Imagine that you’re a physician in the middle of the global pandemic. The life-saving vaccine has just come out, and your job includes administration of the vaccine. At the end of your day, you have 10 extra vaccine doses in an opened vial that will need to be discarded if not used. You know there are not enough vaccines available yet to vaccinate everyone who needs this vaccine as soon as possible, and COVID-19 cases are surging. You go out of your way to spend hours after work seeking patients who meet vaccination criteria and driving around town administering the remaining doses before the doses expire.
In most circles, you would be praised for going above and beyond the call of duty to do something life-saving for someone else. As a physician myself, my gut response is that this action embodies the physician spirit. Ethically, it feels like it was the right thing to do. In December 2020, when cases were surging and when so many of us were desperate for vaccines, it was an atrocity that there were unused doses that needed to be discarded.
However, in this story, the story of Dr. Hasan Gokal, the dialogue was quite different. A few days later, this physician was fired from his public health job, and was subsequently faced with criminal charges for stealing a vial of the vaccine. His case was also brought to the Texas Medical Board.
Health care is complicated. We exist in a sea of regulations and protocols, which we hope are well-intentioned and in the best interest of patient care and safety. That said, most physicians will tell you that the practice of medicine is both a science and an art. In our day to day practice, there is a lot of grey and white, because ultimately, we’re dealing with people’s lives, and every case is different. Our training emphasizes always prioritizing patient care, even when it comes at our own personal sacrifice.
Medicine is a calling. Over the past year, we have heard so many stories of health care heroes putting themselves at risk to care for patients and providing care in suboptimal situations. Policies and protocols take time, understandably, but in the interim, the immediate needs of patients have needed to be addressed. Until March of last year, it would have been grossly against protocol to ever reuse a mask or perform a procedure without adequate personal protective equipment, and yet, we were encouraged to do so by both our institutions and our government because patient care necessitated it. Unfortunately, this has resulted in the loss of the lives of many health care workers. Despite this, we’ve continued to show up to work every day with a commitment to serve our patients.
On the day that Dr. Gokal administered the shots, there were no written protocols for what to do with the unused vaccine doses, nor was there a waiting list for vaccine doses. He called a public health official in charge of operations to inform them of his plans to find 10 people to receive the remaining doses, and was given an OK.
After reviewing the unique aspects of the case, the Texas Medical Board dismissed the investigation, and a Harris County judge dismissed the original criminal charge, pointing out in his statement that he rejected the imposition of criminal law to a doctor’s administration of a vaccine during a public health emergency.
However, the Harris County District Attorney’s office continues to explore criminal charges. They anticipate presenting this case to a grand jury, who would determine whether a criminal charge is appropriate. As Dr. Gokal faces pending criminal charges, his job options are limited.
This story has shook the physician community, who has rallied behind Dr. Gokal and expressed widespread support for the spirit of his actions. It is hard not to perceive the decision to pursue prosecution as a lack of recognition for the good faith efforts the health care community has made to do its best throughout a year of extraordinary circumstances and uncharted territories. When one of our own governing bodies, the Texas Medical Board, an institution that is familiar with the intricacies of health care delivery over the past year, has chosen to drop the investigation, continuing to pursue a criminal case for an attempt to serve patients sends a very clear message to physicians. Unfortunately, the message is that we are not safe from threats to our careers and personal lives when making well-intentioned efforts to serve our patients in these extraordinary circumstances.
On one hand, there has been a rush to laud health care workers for their sacrifices during the pandemic, and the coining of the term “health care hero,” and yet on the other end, we have failed to protect health care workers. Over the past year, health care workers have faced retaliation for asking for adequate personal protective equipment and for informing the public about what they were seeing in hospitals, despite doing so in order to educate the public about the seriousness of the disease. Many health care workers have lost their lives. Burnout and mental health concerns have been exacerbated in a population where burnout was already a very real threat to the workforce, and many are considering leaving the field. Physicians have been furloughed, fired, or asked to work for less pay. Requests to bolster and support the physician workforce through expansion of residency programs and granting of visas have not made significant progress. We have not provided support to the families of essential workers who have lost their lives in this fight. When the medical community asked for liability protections to cover deviations from normal protocols and requests to perform duties outside of their normal scope of practice, they were not offered liability protections on a national level.
It is no wonder that each member of the physician community can see a little of their own story in Dr. Gokal’s story.
To be clear, nobody was hurt. In fact, 10 patients received life-saving vaccines that would have otherwise been discarded. This happened in the midst of a global pandemic where these vaccines were widely sought and not readily available.
If we as a nation don’t stand behind Dr. Gokal, and in fact present him with criminal charges, which physician will go above and beyond the next time they have the opportunity to help?
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