, Twila Brase, of the Citizen’s Council for Health Freedom, pointed out that this provision does, in fact, allow boards and professional associations to take action against practitioners who do harm. The only thing that it forbids is for boards and associations to punish practitioners “solely” because the drug is used off label. In this light, the previous legal analysis of the state boards and associations was cast in doubt.

The elephant in the room was Ivermectin. The problem is this: What happens when the associations and licensing boards are wrong in their judgment? What recourse do highly trained doctors, nurse practitioners, and pharmacists have when the data show that withholding a legitimate treatment or prescribing the latest fad drug could harm their patient? (Witnesses mentioned Remdesivir and Paxlovid.) Should the state require them to do harm to their patients against all better judgment?

An apparent double standard in the application of bureaucratic rules and regulations seems to be part of the problem. Matt Martineau, executive director of the Wyoming State Board of Pharmacy provided a stunning example. Pharmacists, like all medical practitioners, have a responsibility to do no harm. This requires extensive training in pharmaceuticals and their effects. In his testimony, he even asserted that pharmacists should know “what it’s being prescribed for.”

This piqued Representative Jeanette Ward’s (R-Casper) curiosity. She asked, “Have you filled a prescription for the drug Cytotec for the off-label use of inducing labor?” Cytotec is approved by the FDA for the treatment of ulcers. But unethical practitioners often prescribe it to induce live-birth abortions at home. She was openly surprised when Martineau replied, “Every prescription for Cytotec that I ever dispensed never had an indication on it. So, I ultimately do not know what it was prescribed for.”

Cytotec is known to be deadly to unborn babies, and to have a high risk of complications for pregnant woman. Yet, while holding pharmacists responsible to second-guess the reasons for some prescriptions, the director of the Board of Pharmacy dispenses Cytotec without ever knowing what it’s for.

These are only some of many eye-opening and informative moments throughout the two and a half hour hearing. Interested citizens and legislators will want to hear it all. I promise, you will be amazed. In the end, you will understand why HB 119 sailed out of committee (6-3) despite a unified phalanx of opposition.

House Labor, Health and Social Services Committee, January 30, 2023

Sara Penn (R-Lander), Sponsor of HB 119 - 0:01:16

Cori Cooper, Medicaid Pharmacy Program Manager - 0:26:12

Matt Martineau, executive director of the Wyoming State Board of Pharmacy - 0:49:24

Lori Hart, director of Wyoming’s State Board of Nursing - 0:59:59

Kevin Bohnenblust, executive director of the Wyoming State Board of Medicine - 1:07:21

Willard Woods, M.D., 2011 Physician of the Year (fired for prescribing Ivermectin) - 1:15:28

Eric Boley, president Wyoming Hospital Association - 1:30:23

Sheila Bush, executive director of the Wyoming Medical Society - 1:35:00

Nick Agopian, Wyoming Dental Association, - 1:43:41

Marcia Shanor, Wyoming Trial Lawyers Association - 1:45:59

Twila Brase, president Citizen’s Council for Health Freedom - 1:49:37

Leslie Brewer, mother and wife of victims of poor COVID protocols - 1:57:20

Shea Brewer, victim of poor COVID protocol - 2:02:38