In 1945, President Harry Truman was faced with making a decision that could possibly save one million American lives. The decision was to authorize the destructive bombing of Japan with the hope of securing an unconditional surrender. With the consent of the United Kingdom, as requested by the Quebec Agreement, Col. Paul Tibbets flew the mission in a B-29 Superfortress named Enola Gay, after his mother. His crew dropped the first atomic bomb, Little Boy, over the city of Hiroshima. On Aug 6, 1945, three days later, a second B-29 Superfortress, commanded by Thomas Ferebee, flew the same aircraft over Nagasaki and dropped the second atomic bomb, Fat Boy, which resulted in the surrender of Japan on Aug 15. Dropping these two bombs was considered the end of WWII. The combined result of the initial bombings and the radioactive aftermath was the death of 210,000 children, women, and men. Was President Truman’s decision to utilize atomic bombs necessary? Was the tragic loss of innocent life necessary to end WWII? Historians can debate this, but one fact remains: decisions made during times of war are never simple.
We are now engaged in or emerging from, a viral war that has devastated every nation on earth and has caused in excess of 100,000 deaths in the United States alone. Decisions for medical treatment had to be established and, other than approving new drugs at the FDA, previously approved drugs were designated for other indications. There were no long medical trials; there was some enthusiastic guesswork and many victims of COVID-19 were given these drugs in the hope of saving lives. In retrospect, were these decisions correct or failing in substance? Were the hospitals that used these drugs in their formulary too hasty? Are they now going to be held accountable? Are the healthcare providers, who in good conscience gave these medications and infused these patients, now responsible for subsequent negative outcomes? We are only five months from the widespread infection in the USA and already there are thousands of COVID-19 lawsuits. How does this affect medical providers?
We have discovered medical facts concerning treatment that were previously unavailable. The rise and fall of chloroquine and hydroxychloroquine as “game-changing” treatments for COVID-19 should come as no surprise to experts who have paid attention to the history of these drugs, according to findings published in The FASEB Journal.
Mark C. Poznansky, MD, PhD, director of the vaccine and immunotherapy center at Massachusetts General Hospital, associate professor of medicine at Harvard Medical School and attending physician in infectious diseases medicine at Massachusetts General Hospital, and his colleagues combed through the literature in search for a rationale for using hydroxychloroquine in cases of acute severe viral respiratory infection. Their results demonstrated that this drug impacts cytokine production and suppresses antigen presentation in a way that potentially undermines the adaptive anti-immune response to COVID-19. This study from Lancet , May 22 was brought into question because of one of the principals involved in the study was found to be questionable and not without his own interests.
We have tried many other modalities, including steroids, which have demonstrated more severe reactions in older patients with severe co-morbidities. Suggestions such as ultra-violet light were early outriders that were shunned quickly by the medical community. There was a suggestion of using disinfectant solutions either through an orifice internally or by infusion and it provided almost comic relief (or horror) across the country. There was one treatment that was enthusiastically accepted and later proven to be effective with a subset of patients to shorten their hospital course. Dr. Anthony Fauci stated that Gilead’s Remdesivir is now the “standard of care” in hospitalized patients. The FDA gave an “emergency use authorization” of Remdesivir for the treatment of COVID-19. This drug remains an investigational drug and has shown evidence of reducing time in recovery in recent clinical trials. Peter Chin-Hong, M.D. professor of medicine and director of the transplant infectious disease program at the University of California, San Francisco stated, “It’s not a magic bullet but is the best we have right now.”
So, this is the substance of what front line medical heroes have had at their disposal. These were their options. They were looking at the guidelines of institutions. They are now being named in malpractice litigations for the negative outcomes that occurred. There are always people who will question treatments and decisions concerning patient medical care. This is the unfortunate reality with the practice of medicine, and my role is to ask if you are adequately insured to defend yourself in this post-COVID era? It’s not about winning or losing a malpractice lawsuit which may be unjustified – but about the COST of defending yourself. And what is the best defense? A strong offense such as quality malpractice insurance with the highest financial industry ratings and one that defends your actions personally. A lot of healthcare professionals are included in “employer group policies”, but having a professional liability insurance policy in your own name, is the only certain way to assure that YOUR interests are protected, should you ever be faced with a legal claim. You don’t have to search very far; after a lifetime of practice.
By Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
PA Advisor to CM&F