The state attorney general's office Monday defended its actions after St. Peter's Health in Helena said three different public officials "threatened" hospital doctors last week over the care of a COVID-19 patient.
The patient had requested to be treated with ivermectin, a drug not approved for use against the disease.
"St. Peter’s Health can confirm that several providers were contacted by three different public officials last week regarding the treatment of a patient in our care. These conversations were deeply troubling to our physicians and staff because they were threatened and their clinical judgment was called into question by these individuals," a hospital spokesperson said in a statement emailed Monday.
The hospital did not name the elected officials in its statement, but Republican Attorney General Austin Knudsen's office confirmed his participation in a conference call with hospital executives last week.
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A spokesperson for the attorney general disputed the hospital's characterization of the events — which included the Attorney General’s Office dispatching a Montana Highway Patrol trooper to the hospital — as threatening or questioning the medical treatment recommended by doctors.
“The Department of Justice initiated an investigation into very troubling allegations made by the family of a patient at St Peter’s Hospital. After hearing of the allegations and the ensuing investigation, Attorney General Knudsen contacted a board member who set up a telephone conference with hospital executives," spokesperson Kyler Nerison said in the email late Monday. "No one was threatened or had their clinical judgment questioned while the Department of Justice was trying to get to the bottom of the serious allegations that the hospital was mistreating a patient and violating her rights and her family’s rights. The investigation is ongoing.”
In a response to the attorney general’s statement, the hospital again said late Monday that doctors were “harassed and threatened.”
“St. Peter’s works closely with public officials and regulatory agencies, and we occasionally receive inquiries about patient care and patient rights. Last week, several of our providers and care team members who are working tirelessly at the bedside were harassed and threatened by three public officials,” spokesperson Andrea Groom wrote. “These officials have no medical training or experience, yet they were insisting our providers give treatments for COVID-19 that are not authorized, clinically approved or within the guidelines established by the FDA and the CDC. In addition, they threatened to use their position of power to force our doctors and nurses to provide this care.”
After his office was contacted by the responding trooper last week and informed of what the trooper learned after gathering statements, Lewis and Clark County Attorney Leo Gallagher said he found no criminal offense that needed investigating.
St. Peter’s has dealt with a surge of COVID-19 patients, reaching a record-high number of people hospitalized with the virus earlier this month. The hospital, and others around the state, have reported increased hostility against health care workers over requests for treatment and enforcement of measures like mask use and visitor restrictions to prevent the spread of the virus within facilities.
The situation stems from a Helena woman in her 80s who was at the hospital and requested to be treated with ivermectin, a drug that's become controversial recently as some have used it to treat COVID-19 though the FDA says it should not be.
The drug is used in humans to treat infections caused by parasitic worms, as well as for things like head lice and rosacea. It is also used as a livestock de-wormer.
A Facebook post last week from the president of the Montana Federation of Republican Women said the patient supported publicizing information about the situation online.
"Family and friends desire to have the hospital obey the law and follow the 'right to try' signed by Gov. Bullock and allow (the patient) to have the medications she wants," MFRW president Heidi Roedel said in an email Monday when asked about the incident. The Right to Try Act was passed by the state Legislature and signed by former Democratic Gov. Steve Bullock in 2015. It allows for the use of some experimental treatments for terminal illness.
A voicemail to the patient's daughter was not immediately returned Monday.
In replying to a list of questions from the Montana State News Bureau sent last week, the attorney general’s spokesperson Monday confirmed the office dispatched a trooper. The office has not provided a copy of any report generated by the patrol in response to the incident the evening of Oct. 12.
"The family asked for our assistance and a trooper was dispatched to speak with the family at the hospital. Following that conversation, Attorney General Knudsen spoke with hospital executives and received assurances that they would cease preventing communication between the patient and her family and deliver the legal documents she needed,” Nerison said Monday afternoon in an email.
Nerison also said the office was told by the woman's family about claims of the hospital cutting off their access to the patient.
"The Attorney General’s Office received a report from a family that said St. Peter’s Hospital was violating their relative’s rights by refusing to allow her to receive prescribed medications, not delivering legal documents, not allowing them to see their relative, and at one point, even cutting off text message communication between them and their family member."
The hospital, which has visitor restrictions in place to prevent the spread of COVID-19 within its facility, strongly rebutted that statement late Monday.
“We have reviewed all medical and legal records related to these incidents, and we have verified that our teams are providing care in accordance with clinical best practice, hospital policy and patient rights,” Groom wrote. “Any allegations or assertions otherwise are unfounded. St. Peter’s is focused on providing the very best care for our patients. We stand behind our care teams, who are doing an exceptional job during these extenuating and incredibly challenging circumstances.”
Steve Hagen, the Helena Police Department chief, said last Friday in response to a question asked during an interview that St. Peter’s is within the city limits of Helena and therefor under his department's jurisdiction. When a call was made about a person trespassing at the hospital by refusing to leave Monday, for example, officers from HPD responded.
Last week Hagen said his department did not have anything to do with the Oct. 12 response. Asked why the highway patrol would respond instead of his department, Hagen said: "I don't want to interject anything."
When asked why the attorney general didn't refer the matter to the Helena Police Department after hearing from the family, Nerison responded: "The question is why we didn’t tell a distressed family to call someone else? The Department of Justice is a law enforcement agency that has concurrent jurisdiction."
Nerison referenced Title 45 of the Montana Code Annotated, the segment of state law that broadly deals with crimes. He later responded: “Concurrent jurisdiction means that two agencies could have jurisdiction.”
In response to a follow-up email asking if the AG would have a similar response for other families in distress and clarifying the Helena Police Department had said the hospital was routinely their jurisdiction, Nerison responded by asking if a reporter had "inferred" the jurisdictional boundary and requested to be shown a statement clarifying jurisdiction.
Because the Oct. 12 call wasn't made through the 911 system, there was not a public record of it in the calls-for-service report sent out by the Helena Police Department each day.
Last Friday a dispatcher for MHP said the patrol’s colonel called the incident into dispatch. The Montana Highway Patrol colonel is Steve Lavin and the patrol is part of the Department of Justice.
Reached Monday about MHP's response, Sgt. Mike Jensen, from District 3 that includes Helena, said he was "advised that all inquiries go to the AG's Office."
The Lewis and Clark County Attorney said last week the trooper called into the county attorney office’s on-call line after taking statements at the hospital. Gallagher said that's when he concluded there were no alleged criminal offenses that needed investigating.
In a statement Friday, St Peter's explained that ivermectin is not authorized or clinically approved to treat COVID-19.
“Despite occasional requests by patients or family members to use alternative therapies or medications like Ivermectin that are not authorized or clinically approved to treat COVID-19, St. Peter's Health will continue to follow clinical protocols that have been developed by medical experts and are consistent with FDA and CDC guidelines and recommendations,” the hospital spokesperson said. “Any efforts to exert pressure on our providers, including by public officials, will not result in deviation from widely accepted clinical treatment protocols or our hospital policy. Furthermore, harassing our care teams places an additional burden of stress on these individuals, diverting their time and focus away from caring for these critically ill patients.”
Montana Hospital Association President and CEO Rich Rasmussen said in a phone interview Friday he has no concerns about hospital staff being threatened with criminal prosecution in such an episode because hospitals are “on very safe footing” with the systems in place to ensure proper administration of federally approved medication.
He said the association was first made aware of the situation when the Montana State News Bureau reached out for comment.
“We don’t have any concerns about that at all,” Rasmussen said. “… Hospitals are going to rely on what is a generally accepted practice for medication and ivermectin is not indicated for that.”
Rasmussen said he’s not aware of any hospitals that are dispensing ivermectin because it is not approved by the federal Food and Drug Administration or the American Medical Association for treating COVID-19. The tablets are also not approved to treat COVID-19 when an animal contracts the virus, he said.
“It would be very difficult to find a facility that would dispense ivermectin,” Rasmussen said.
“What’s most important is to make sure folks take the opportunity to get vaccinated,” he added. “Other approaches that are often written about on social media are irrelevant if you’re vaccinated.”
Rasmussen is confident the hospital is on sound legal grounds.
“We’re really not concerned whether or not any outside organization would raise concerns about that because the hospitals are going to do what’s the right thing,” he said.
— Reporter Seaborn Larson contributed to this story.
Holly Michels is the head of the Montana State News Bureau. You can reach her at firstname.lastname@example.org