In a letter sent to hospitals and healthcare clinics earlier this week, Mark Steffen, MD, a state senator from Kansas, seemed to suggest a bill that would remove restrictions on the use of treatments like ivermectin and hydroxychloroquine for COVID-19 had already passed.
“With the recent passage of Senate substitute for HB 2280 … there is no reason to think that prescribing problems will arise from pharmacist or Board of Healing Arts interference,” Steffen, an anesthesiologist, wrote on official Kansas Senate letterhead.
However, the bill — which would authorize prescribers to prevent or treat COVID-19 with ivermectin and hydroxychloroquine, even in cases without a positive test, and would weaken the medical licensing board’s ability to discipline doctors for doing so against their recommendation — only passed the state Senate before stalling in the House.
“It’s presented like this is now the law and you should follow it, and that’s fairly misleading,” Rachelle Colombo, executive director of the Kansas Medical Society, told MedPage Today, noting that members of the society had expressed concern about the letter.
The letter also stated that “the standard of care is early treatment with FDA-approved medications regardless of their labelled uses,” and that “‘failure to treat’ will now be considered ‘wanton disregard.'”
“Ivermectin, hydroxychloroquine and fluvoxamine remain readily available and are historically well tolerated,” Steffen wrote. “The hundreds of studies utilizing these medications as part of a multidrug regimen used early and at correct dosages have a clear signal of significant efficacy that can no longer be dismissed.”
A recent study in the New England Journal of Medicine of 3,515 patients found no reduction in hospital admissions due to COVID-19 in those treated early with ivermectin.
On April 3, Steffen, who is licensed as an anesthesiologist in Kansas, wrote on his Facebook page that he had sent the letter to “over 250” hospitals, clinics, and government agencies.
Cindy Samuelson, senior vice president of the Kansas Hospital Association, told MedPage Today that she fielded many calls from confused hospital administrators.
“The main confusion was, ‘is this law?’ The letter was just written as such that was a little confusing,” she said, noting that her association clarified to hospitals that the law had not yet passed. “As some folks might imagine, not everyone follows every heartbeat at the House and Senate in capital cities like Topeka.”
The Board of Healing Arts, Kansas’s medical licensing board, told MedPage Today in an email that “the Board has not yet taken a position on Dr. Steffen’s letter.” During a Senate committee hearing in January, Steffen said that he is currently under investigation by the board, though acting executive director, Susan Gile, would not confirm or deny this in an email.
However, according to a memo that the board attached to their email, off-label prescribing is allowed, and any investigations by the board related to prescribing evaluate whether or not the “standard of care” was met. In bold, they wrote that, legally, the standard of care is “what a reasonable physician would have done under the same or similar circumstance. This is incredibly fact dependent.”
Both the Kansas Hospital Association and the Kansas Medical Society are directing members to a recent opinion from the Kansas Attorney General that clarifies that physicians and authorized prescribers are allowed to prescribe FDA-approved drugs off-label.
However, this action may or may not be considered the “standard of care” for treating COVID-19, depending on the circumstances. “Standard of care, of course, takes into account a lot of specifics, and those are really determined within the physician community, by peers,” said Colombo. “It’s not something that’s decided in state law or by government.”
She pointed out that the letter might have been meant just as much to garner support as to actually convince doctors to change their treatment practices. “As much as the medical community might be a little bit flummoxed by why he’s saying these things, it certainly plays to those folks who support that bill to get them riled up,” she said, adding that it is unlikely that any physician would change their medical practice because of the letter.
Colombo also noted that Steffen is not a member of the Kansas Medical Society, and his letter “is not reflective of our membership or the way in which we communicate in the physician community.”
In response to inquiries from MedPage Today, Steffen sent a link to a Rumble video of an Early COVID Treatment Symposium he hosted on March 2, featuring Pierre Kory, MD, who has advocated for the off-label use of these drugs.
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