The controversy began in September, more than a year into the pandemic, when the Tennessee Board of Medical Examiners issued a warning to doctors in the state: Spreading misinformation about COVID-19 vaccines could land them in big trouble with the board, including the possible revocation of their medical licenses.
Board members acted after hearing that some doctors were relaying fantastical, unsupported claims about the vaccines, including that they magnetize the body, cause infertility and inject microchips under the skin so the government can track patients’ movements.
“First, do no harm,” board President Dr. Melanie Blake said at a meeting that month. “You don’t get to use your Tennessee state medical license in order to promote a platform of just spewing misinformation to your patients.”
Blake said members of the board, which licenses and regulates doctors in the state and is appointed by the governor, had “an ethical obligation to investigate it and stop it, and I think the citizens of our state expect nothing less.”
On a voice vote in its September meeting, the board adopted a policy warning that doctors risked their medical licenses if they spread misinformation about the COVID-19 vaccine. The warning was posted on the board’s website.
Those actions soon caught the attention of the powerful chair of the Tennessee House Government Operations Committee, Republican state Rep. John Ragan, who determined that the board had overstepped its bounds. In a series of letters in the fall, Ragan ordered the board to remove the warning from its website and threatened to terminate the board.
Lawmakers in other states also have tried to protect doctors, nurses and pharmacists who departed from mainstream medical findings about COVID-19 treatment. Both the federal Centers for Disease Control and Prevention and the U.S. Food and Drug Administration recommend against taking the anti-parasite drug ivermectin, for example.
Legislators in half the states have introduced bills that would prevent regulatory bodies from punishing medical providers who promote COVID-19 misinformation or unproven treatments, according to the Federation of State Medical Boards. So far, only North Dakota has approved legislation—its law protects providers who prescribe or dispense ivermectin—but bills are still alive in many states.
“The fundamental issue is how much state legislators and legislatures are going to get involved in practicing medicine,” said Dr. Richard Baron, president of the American Board of Internal Medicine.
“They are not trained as doctors or people who are trained in science,” Baron said in an interview. “The medical boards consist of people who have been trained, who have gone to medical school and passed medical exams. State legislators have not done that.”
But legislators who are pushing the protections say medical boards are interfering in the relationship between patients and their doctors. They say providers should be free to make their own judgments about medical practice.
“I had several doctors contact me last summer and into the fall about what they were seeing and hearing from the Board of Medical Examiners, that would potentially punish them for prescribing treatment for COVID that they felt was in the best interest of their patients,” Tennessee Republican state Rep. Chris Todd told Stateline. “That hit me, because they have a perfectly valid license and have practiced for years, and there’s no reason to issue a statement carte blanche.”
Tennessee lawmakers say doctors complained to them about receiving emailed warnings. At its meeting in September, the board discussed sending a warning to all physicians in the state. But Bill Christian, spokesperson for the Tennessee Health Department, which oversees the medical board, said in an email that if doctors received any emails, they came from professional organizations, not the board.
In any case, the board in December deleted the warning from its website, although Christian said that the policy behind it remains in effect.
‘A CDC That’s Gone Berserk’
The Tennessee board’s statement pertained only to doctors spreading false information about COVID-19 vaccines. But Todd was sufficiently concerned that a month later he filed a bill that would have prevented the board from disciplining any doctor for administering any treatment for COVID-19, even if it “is not recommended or regulated by the department of health, the board, or the federal food and drug administration (sic).”
Todd called the bill the “Tennessee COVID-19 Treatment Freedom Act.”
The bill did not make it to a vote before last year’s legislative session ended, but he felt he had succeeded in sending the board a message, “that we were willing to step in and rein them in when they made a bad decision.” He said he believed the board’s decision resulted from “a heavy-handed administration and a CDC that’s gone berserk.”
A few Tennessee legislators have filed new bills this year that would prevent the board from disciplining any medical provider for administering COVID-19 treatments not approved by the FDA.
The Tennessee Department of Health did not allow Blake or anyone else from the board or department to be interviewed for this story. No member voted against posting the original warning at the September meeting. The vote to delete the statement from the website was 7 to 3.
At the public meeting in September, Blake said the agency had received numerous complaints about doctors spreading misinformation or promoting unproven treatments. She did not specify what the complaints were and said no doctor had been disciplined for issues related to COVID-19.
Lisa Robin, chief advocacy officer for the Federation of State Medical Boards, said in an interview last week that many state medical boards have received similar complaints. Last July, the federation issued a warning to doctors that spreading misinformation about COVID-19 vaccines could lead to disciplinary actions by their state medical boards. Half of the state medical boards, like Tennessee’s, have issued similar warnings, the organization says.
According to the federation, at least 10 states have disciplined doctors for disseminating false or misleading COVID-19 information. The Texas Medical Board in October imposed a $500 fine on one Houston physician, Dr. Stella Immanuel, an outspoken promoter of hydroxychloroquine for treatment of COVID-19, for failing to disclose to a patient the risks of using the drug for the virus.
Rhode Island’s Board of Medical Licensure last year reprimanded and fined a psychiatrist for sending letters to patients advising them against getting the COVID-19 vaccine. Also last year, the Oregon Medical Board revoked the license of and fined a family practice doctor for, among other practices, advising patients against wearing masks to protect them from COVID-19 and otherwise failing to follow accepted COVID-19 safety protocols in his office.
Baron of the American Board of Internal Medicine said physicians should be allowed to prescribe medicines for “off-label” uses not approved by the FDA. For example, doctors often prescribe certain chemotherapy drugs approved for one type of cancer for other cancers because they have been effective against them.
Prescribing ivermectin and hydroxychloroquine for COVID-19 is different, Baron said, because no studies suggest they work against the virus, and they might even be harmful when used with other medications. He also noted that there are other treatments that have been proven effective, including antivirals and monoclonal treatments. Best of all, he said, there is a highly effective vaccine.
“If you get a doctor saying you should not be vaccinated, you should take ivermectin instead, that is contraindicated by literally billions of vaccines given around the world, and study after study showing vaccines are effective in preventing hospitalization and death,” Baron said.
“Why recommend an ineffective treatment when an effective treatment is available?”
Baron said he worries lawmakers could become emboldened to get involved in areas unrelated to COVID-19 and pass laws that conflict with evidence-based medicine.
That argument did not persuade North Dakota Republican state Rep. Bill Tviet, author of the state law that protects medical providers who prescribe ivermectin. Tviet said he was prompted to introduce the legislation by what he deemed overreach from Washington.
“There were doctors willing to treat with ivermectin and hydroxychloroquine and having good results,” he said. “Locally, we found doctors who were willing to try but were threatened [with having] their licenses revoked if not under the protocol.”
Tviet couldn’t identify who had issued those threats.
No Authority to Issue Warning
The FDA in June 2020 revoked its emergency use authorization of hydroxychloroquine, which then-President Donald Trump had championed, saying it hadn’t proven effective for COVID-19 and in some patients had serious side effects.
In an email last week, Sandra DePountis, executive director of the North Dakota Board of Medicine, which licenses and regulates doctors in the state, said her board had issued no warnings. “The North Dakota Board of Medicine has not issued any statement, and has not sought nor disciplined a physician for prescribing ivermectin or hydroxychloroquine,” she wrote.
Originally, Tviet’s bill was much broader, requiring hospitals to honor any patient’s prescription for the off-label use of any medicine for any purpose and pharmacists to dispense such medicines when presented with a prescription. The bill, opposed by the North Dakota Board of Medicine and some professional medical organizations, was amended to pertain only to protecting providers prescribing or dispensing ivermectin.
Tim Blasl, president of the North Dakota Hospital Association, said he was pleased that the original bill was pruned back, but, he added, “I don’t think this is the end of the discussion regarding this issue.”
Ragan, the Tennessee state representative, said his insistence that the Board of Medical Examiners remove its warning to doctors on its website did not reflect his views about what physicians were or were not saying about COVID-19 vaccines. While he said that he respected board members, most of whom are medical doctors, he added, “Just because they sit on that board doesn’t mean their medical opinion should have more sway than others.”
But, Ragan, a former Air Force pilot, stressed that he was not making a medical judgment himself. “My medical knowledge is limited to battlefield first aid,” he said.
Instead, he insisted that the board had overstepped its authority when it issued the warning. If the board intended to discipline doctors for spreading false information about the COVID-19 vaccines, Ragan said, it had to first adopt a rule and bring it before the legislature for approval. The board had not done that, he said.
The Republican-controlled Tennessee legislature made that explicit in a bill it passed at the end of October that the governor signed. It specifically states that no health-related board can discipline medical providers for COVID-19 treatments without first adopting a rule, one that would have to be approved by the legislature.
At a Senate committee hearing in February, Blake and an attorney for the Tennessee Health Department said they had no intention of pursuing such a rule.