A former part-time doctor at the Conway Human Development Center told state lawmakers Monday that she resigned in June because she didn't believe she could prescribe hydroxychloroquine to the center's residents for covid-19.
Dr. Sandra Young of London said she made that judgment based on an email that she received from now state Department of Health Secretary Jose Romero.
Romero said that while he didn't recommend or endorse the use of hydroxychloroquine to treat covid-19, he hasn't prevented Young and other doctors from using the contentious medication.
"Physicians in this state are free to use the medication off label, if they and their patients think it is appropriate," he said.
Hydroxychloroquine has been touted by some groups as a cure for covid-19, but current research has been inconclusive about its efficacy to treat the respiratory virus. Public health officials have also warned about the drug's potentially harmful side effects.
The U.S. Food and Drug Administration last month cautioned against the use of hydroxychloroquine and its cousin chloroquine to treat covid-19. Hydroxychloroquine is FDA-approved as medication for rheumatoid arthritis and lupus; chloroquine is approved to treat malaria.
Young worked at the Conway Human Development Center from Feb. 12, 2018, until June 30 of this year and didn't submit a formal letter of resignation, state Department of Human of Services spokeswoman Amy Webb said. Young said she is now retired.
Romero and Young testified at a joint meeting of the House and Senate Insurance and Commerce committees and the Arkansas Health Insurance Marketplace Oversight Subcommittee. Both were sworn in by Sen. Jason Rapert, R-Conway, chairman of the Senate Insurance and Commerce Committee.
At issue is a June 21 email from Romero, then the state Department of Health's chief medical officer, to Young.
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According to a copy of the email provided by Young, Romero wrote that the Health Department updated its guidance regarding the use of hydroxychloroquine and chloroquine, and the newest guidance points out that the FDA had rescinded its emergency approval for the drugs as therapy for the coronavirus.
"While it may be argued that prophylaxis is not truly therapy, ADH considers it to be within the same scope," he wrote in the June 21 email.
Thus, the Health Department cannot endorse the medication to treat covid-19 patients, Romero said. Although the dose of hydroxychloroquine for prophylaxis may be less than that used for therapy, no clinical trials have been conducted to show that a lower dose is associated with fewer or no complications in covid-19 patients, he said.
"I believe that until clinical trials with a combination of hydroxychloroquine and zinc have been conducted and show efficacy, I cannot recommend or endorse its use for patients and staff at the Conway Development Center," he wrote.
Romero told lawmakers that he was simply saying the state Health Department didn't endorse the drug for covid-19 treatment.
"You may use it but we are not in favor of its use nor will we recommend it to you," he said. "I, as a physician, have never told another person not to use the drug if they are under the care of a physician."
But Young said it was her understanding that she was being advised by Romero not to use hydroxychloroquine at the Conway Human Development Center.
She said she also talked with Conway Human Development Center Superintendent Sarah Murphy, who indicated "we are controlled by the Department of Health and we have to follow what they say."
Afterward, Webb said that "Sarah told Dr. Young that we should follow recommendations of the Arkansas Department of Health and the CDC [U.S. Centers for Disease Control and Prevention] and should consult with our consulting physician."
Hydroxychloroquine was used at the Conway Human Development Center "once early in the public health emergency before CDC recommended against its use," Webb said.
Webb said Young and Murphy discussed Young's frustration over feeling that she couldn't prescribe the drug.
"After talking with Sarah at length, Sarah indicated that Dr. Young seemed to feel somewhat better but said she still needed to resign to take care of her husband whose health was failing," Webb said.
Young gave lawmakers a different reason for resigning on Monday.
"I felt that I could not stay there and watch people get sick and die when I knew I could prevent it or to watch the people that I worked with, the staff, get sick and possibly die and not prevent it."
She said she received the June 21 email from Romero and subsequently decided to quit.
"Of course, my husband wanted me to quit anyway, so he came up with another excuse, but that [hydroxychloroquine issue] was the main reason," Young said.
She said she told Romero that she had quit because Romero indicated she couldn't prescribe hydroxychloroquine at the Conway Human Development Center.
But Romero said, "I didn't know it had anything to do with my letter and that email in no way should have prompted her to quit."
He said that Young has the right to use medications off-label as a licensed physician in Arkansas.
"We do not and did not prevent her from using the medication," he said.
Romero said no other physicians at the Conway Human Development Center asked to use hydroxychloroquine and it wasn't brought up at the monthly meetings there.
Rapert said that he interpreted Romero's June 21 email to Young to mean that "you won't use it."
"Now you can split the hairs if you want to, but it got to the point where you had a doctor that resigned her position," he said.
Romero said he doesn't know why Young resigned.
"But I can tell you that that is not a reason to resign," he said. "I don't know if there are other underlying issues that surround her employment. But not offering an endorsement doesn't mean you do not use something."
"I am sorry that Dr. Young felt that way," Romero said.
He said he is a consultant at the Conway Human Development Center and hydroxychloroquine is not being used there. So far, there have been no deaths as a result of its non-use, Romero said.
Referring to Romero's email to Young, state Rep. Mark Lowery, R-Maumelle, said "when someone is asking very specifically for direction" the email sounded like a directive not to use the drug.
"I just want to give you one more chance how that can not be taken as a mandate or a very strong directive to not use the treatment," said Lowery, who is chairman of the House Insurance and Commerce Committee.
Romero said "it is not a strong recommendation."
"The physician has the right under law to use the medication off label if he and his patient feels it's appropriate. We have never stopped a prescription from going through," he said.
Rapert said he asked whether he could get hydroxychloroquine when he entered Conway Regional Medical Center with pneumonia and covid-19 in July, and he was advised that the hospital couldn't provide it.
"You stated to me that you have not issued any directive or guidance or told anyone that they should not use hydroxychloroquine in treatment," he said. "Is that true?"
"That is correct," Romero replied.
Rapert said he wanted Arkansas residents to have access to treatment that can help them.
"And for me, to be told I can't have a treatment, I just think is wrong," he said.
The committee also heard from Dr. Simone Gold, founder of America's Frontline Doctors in Los Angeles and Dr. Robin Armstrong -- two prominent proponents of using hydroxychloroquine to prevent and treat covid-19.
But Rep. Deborah Ferguson, D-West Memphis, said that "anytime there is a disease that there is no treatment or cure for or no vaccination, people are reaching for straws."
"The overwhelming preponderance of the valid controlled studies do not show that hydroxychloroqine [has] any benefit," she said.
Sen. Terry Rice, R-Waldron, said that the state Department of Health is working under extreme pressure, but "Dr. Romero, I believe, downplayed what his words mean."
Rice said he has seen criticism on social media that lawmakers are practicing medicine.
"No, we are not," he said. "We are trying to give people their rights and give doctors back what they are supposed to be doing and let them treat their patients. Common sense, let's try it."
Asked whether Gold and Armstrong will be reimbursed by the bureau for their expenses to appear at Monday's meeting, Marty Garrity, director of the Bureau of Legislative Research, said the doctors were sent reimbursement forms.
"It is incumbent upon them to submit receipts for reimbursement," she said in an email.