Doctors, Not Administrators, Should Be Treating Patients

Before COVID-19, physicians routinely treated patients based on our best clinical judgment. But politics have corrupted the practice of medicine, and today hospitals tie physicians’ hands while their patients needlessly suffer and die.

Patients at Sentara Norfolk General Hospital where I work are dying because they are unjustifiably and unlawfully being denied safe and effective treatments that their attending physician determines to be medically appropriate. This same scene is playing out in hospitals across the country. It must stop.

I have devoted my life to caring for people. As a physician scientist, I have tried and tested new methods to fill gaps in our ability to treat patients and have established protocols based on what works. Through these efforts I developed a protocol for sepsis treatment that is now used all around the world.

Early in the pandemic, together with a team of practicing physicians across the United States, I developed a protocol for the use of corticosteroids to treat COVID-19. At the time our public health agencies recommended against the use of corticosteroids—but we were soon vindicated, and corticosteroids are now part of the CDC’s recommended protocol.  

As the pandemic wore on, we pooled our experience treating patients on the frontlines, and based on emerging data from academic studies, including peer-reviewed randomized-controlled trials (RCTs), we expanded our treatment protocol to employ various FDA-approved medicines. This includes fluvoxamine, methylprednisolone, ascorbic acid, thiamine, heparin, vitamin D, zinc, melatonin, and ivermectin.

I’ve used this treatment protocol to reduce COVID-19 deaths in my intensive care unit by up to 50 percent. And one of my colleagues, Dr. Joseph Varon, a renowned critical care specialist, has used this protocol at his hospitals in Houston since the beginning of the pandemic and has consistently maintained a mortality rate for COVID-19 patients between 4.4 percent and 7 percent. By comparison, the average nationwide mortality in hospitals is around 23 percent.

Yet Sentara Norfolk Hospital System has now prohibited the use of several medicines in this treatment protocol, stating that their safety and efficacy are not supported by peer-reviewed randomized control trials (RCTs). This is simply false. The efficacy of these medicines has been established, including by RCTs for fluvoxamine and ivermectin. Moreover, the medicines in question are FDA-approved and therefore known to be safe at specified dosages. 

Unsurprisingly, there have been no reports of adverse medical events resulting from our treatment protocol.

Sentara’s prohibition is indefensible regardless, as the hospital routinely permits its attending physicians to prescribe many drugs for uses that have not been validated through RCTs. In fact, such a basis for categorically prohibiting the use of FDA-approved drugs that an attending physician deems medically appropriate is virtually unheard-of in American medicine and establishes a dangerous precedent. 

RCTs provide important information about how to understand a drug’s efficacy and safety. But they paint a limited picture, which is why historically they have been considered alongside data published by practicing physicians, clinicians, and scientists. Prior to the hyper-politicized response to COVID-19, no one on earth believed RCTs should be the sole criterion by which to determine patient care.

The prohibition is also illegal. Virginia law states that patients with a terminal condition can receive investigational medicines so long as their treating physician recommends them. The law is based on a core principle of American medical law and practice, recognized by the U.S. Supreme Court and hospitals all over the country, that patients’ “right to receive medical care in accordance with [their] licensed physician’s best judgment and the physician’s right to administer it” are not to be overridden by “unduly restrictive” hospital oversight committees (Doe v. Bolton).

Given the flimsiness of Sentara’s justification, it is difficult to see the prohibition as motivated by anything other than political fads. And I have already witnessed the deadly consequences of injecting politics into medical care. When I used these treatments, we kept the mortality rate of critical COVID cases to approximately 10 percent. 

On October 25, I assumed my monthly duty as attending physician in my hospital’s ICU, barred for the first time from using the therapies I know work. Seven ICU COVID patients came under my care. Four died with the remaining three also likely to die. I will have to go on knowing that I did not do—or rather was forced by hospital diktat not to do—everything I could to save their lives. I will soon resume my duties and unless something changes, history will repeat itself.

All I want to do is help people and save lives. But politics, driven by fear, is keeping me from doing my job and fulfilling my oath. Thousands of doctors across the country face the same perils every day. We must take these life and death decisions out of the hands of politicized administrators and place them where they belong, with the patients who bravely face the worst and the physicians who care for them.

 

About Paul Marik

Paul Marik, M.D., is chief of the division of pulmonary and critical care medicine at Eastern Virginia Medical School. He practices in the Sentara Norfolk General Hospital.

Photo: Dr. Paul Marik, center, discusses patient care with medical students and resident physicians at Sentara Norfolk General hospital on Monday, Oct. 20, 2014. Jay Westcott/Getty Images

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