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A Maine doctor was sanctioned for COVID practices. But the misinformation battle is far from over

FILE - In this Jan. 21, 2021 file photo a medical staff member prepares the Pfizer COVID-19 vaccine at Tudor Ranch in Mecca, Calif. With vaccination against COVID-19 in full swing, social platforms like Facebook, Instagram and Twitter say they’ve stepped up their fight against misinformation that aims to undermine trust in the vaccines.
Jae C. Hong
FILE - In this Jan. 21, 2021 file photo a medical staff member prepares the Pfizer COVID-19 vaccine at Tudor Ranch in Mecca, Calif. With vaccination against COVID-19 in full swing, social platforms like Facebook, Instagram and Twitter say they’ve stepped up their fight against misinformation that aims to undermine trust in the vaccines.

In this week’s Pulse: Ellsworth doctor faces license suspension over COVID misinformation allegations, political hits with no context, a parole bill still in limbo, and what's coming up next week in the Legislature. 

Three days before Dr. Meryl Nass admitted to state lawmakers that she had lied to a pharmacist in order to fill a prescription of hydroxychloroquine for a COVID-19 patient, the Ellsworth internist made sure to let the patient’s spouse know that she had self-reported her deception to the Maine Board of Licensure in Medicine.

The spouse texted Nass on Dec. 11 to let her know that the drug, which has yet to be proven effective against COVID and is not approved for use in fighting the disease, had been obtained.

“Good,” Nass responded. “And I wrote a letter to the board of medicine telling them they had forced me to miss inform [sic] a pharmacy today in order to get a life-saving medicine to a patient. Let’s see what they do with that.”

This week the Maine Board of Licensure in Medicine suspended Nass’ medical license for 30 days. It said allowing Nass to continue practicing medicine “constitutes an immediate jeopardy to the health and physical safety of the public who might receive her medical services.”

The board’s rationale for the 30-day suspension is extensive: lying to a pharmacist to obtain a drug, hydroxychloroquine, that is not approved by the FDA to treat COVID-19; involving a patient in the “deception”; and record keeping inconsistent with telemedicine standards.

The suspension sets the stage for a Feb. 11 adjudicatory hearing that could determine Nass’ ability to practice medicine in Maine. It also signals that an already rancorous political dispute over vaccines and misinformation raging here and across the country is about to intensify.

It’s a fight that Nass appears eager to have. Her battle with the licensing board might draw the attention of national anti-vaccination groups with financial resources and influence that have expanded during the pandemic. Nass is a consultant for one of those groups, the Children’s Health Defense, which was described recently by the Associated Press as an “anti-vaccine juggernaut.”

“I am very happy to discuss in any forum, in front of any board, in front of the board of licensure in Medicine, how to treat a COVID patient,” Nass told Maine Public Radio last month. “I have plenty of experience.”

Upon ordering her to undergo a psychological evaluation, the licensing board released a text message between Nass and the son of a patient. Nass indicated again that she was spoiling for a fight with the licensing board, telling the patient’s son that she knows “some crack attorneys.”

“I certainly was hoping to make a public spectacle of an investigation,” she said. “Hopefully the attorneys will allow that.”

The licensing board on Wednesday released preliminary findings of its investigation into Nass’ conduct. Included are excerpts of correspondence between Nass and several unidentified patients, as well as subpoenaed medical records. The findings show the doctor repeatedly told patients or their family members about the licensing board’s investigation.

In one instance, she appeared unclear about who she was corresponding with -- an observation noted by the licensing board when it suspended her license.

“I cannot remember your name, town, and date of birth,” she texted to the spouse of someone described as Patient 2 in the licensing board findings. “I do remember lying to the pharmacy. Please send me that information. Texting does not provide me names.”

According to the licensing board’s preliminary findings, Patient 2 was hospitalized five days later, Dec. 16. The patient, who had multiple conditions that put them at risk of serious illness from COVID, was put on a ventilator two days after being admitted and was discharged 20 days later on Jan. 4.

The patient’s hospitalization was one of hundreds during the past several months. State data show the surge in COVID hospitalizations is driven largely by unvaccinated patients. But Republicans are blaming the current health care crisis, in part, on Democratic Gov. Janet Mills for requiring health care workers to get vaccinated against COVID.

Sen. Lisa Keim, R-Dixfield, is among them. Keim is the one who invited Dr. Nass and several other doctors to brief about a dozen state lawmakers last month about the harmful effects of the vaccine mandate. It was during that briefing that Nass suggested she was under investigation for spreading COVID misinformation. It’s also when she voluntarily disclosed that she lied to a pharmacist.

"And so I lied and said the patient had Lyme disease, which is another legitimate reason to get this drug,” Nass told lawmakers. “And so the pharmacist dispensed the medication only because I lied. If I had said the patient was getting it for COVID, they would not have received the drug.”

Nass told Maine Public Radio last month that she believes drugs like hydroxychloroquine are being suppressed by government officials who want to push newer, more expensive treatments and the COVID vaccines. It's a belief central to some factions of the anti-vaccine movement that often ascribe nefarious, profit-making or power-grabbing motives to top health officials who promote or authorize vaccines.

In fact, as the licensing board noted in its preliminary findings, Nass harbors a host of views about the pandemic and vaccines that the overwhelming consensus of her profession considers misinformation. Some of those views run up against conspiracy theories that assert that vaccines are a method of surveillance and control.

Nevertheless, how to handle such misinformation is the subject of a raging political debate.

Keim, for example, told Maine Public Radio last month that she’s disturbed that the licensing board hasn’t defined what constitutes misinformation, yet could move to sanction doctors like Nass. Saying that the state is "way too cavalier with Mainers' livelihoods," Keim said she planned to write the board to complain about its policy.

"I definitely want to pursue that,” she said. “Again, when I heard a few physicians mention that to me, I thought, 'Wait, what is that?' That is not how we create policy in any way that I have ever seen it because if you're going to threaten someone's livelihood, they need to be very clear on what the parameters and the guidelines are, right?"

The battle over COVID misinformation isn’t unique to Maine.

In some Republican-controlled states medical licensing boards have been hamstrung in their efforts to punish doctors pushing conspiracy theories or unproven COVID treatments. Last year Tennessee's medical licensing board removed its COVID misinformation policy amid fears that a Republican lawmaker would dissolve the panel and replace its members. In California, the head of the state’s medicine board said she was stalked and harrassed by activists from America’s Frontline Doctors. (A Maine physician once affiliated with the group participated in the Dec. 14 briefing call with state lawmakers.)

Meanwhile, others worry that medical boards aren’t being strict enough.

Last week, Brian Castrucci, president and CEO of the de Beaumont Foundation, and Nick Sawyer, executive director of No License for Disinformation, wrote a column for NBC News lamenting the lack of action against physicians who spread COVID-19 vaccine misinformation. They noted that while 71 state medical boards, including Maine’s, warned that doctors who spread misinformation could face sanctions, just 12 of those boards reported taking disciplinary action.

They wrote:

“This lack of accountability is all the more troubling because, as the medical board federation noted in its July statement, doctors have an elevated responsibility and expectation for truthfulness. ‘Due to their specialized knowledge and training,’ the federation said, ‘licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not.’”

That engrained trust in doctors is present in the Maine licensing board’s preliminary investigation into Nass’ conduct and its order for a psychological evaluation.

On Dec. 15, the day after Nass briefed lawmakers, the son of one of her patients texted her alarmed at his father’s deteriorating condition.

Two days later the son texted again.

“Dr. Nass my parents aren’t doing very well. My dad’s breathing is very shallow and when he tries to breathe deeply he begins to cough violently,” the son wrote. “I don’t see any signs of improvement. When do I need to consider taking him to the ER? Should we be taking more ivermectin?”

The son and his parents, who all had COVID at the same time, were ultimately hospitalized in December.

In another instance, the son of a patient asked Nass where he could send money for her legal defense.

“I haven’t even thought about details like payment,” Nass replied. “Let’s see where this is going.”

Political hits with no context

The Mills administration has also taken heat in recent days over contradictory reports about whether COVID-positive staffers were working in Maine hospitals.

Again, this is an area where exploring the details of what is going on – what is allowed when, and what hospitals must do – can help wade through the politics and partisan messaging.

Last week, News Center Maine quoted a spokesperson from Maine DHHS saying that no hospitals in Maine were taking advantage of a federal policy change that allows COVID-positive staff members to return to work during a crisis-level staffing situation. Then, on Tuesday, St. Mary’s Hospital in Lewiston disclosed that it was allowing some infected-but-asymptomatic workers to return before testing negative.

The seemingly conflicting stories were quickly noticed by the Maine Republican Party.

“Is the Mills admin incompetent or lying?” reads a Tuesday tweet from the Maine GOP.

The Republican National Committee picked up the line attack a few hours later, posting a blog entitled “Is the Mills admin lying, or simply incompetent, on COVID in hospitals?”

Political operatives have been pushing the issue on social media, and the state party again used the lying-or-incompetent language in a Thursday email blast to people on their list.

First, a little background.

The U.S. CDC changed its guidance on Dec. 23 to allow health care facilities to bring COVID-positive employees back to work before the five-day quarantine period was over and without a negative test. But those staffers are only supposed to be used as a last resort and on a temporary basis. The Maine CDC then adopted the federal guidelines and issued a public health advisory to health care facilities on Dec. 27.

St. Mary’s Hospital told Maine Public that two employees with minor symptoms were allowed back to work for one shift each in the COVID ward.

DHHS Commissioner Jeanne Lambrew and Maine CDC director Dr. Nirav Shah told reporters on Wednesday that St. Mary’s Hospital did not notify the state before bringing those employees back, nor did they have to.

“The way that those guidelines are drafted, they are meant to be self-implementing by the facility,” Shah said during Wednesday’s COVID briefing. “The facility need not get clearance approval or even notify the Maine CDC. The guidelines are completely packaged such that any facility take them off the shelf, read them and implement them for the situation that they are facing.”

Lambrew added hospitals have medical-grade PPE, such as fit-tested N95 masks that provide a high level of protection.

“This crisis use of COVID-positive staff is a last resort, but the circumstances for health care facilities like hospitals are different,” Lambrew said.

Of course, the Maine Republican Party has fiercely opposed the Mills’ administration requirement that all health care workers be vaccinated against COVID-19 as a condition of employment.

The party has been hammering Mills for months over the issue, declaring in a mid-December email to supporters that “Gov. Mills’ mandate has thrown gasoline on the raging fire of staffing shortages in a number of critical sectors.”

The vaccine mandate has clearly further strained staffing issues in some sectors, most notably fire departments and EMS staff where some staff refused to get vaccinated. But a very small percentage of staff at Maine’s largest hospital systems quit or was fired because of the requirement.

Parole bill still in limbo

Last week, the Legislature quietly recalled from the governor’s desk a bill that would have created a commission to study the issue of reestablishing parole in Maine.

As reported in this Maine Public story from December, the bill was stuck in limbo after it passed the Legislature in July but has lingered on Mills’ desk, neither signed nor vetoed, ever since. The bill from Rep. Jeffrey Evangelos, I-Friendship, was originally drafted to reestablish parole, which was eliminated in Maine in 1976. But it was watered down to a study commission in order to win passage.

Mills, who is a former prosecutor and Maine attorney general, has expressed concerns about the prospect of reinstituting parole to allow people early release from prison for good behavior. Speaking on Maine Calling on Thursday, Mills said she was unclear why lawmakers recalled it from her desk – a process that allows for additional changes.

“It wasn’t discussed with me,” Mills said. “But if they wish to recall it back to the Legislature, that’s their prerogative.”

Pressed on Maine Calling whether she would support a bill to reestablish parole, Mills didn’t take a position on what she called a “complicated issue.”

“Parole as it was instituted before had a number of unfairnesses to it,” Mills said. “In particular, the victim was having to relive the crime over and over again every time the individual came up for parole. And I don’t think that was fair to the victims and their families. But I think there is a way we can encourage rehabilitation, encourage good works while incarcerated or under the supervision of the state.”

Coming up…

Below is a roundup of a few potentially newsworthy or noteworthy items coming up in the next week in the Legislature, Congress or elsewhere in Maine politics:

  • State and legislative offices are closed Monday for the Martin Luther King Jr. holiday.
  • Campaign cash: We’ll learn more about the money race in Maine political campaign on Tuesday when the candidates running for governor as well as political action committees and ballot question committees file their latest campaign finance reports. The 2022 gubernatorial campaign between Mills and former Republican Gov. Paul LePage has been quiet on the surface, but both campaigns have been busy raising money. So this will be the first filings since July for those campaigns.
  • Deliverable pot: The Legislature’s Veterans and Legal Affairs Committee will hold a public hearing Wednesday on a bill, L.D. 1827, that would allow licensed marijuana retail businesses to offer a “limited delivery service” of their goods anywhere in the state, regardless of the local policies on the books of the town where the buyer lives.
  • Shopping for insurance: The Health Coverage, Insurance and Financial Services Committee will get an update on CoverME, which is Maine’s insurance marketplace for those eligible to purchase health insurance through the federal Affordable Care Act. The state launched the CoverME.gov website in November and more than 65,000 people have signed up for coverage. But there have been some issues with the rollout of the website, which will certainly come up.
  • Gender discrimination: The Judiciary Committee will hold a work session on Thursday on a proposed constitutional amendment to prohibit gender discrimination by governments and political subdivisions in Maine. A local version of the national Equal Rights Amendment, the proposal garnered support from Mills and others this week.
  • Vaccine mandate: Another bill that got a lengthy public hearing this week, L.D. 867, is scheduled for a work session on Thursday in the Health and Human Services Committee. The bill, which is unlikely to pass the Legislature, would impose a five-year moratorium on a vaccine mandate for COVID-19.

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Journalist Steve Mistler is Maine Public’s chief politics and government correspondent. He is based at the State House.