Rory Bellina (00:00:15):
Hello everyone and welcome to Help Law Talk, presented by Chehardy Sherman Williams. Before we get started, please be sure to subscribe to our podcast and follow us on Facebook, Twitter, LinkedIn, and YouTube – linked in the description below. We hope you enjoy this episode,

Conrad Meyer (00:00:33):
And good morning everyone. Good afternoon, everyone. This is Conrad Meyer here in the office today, and with the studio with Rory Bellina at another episode of Health Law Talks. Rory, how are

Rory Bellina (00:00:42):
You? Doing well. Good afternoon

Conrad Meyer (00:00:43):
Everyone. And today we have two special guests in the studio that I think are just fantastic. It’s gonna be a great show. we have in the studio with us today Greg Waddell. And Greg is the VP of Legal and Governmental Affairs for the Louisiana Hospital Association. Greg, how are you? Welcome excited

(00:01:01):
To be here. Fantastic. And we also have Dr. Joe Kanter. Dr. Joe Kanter. He is with the Louisiana Department of Health. He’s the state medical officer. Dr. Kanter, how are you?

Dr. Joseph Kanter (00:01:09):
I’m good, thank you. It’s a pleasure to be here.

Rory Bellina (00:01:10):
Thank you for joining us.

Conrad Meyer (00:01:11):
We are, we’re very happy to have both of you here on a I guess a very, very timely and and a very good topic here. We’re gonna be talking about a lot of covid stuff, and I think a lot of things that, that lawyers would like to know and even, you know, the general public would like to know. So, Rory, what, what are, what is our agenda for today? What are we gonna learn today?

Rory Bellina (00:01:32):
Sure. So I think before we get into a, a quick, you know, background and, and recap from Dr. Kanter, you know, three things we, we talked about discussing were the various different orders for Ivermectin. That’s a, that’s a big topic right now on the North Shore in St. Tammany. And then we’re seeing it in other states and counties as well. It looks like it’s kind of starting to expand nationwide vaccine mandates. That’s obviously a very popular thing, especially being here in the New Orleans area. and we’re gonna gonna go from there and it might lead us into other topics that we didn’t plan on talking about, but that’s what this is for. So we’re very excited to have you here. Thank you for taking the time out. And you know, if you’d love to give us an update on kind of, you know, what’s been going on in your world, where things were, where, how things are now, you know, what do you see going on. but we’ll get into the more detail, but we’re gonna turn over to you. Sure.

Dr. Joseph Kanter (00:02:22):
I’m happy to be here. It’s not always easy to get a doc in the room of three attorneys, but I, it’s for a good cause, so I’m pleasure, proud to be here. Thank you. you know, thankfully we’re in a much better place now than we were even, you know, four or five weeks ago, looking back and now been spent 18, 19 months of this pandemic. We’ve had four discreet surges in Louisiana the first one back in March of 2020, which was one of the first surges in the country. And I’ll remind people, there were two weeks back in March of 2020 when Louisiana and particularly New Orleans led the world in the raid of new cases. Wow. Had the fastest growing outbreak to date at that point in time. Faster than Italy, faster than South Korea, faster than even Wuhan China itself. We had two additional surges after that.

(00:03:10):
And then that led us up to this prior surge, the delta surge mm-hmm. , which was our fourth surge. It was our most damaging surge as measured by the number of cases, the number of deaths, the number of hospitalized covid patients. We’ve pushed our hospitals to the absolute brink in this last surge. It was driven by the Delta variant. and it was, it was tough to get through. I’ll tell you now, this is about five states nationwide that have formally enacted crisis stem of care. We never did that statewide, but we came awfully close to doing so. Well, we peaked around the first or second week of August, and we’ve come down consistently, and we’re happy to say that right now we’re at, at about the same point that we were just before the surge started. So our, our rates are about where they were on the 1st of July. Sure. So we, we recouped all those losses. Hospitals feel the difference. There’s about 250 hospitalized patients with covid in the state. Now that’s down from a peak of 3000, 22%.

Conrad Meyer (00:04:08):
Oh, wow.

Dr. Joseph Kanter (00:04:09):
Significant is decrease percent positivity of all tests being conducted is at at about 2%, which is a very low number for us. the challenge that I see going forward is there’s always gonna be a new variant. And until we can get our vaccination rates up, I think we’re gonna be vulnerable to another surge like this down the road. Usually have a few months of quiet. Okay. so that’s gonna be the focus now that we have some breathing room, now that we’re not with our backs against the wallets, how do we really protect ourselves going forward?

Conrad Meyer (00:04:39):
Do we have any idea, like percentage of population for the state of Louisiana in terms of vaccination? Where are we right now? Do we know?

Dr. Joseph Kanter (00:04:46):
Just below 50%, 48, 40 9%, something like that. General population fully vaccinated. It’s about 10 percentage points behind the national average right

Rory Bellina (00:04:53):
Now. And where, where do you think we need to be, or what do you think we would be comfortable was to where we’re gonna keep, like you said, we’re gonna keep getting these variants. At what point will it not matter if we keep getting the variants here because we’re vaccinated at a certain threshold?

Dr. Joseph Kanter (00:05:06):
65, 70%. Okay. Something like that. You know, you also factor in people who were infected, you know. Okay. Protection by way of infection with the virus. It’s difficult to quantify. It certainly counts for something. It’s tough to know how much we had a lot of exposure that’s passed surge. So that counts for something, but I don’t think we have enough vaccine related protection right now to really ensure we don’t have another surge going forward.

Conrad Meyer (00:05:29):
Okay. And what about children? I mean, I know that’s a big question on, on parents’ minds right now. I think you have a one camp that thinks I can’t wait till we get, you know, e emergency use authorization for certain vaccines for children. there’s another camp I’m sure that says, Well, I don’t want my kids vaccinated no matter what happens. So, so where do, where do you equate the, the, the general population percentage of vaccination with the children?

Dr. Joseph Kanter (00:05:54):
I think it’s gonna be a struggle in Louisiana. You know, it’s interesting times now. So it, we’re recording this on November first first, right? That’s right. So last Friday, a couple days ago, the FDA gave emergency authorization to Pfizer. Right. Going down to H five, the CDC advisory committees meeting tomorrow mm-hmm. . Okay. And then the CDC director at some point thereafter will render a formal recommendation. So we should expect to be vaccinating kids down to five, within one to two weeks. Okay. Is a reasonable timeline. It’s a lot of people. It’s about 420,000 people throughout the state. I think we’ll see a little bit of a bolus of families who are eager to get their kids vaccinated. Mm-hmm. . And then I think it’s gonna be a slog, to be honest with you. It’s highly contentious. It’s been politicized here. Sure. But it is a vulnerable population. And even though kids don’t get that sick themselves on average, that doesn’t mean anything if it’s your family that has a kid that gets sick. Right. And kids are highly effective vectors that can bring that virus home to mom and dad and, and grandpa and grandma who might not be fully protected because they have weakened immune system. So we think it’s an important part of

Conrad Meyer (00:06:55):
The puzzle. Any discussion or anything that you’ve heard in, in, in your line, especially at the state level regarding vaccine mandates for children? Is that, do you think that’s possible? any discussion that you can reveal at this time regarding that?

Dr. Joseph Kanter (00:07:09):
Yeah, and you know, to be honest, the governor’s been pretty transparent about this. So revised statute 17, colon one 70 talks about vaccine requirements for educational settings, daycare, K through 12 institutes of higher education. We have started the formal rule making process to add covid to that list. And the way it’s being done is we’ll wait until it receives full FDA

Conrad Meyer (00:07:33):
Approval. I see full loss insurer. So get past emergency use author EUA authorization and in full, full blown approval. Yeah. And at that point, follow it under like the mandated vaccines for for education.

Dr. Joseph Kanter (00:07:44):
Yeah. Which has a lot of exemptions. you can do an exemption for medical, religious, or just personal slash philosophical.

Conrad Meyer (00:07:51):
And where’re, you get more into that too, because I mean, I’ve, I’ve heard of stories where, and I don’t, you know, again, this is all third party hearsay, but people coming in with religious exemptions or medical exemptions that are being reviewed by various boards, by various institutions who are denying them blanketly for whatever reason. And usually these boards have zero medical personnel on them. and I’m hearing this, you know, haphazardly. I don’t know if Roy, if you’re hearing that. Yeah, absolutely. But just wanted to know any comments on, on, on that, if you’ve heard the same thing and what, what, what’s your, I guess, opinion on that?

Dr. Joseph Kanter (00:08:22):
You know, I think it’s different if it’s an employment setting or if it’s educational. Mm-hmm. , the law gives broad exemptions for educational settings, uhhuh , and that’s the intent. We know it’s not gonna be a hundred percent not gonna be close to a hundred percent sure. And we don’t want to force people to really prove their exemption for the educational setting. Right. I still think with those exemptions, you move the needle significantly in the population. Got

Conrad Meyer (00:08:42):
It. Okay. Good point. Good point.

Rory Bellina (00:08:43):
All right. Well, like you said, we’re gonna, we’re gonna jump back in and talk more about vaccine mandates are especially vaccinations for kids. We also wanna talk about the recent issues going on with ivermectin orders and treatments in the state, and just kind of a state of overall with, with vaccine mandates. So please stay tuned.

Conrad Meyer (00:09:05):
All right. So Greg, one of the things, and, and I know we’ve talked about this, Roy, the lawyers on the panel have talked about this. are the recent cases in Louisiana dealing with off-label use and, and actually of like Ivermectin, for example, in, in Covid and that recent 22nd JDC case that where the, the court ordered the hospital in the case to Minister Ivermectin for the patient, or the patient brought in the Ivermectin and, and Correct. And so I wanted to get your thoughts on that case, because I know that affects you and, and what you do for the hospital association.

Greg Waddell, Esq. (00:09:40):
Yeah, certainly we’ve seen we’ve seen the case here in Louisiana. We’ve also seen cases in other states around the country. I think the Louisiana case is, is certainly interesting. the background there was the patient was at a very severe case of Covid. you know, sort of in that sort of end stages there. The family really wanted to do everything they could to try and, you know, obviously help their family member. Right. I mean, that’s a totally natural position. The hospital was uncomfortable with prescribing ever Macin you know, did not feel like that the, the benefits you know, outweighed the risk. and so ultimately the, you know, the family went to court. the court issued a parte order ordering the, the hospital to either administer the ever macin or, or allow a family member who also happened to be a, a physician assistant to actually come in and administer from Macin.

(00:10:44):
which obviously from the hospital standpoint was, was, you know, problematic really on both fronts. but I think it’s certainly you know, you can, you can kind of look at these cases and get caught up, I guess, in the sort of immediacy of, of, of Covid. but when we really look at these cases, I think they raise much bigger issues about, you know, is there really this separation or the proper separation between courts and, you know, the practice of medicine? should we be concerned as healthcare providers? This idea that the, you know, courts would inject their idea of what the appropriate practice of medicine really is. And, and I think Dr. Can, you know, as a state health officer, really, I think from a just the fact that you’re a, a physician, you know, I, I’d love to kind of hear your thoughts, you know from a physician’s standpoint, you know, ha this idea of the court saying, All right, Dr, can, you know, you’ve gotta administer this medication. Or, or maybe if you even took it out of the realm of a medication, you know, what, what are the limits? Yeah. you know, in these situations. and is this the, is this where the courts really should be? you know, I’d love to kinda hear what, what your thoughts are there.

Dr. Joseph Kanter (00:11:58):
I think it’s a rather scary proposition. You know, if I was a, a doc on this team, I might say, Well, I guess I can go home. , Joe’s gonna take call for

Conrad Meyer (00:12:06):
Me .

Dr. Joseph Kanter (00:12:07):
Sure. So you know, this is an interesting case. I’m, I’m glad the hospital in this case fought it. they didn’t have to, and even, I think the patient expired, but, and they continued to fight it because it’s a, it’s a rather important precedent, I think, to, to make a point on. you know, physicians are bound by ethical duty, by professional duty to practice according to the data and the science. And that’s, that’s what we do. A a as docs. we’re free to make recommendations. A patient is free to seek out a second opinion. A patient is free to request a transfer to another hospital. all those things are, are good sound things a patient can do mm-hmm. . But for a judge to step in and order a physician to administer a medicine, or provide treatment, or do surgery or do anything else like that, when the physician doesn’t think it’s in the patient’s best interest, according to the data.

(00:12:55):
And the science, to me, is a broach of ethical responsibility and opens up a Tampa Pandora’s box. What about if it is surgery? What about if it’s something more drastic? The details in this case, I mean, to be honest, if you’re taking ivory mein in human formulation and in a normal human dose, it’s not that dangerous of a medicine to be honest with you. And there’s not a lot of side effects. So the downside isn’t really harm, it’s just that you’re not doing anything to, to help treat the covid. But the precedent of forcing a physician to do something that they think is not in the patient’s best interest is a slippery slope that I think we need to be careful about.

Greg Waddell, Esq. (00:13:31):
Certainly has a lot of implications too, when you sort of start peeling the onion back, you know, medical malpractice. And where does that leave everyone? If the physician did order, even if they didn’t you know, I think it just opens up a really number of different Sure. Interesting sort of legal questions where you’ve seen sort of, I’m, I’m not sure outside of maybe this sort of hyper focus around covid, that, that we would be as a general society okay. With the idea of courts doing this. But we, we sort of get wrapped up, you know in covid that you know, maybe folks aren’t really thinking through that all

Conrad Meyer (00:14:12):
The way. And that, and that was interesting too, because the, the, the, the motion of the, the, the, the declaratory ruling that was submitted to the court on this had zero case law.

Greg Waddell, Esq. (00:14:23):
Absolutely. No, no.

Conrad Meyer (00:14:25):
Zero case law, no precedent set. Now, maybe that’s cuz it’s never been done. Right. But I think the question is, is is are we, we, in this particular case, the judiciary has supplanted its opinion for that of providers. Sure. Now, the issue, I mean, I can understand the problem that the, the dilemma is the patient can’t be moved because they’re intubated. So you can’t, I mean, how it’s hard to get a second opinion, right? You can’t just switch facilities in the covid crisis.

Dr. Joseph Kanter (00:14:51):
I mean, it’s hard, but not impossible cuz we transfer intubated patients from hos to hospital occasionally. But

Conrad Meyer (00:14:56):
With, I mean, let’s just say it’s hard, hard because everything’s

Dr. Joseph Kanter (00:14:59):
Packed. Everything’s packed. Right?

Conrad Meyer (00:15:00):
Everything’s packed. So, you know, could you go on from one hospital A to hospital B that maybe would’ve, okay, you can issue the, you know, administer the ivermectin. But, but to me, I agree with Greg, this is a dangerous president because people haven’t thought, I, I guess there’s so much emotion with Covid. I’m not, I’m not, I’m not dis disregarding that. But if the court is allowed to impose its own will over providers, are we opening up Pandora’s box for other things?

Rory Bellina (00:15:28):
And that, that’s one thing that, that I, excuse me, thought of as well. Greg and Dr. Karen, I’d love to get your opinions on it. Is that the, the, the judge in this case? I, I believe the order was twofold. It was that the, I believe the po the patient presented with the ivermectin, and I don’t know if the, the staff took it from her or what, but she had already started the, the dosage and the order was to allo like, give it back to her, allow her to continue to take it or allow her, I believe it was her daughter to come in who was a PA and administer it to it. You know, Dr. Can I assume you’re on numerous medical staffs. You’ve gone through the bylaws, you’ve got privileges at different places. I mean, there’s, there’s rules and regulations on what you can and can’t do. You know, I if a, if a judge that’s unfamiliar with those bylaws says, you know, Dr, can I want you to write a prescription for this? I mean, how does that play into, into your professional responsibility and, and your malpractice essentially? No,

Dr. Joseph Kanter (00:16:21):
I’ll tell you, if my employer ordered me to do a course of treatment, I didn’t agree with her, I’d probably try and find a new employer. Okay. To be frank with you. Sure. You know, patients are not prisoners. And if a patient wants to eat something in their hospital room that’s counter to their treatment plan, to be honest, they’re free to do so by and large. If they wanna sneak in some medicine, they’re probably free to do so. This patient was intubated, so it wasn’t just an issue of the patient taking medicine, someone had to administer that medicine Right. To the patient. And therein is the ethical breach. And this is complicated by the desperation of the family. Sure. They have a patient who’s crashing, likely gonna expire. and they are desperate and a lot of families are desperate. And that’s why this snake oil treatment, you know, it was hydroxychloroquine, now it’s ivermectin. Next week it’ll be something else. That’s why there’s so easy to fall victim, people fall in this trap because everyone wants it to be a silver bullet. And we all wish there was a silver bullet. This just isn’t it, unfortunately.

Rory Bellina (00:17:15):
Sure, sure. And Greg, I mean, what do you think your issues are on behalf of the various, you know, hospitals that you work with that, you know, is this gonna open up a case where, you know, Connor and I would want a judge to tell us to prepare a, you know, prepare deposition a certain way? I mean, what do you think the, you know, in this case, it, it’s gonna be interesting to see where it goes, but for a judge ordering a hospital to allow something to happen, I I’m not familiar with this happening

Conrad Meyer (00:17:40):
Before. Yeah, no. What are the implications? I mean, where, where does this go for the hospitals if, if this is allowed to go, you know, if this is not resolved? I, I think

Greg Waddell, Esq. (00:17:48):
The, the couple things, one, you know, the, the order required either the CEO of the facility or the cmo to administer the ever McDon. And, you know, in any sort of hospital setting, you know, the the CEO is never going to tell Dr. Kanter or any other physician

Conrad Meyer (00:18:11):
Here’s what you should do, doctor,

Greg Waddell, Esq. (00:18:11):
Here’s what you should do. Right. That would be, you know, completely inappropriate. Sure. on, on a host of different levels. Right. but, but again, so here’s the hospital in this situation where arguably not complying. Does that really put them in a, in a you know, a place where they can be held in contempt of court and again, or take the other untenable position of, you know, walking in and telling the physician, you know, you have to do this and that they’re both are equally just is, is, is untenable. And I think a terrible position for the, for the facility. I think on the question of having another healthcare provider that has not been credentialed with the facility to come in, you know, again another host of, of sure of really problematic,

Rory Bellina (00:18:53):
Which was this case because like we said, she was a pa but she wasn’t credentialed at this, at the facility. So, you know, what happens in that case.

Greg Waddell, Esq. (00:19:01):
Sure. And I, I think you know, Dr can would agree that he wouldn’t really dream of, of going in you know, to a hospital that, that he didn’t have credentials and, and, you know, try and order you know, medications or anything like that. I mean, there’s set processes and they’re there for a really good reason and, and really, you know, should be respected. And I think it, this, these types of orders, I think just kind of blow through you know, all of those different, different things. you know, and that’s, that’s really a lot of difficult questions, I think. And, you know, in other areas, in other states, they’ve really tried to do this under the sort of underneath the, the preliminary injunction type of, of action. and the Louisiana case, it was a little bit unclear you know, what legal basis was actually being asserted that the courts would have the legal authority to even do it.

(00:19:53):
so I think that’s makes it even a little bit more different than what we’ve seen you know, in some of the other, in some of the other states. And, and I haven’t, I didn’t really go back to look to see if, if other states had had allowed the actual orders or not. the, the two that I could find one was Ohio the court denied the preliminary injunction. And then also there was another one Staten Island where their Supreme Court, which I think is, is actually probably one of their lower level courts. That’s the district court level. We kind of do it weird. Yeah. or maybe we do, I don’t know

Conrad Meyer (00:20:25):
We might have it backwards. Right, right.

Greg Waddell, Esq. (00:20:27):
but they, you know they declined to issue the order. Well in that case, the court said the court would not require any doctor replaced in a potentially unethical position wherein they could be the committing medical malpractice by administering a medication for really an un unapproved and not a lot of basis for, you know, an off-label use.

Dr. Joseph Kanter (00:20:50):
Yeah. And you know, the issue of it being improved, clearly off-label use is a part of medicine and an important part of medicine, but it’s usually based in guidance based in established practice. And there was not really much attempt at all in this case to argue that this was, it’s pretty, you look at that leading healthcare agencies and recommendation bots out there, there’s nothing for this except some people on the fringe. So that a judge would go in, as you say, Greg, and, and, and order a physician to do something clearly against not only their own judgment, but the judgment of, of every leading medical society in the country is, it’s a half baked notion the way I see

Rory Bellina (00:21:27):
It. Sure, Sure. Dr. Karen, I have a directed question for you. You know, with this, we don’t know where this is gonna go right. With the hospital because there’s, like Greg mentioned, there’s some concerns that they might be held in contempt because they didn’t allow it to happen before the patient expired. What’s your biggest concern if other districts or other plaintiffs in this case, you know, see this and see the success that this one case held? You know, what do you think, you mentioned Pandora’s box being open, so what’s your biggest concern with Pandora’s box being open and lawyers and judges in the judiciary getting involved in essentially kind of dictating how you or, or someone would call in Greg’s and since someone would come into a hospital and, and kind of practice medicine, what’s your you know, what’s your issue with that?

Dr. Joseph Kanter (00:22:12):
Yeah, I think there’s harm to the, to, to physicians as an individual. There’s harm to the institution of medicine. There’s harm to hospitals, but ultimately there’s harm to patients in their families. And there’s a reason why we don’t do unnecessary medical procedures or treatments, because when there is no potential for benefit, all there is is potential for harm. And at the end of the day, patients and families are gonna suffer from this. And I think the judge probably led into this emotional case. And of course, it’s emotional and we’re in the middle of a pandemic, and that’s stressful. But you can’t let emotion get in the way of this, and something has no potential to hurt a patient. Only thing that’s left is the potential to harm them.

Rory Bellina (00:22:49):
Great point. We got cut. Okay.

Conrad Meyer (00:23:00):
Oh, we’re back. Okay. I, I didn’t see the timer fly up, so that, that’s why I’m looking at the timer. All right. Back on. one thing that we talked about is, is judicial interference, which is, you know, what this case seems to be about in covid land. One thing that you know, bothers me or not really concerns me is, is how does this affect bylaw provisions now with Granger, which are contractually related in according to the Supreme Court? So with Granger case bylaws, the bylaws are co a contract. And so what if the bylaws have a prohibition a against this or don’t allow for it? Are you now opening up hospital liability or that physician’s opening up liability from a, a bylaw perspective if the court order contradicts what the bylaws provide? And I like, I’d love to hear your comment, both of your comments, Greg, your comments on that. And then Dr. Cantor again, I think there’s so many questions like that. There’s so many angles to this because it’s such a, a, just a blush, you know, give the, give the, the medication. and, and we don’t account for any of the other possible things that this is going to, you know, call into question. Whether it be hospital bylaws, whether it be the medical ethics of the professional. you know, I, I don’t know. and even, even to me, even if you had a situation where in this case you didn’t, there wasn’t really an opportunity for a contradictory hearing you know, for the medical professionals to come in and even have a debate. Right. But frankly, I think even if there was, I still think all those questions remain. you know, when ultimately it’s not the, the medical judgment you know that’s driving you know, the care, it’s, it’s it’s, it’s the court, which is wholly different than what we do in any other, I guess you’re more typical even end of life cases, Right? In those cases, typically we’re arguing who has the power to consent for either continuation or, you know, not continuing the care. Right? Right. That’s right. But I don’t think we’ve ever seen a situation, even in those cases where the courts would be so specific to say, you know, you’ve gotta administer this, or you have to give that,

(00:25:21):
Well, I guess we’re lucky in a sense that if there was an issue, right, at least now with the government, the governor’s emergency order, you, you would have a very difficult time proving gross negligence for a med mal claim, because there’s no, you know, right now with that, that order in effect, you know, there’s no professional liability claims unless let’s gross negligence involved. So at least you have that. but still, I mean, imagine if that wasn’t in effect and you still have a court order regardless of covid or not, or some other issue. And it really kind of puts the, the crosshairs on providers, you know, here, shut up and do it, and do what I say from the judiciary. Now, I mean, I’m not, that’s a hard line, but I mean, that’s, that’s essentially what was said here.

Greg Waddell, Esq. (00:26:02):
I think also in the context, if you take it out of, you know, in this instant case we’re talking about ever mein is Dr. Can, you know said just a minute ago, right? taken for its you know, usual treatment, right? Minimal probably downs sides. But, but let’s say it wasn’t ever macin, Let’s say that it was, let’s say it wasn’t in medication at all. we, we’ve heard a lot of other,

Conrad Meyer (00:26:29):
Let’s see, let’s say it’s hydroxychloroquine. I mean, that that was the drug before. And a lot of the and you know this from as a physician, but hydroxychloroquine has its own issues. It’s not like ivermectin in a, a sense, because of it has its own side effects. It has its own problem, problematic you know, issues. it’s a little bit different. So what if it’s a drug like that? How, I mean, it’s a more problematic, I mean, you don’t know. Ivermectin is a little more common place in, in, in, in what we’re talking about, but hydroxychloroquine is not,

Dr. Joseph Kanter (00:27:02):
It’s a great point. You know, the precedent’s obviously the same, the practical effect, you’re right, Hydroxychloroquine has a worse side effect profile than I from Medo that has some cardiac side effects, right? Some conduction delays. People can go on cardiac arrest and rare. But again, it’s not, again, when you have no benefit, all you’re left with is the potential harm. it’s, it’s, you know, I’m putting myself in the shoes at the dock who might be ordered to do this. Sure. And I would think I would turn around and say, Well, judge, what dose do you want me to give? Because there’s no treatment guidelines here. There’s no real treatment guidelines. You want me to make up a dose and, and just do it. It’s an absurd order. I think it’s totally half baked. And I’m, I really am thankful that the hospital is taking this seriously. They could have just said after the patient expired, Well, well, it’s Mott and I don’t think it’s

Conrad Meyer (00:27:47):
Mod. Right.

Dr. Joseph Kanter (00:27:47):
Which the precedent here, the underlying issues are worthy of pushing this issue

Rory Bellina (00:27:52):
Forward. Sure. Now, Dr. Kanter, some of the proponents of this order that support the patient and the patient’s family, were saying that, like Greg mentioned, this is no different than a, a fat, a family battling between should a patient be removed from a ventilator and the court is ordering the court’s, ordering the patient being removed from a ventilator. The court is ordering the patient to be given this medicine. And, you know, how do you answer that? And, and do you see an instance where, you know, besides the ventilator example, where a court would be or should be allowed to dictate, you know, what you do, how do you kind of compare and contrast the two?

Dr. Joseph Kanter (00:28:25):
And, and those are always really challenging cases. One difference is you’re typically withdrawing care where here you’re actually gonna give something that wasn’t being given before. And those cases typically involve some disagreement either between family members or between the family member and the institution. And, and people who are, it can be declared brain dead, but on life support, go to court. It’s a completely separate issue because no one is negating a, a treatment that hasn’t yet been, been given. It’s, it’s whether or not it’s futile at that point, but to, to order a physician to actually initiate something that there is no consensus at all on, on whether or not Sure. It’s, it’s potentially beneficial, I think is, is a step way too far in that.

Conrad Meyer (00:29:10):
And so now, I mean, actually now you’re asking the judiciary to be the IRB board, you know, irb, you know, so, so, so my, what I think what I see happening is if this is allowed to go forward, if it’s not challenged, right, then you’re gonna have patients who look up any kind of thing on the take covid out of it, any kind of, you know, potential treatment for any kind of, you know, any remedy they can think of could be on the internet, and they’re gonna go to court and say, Well, you know, judge, I want, I mean this, I, I saw this on the internet, I saw this, and this could save, you know, my life. And I understand the plight behind that. But now you’re gonna have the judiciary act as the as sort of the gateway or the gatekeeper, if you will, if you allow this to go forward. If it’s not put to bed, you could see the, the Pandora, this is the Pandora’s box, right?

Dr. Joseph Kanter (00:29:56):
That’s right. And those type of conversations, as absurd as there are, happen all the time in hospitals, families come in with all types of things that they’ve heard or read and try and get their clinicians to do it. Right. And the conversation usually doesn’t go farther than, than that.

Conrad Meyer (00:30:09):
Right. And, and hopefully now, this, right now, Greg First Circuit, is that right? has it gone up to the First Circuit? I don’t know the answer, or I know it passed the order, and so I know it’s been appealed, but I don’t know if there’s been an actual Yeah,

Rory Bellina (00:30:24):
I believe they’re, I believe they’re appealing the, the, the systems appealing because of their concern, like Greg mentioned, is are they gonna be held in contempt of court for not providing it, you know, immediately.

Conrad Meyer (00:30:34):
So we’re gonna keep a close eye on that. Absolutely. Because I think that’s something that, that definitely requires follow up on. just to make sure, you know, where, where do the, where do the courts stand? I mean, if you think about it, the state has licensed your power over all professions, over physicians, over hospitals, and, and they don’t really interfere with that because they feel those agencies can govern themselves. And so, you know, this will be an interesting situation to see how the courts rule on this. and hopefully we’ll put this issue to bed. so that, you know, I guess, you know, we can decide if there needs to be further legislation to to cover the hospitals and the physicians going forward.

Greg Waddell, Esq. (00:31:11):
Yeah, definitely. Something that’s gonna, gonna remain really high on our

Conrad Meyer (00:31:14):
Radar. Oh, yeah, Absolutely. Absolutely. So now let’s, let’s pivot a minute, because I think we’re gonna talk about the, the next issue that I think is hot, right, is the mandates. I mean, I know you’ve heard, I’m sure you’ve heard this a hundred hundreds of times. and we’re, as, as practitioners, we’re getting this question literally, I would say

Rory Bellina (00:31:39):
Daily for me. Daily.

Conrad Meyer (00:31:40):
Daily for me, Every other day I’m getting a call from providers. Now this is dealing with the employer mandate. And so what, what has, what’s been the discussion at the state level regarding, we know the issue on the, on the fed side and even on the hospital provider side with the OSHA ETS that was issued in June. So we know that’s covered. But from a private employer’s standpoint, what have been the high level discussions that you can share with us with respect to mandating vaccines at the private level?

Dr. Joseph Kanter (00:32:12):
So, again, in the educational setting under the context of broad exemptions, which allows this, I think, makes it possible in a state like Louisiana that’s going forward, right? If and when full licensure is extended, right now, full licensure applies to give 16 and above outside of the educational setting into the employment setting, the state really is taking a back seat. okay. You know, we are waiting a number of federal rules. CMS is due out, right for a rule for, for healthcare providers and institutions. We’re waiting on a, a final OSHA rule for, for other employers as well. I don’t see the state getting more aggressive than that. Perhaps our own clinical entities, that Department of Health runs clinical entities, and, and we’ll be following federal guidance on that. But I don’t see the state getting more aggressive on this. That’s not to say that there’s not grounds for this.

(00:33:01):
I mean, clearly employers, particularly healthcare employers, have been mandating vaccines for, for many, many, many years. Sure. you know, as a member of a healthcare staff, a house staff, I’m required to show vaccines. That’s, that’s nothing new. and, and I think on another level of this, we have to find a way to get more people vaccinated. And there’s multiple avenues to that. There’s carrots and sticks and incentives and everything else. I feel like we have in this state tried everything we can. I’m being completely honest and a little bit frustrated with that. Right. We’ve tried financial incentives. We had a high dollar lottery program. We have a hundred dollars.

Conrad Meyer (00:33:41):
I, I, I never got that. I mean, I wish I,

Rory Bellina (00:33:43):
I saw the commercial

Conrad Meyer (00:33:44):
Score. Yeah. I never got my ticket.

Rory Bellina (00:33:46):
I think you were you weren’t allowed to participate. I remember there was some exclusions. Some exclusions. I, You were, Yeah. I think Greg probably wasn’t allowed to participate. That’s

Conrad Meyer (00:33:54):
Right. I saw. So, I mean, I saw the incentives. There’s been a lot of carrots and, and I get that. So it’s good. Yeah. So basically LDH is gonna be taking a step back, not really talking about private, let that kind of govern itself. And and interestingly enough, I mean, when, cuz when Rory and I did the show about what it a month ago. Yep. Yep. A month ago when President Biden came out on this private employer mandate of a hundred employees or more, the first thing that we did, we looked at each other like, Wow, okay. Here, here it comes. Right. And we were waiting for this because I did see the OSHA emergency temporary standard at ETS for the healthcare providers back in June. And so now I’ve been patiently waiting. I think we’re now it’s two months. Yep. and so we’re waiting for the ETS to come out, but it looks like the, the private industry is not waiting. They’re just saying, We’re gonna do it now. Yeah. You know? So have you personally, professionally have you got, what, what’s been sort of the, the, the discussion? I mean, Yeah, I know LDH is not getting involved, but as a, as a physician yourself what’s your thoughts on private mandates from the employer side? How do you feel about that? Should they wait for the ets? Should we do it now? I mean, what’s sort of your, your thought process on that?

Dr. Joseph Kanter (00:35:06):
It’s an easier call in my mind for healthcare institutions because there’s just no question. The care being provided to a patient is safer if the caregivers not just the doc, but the nurses and everyone else are vaccinated there, there’s absolutely no question about that. So it’s clearly centric. I think the conversation is a little bit more complicated when you move outside of the healthcare provision. I’ll tell you what drove the federal decision on this was Louisiana’s experience with Delta. Really? Wow. And, you know, we were like initially, you know, a year ago with, with Covid mm-hmm. , we were on the leading edge of the Delta surge in one of the first states to have a Delta surge. And it almost wrecked us. Came pretty, pretty darn close. Mm-hmm. , we were in close communication with the feds. They saw what was happening. You know, we are at the bottom of the barrel with vaccination rates, but there’s a lot of states, only a few percentage points above us right now. And if they think that two percentage points are gonna protect them against the Delta surge, they’re wrong. That’s what’s happening now. Delta is moving up, North is moving out west. You have a number of states enacting crisis standards. And the Feds took that and said, We need to pull every lever that we can to get ahead of that. And those type of mandates we’re part of that. And

Rory Bellina (00:36:13):
You mentioned other states, I think that that’s an interesting thing to bring up. I know where Louisiana and focus heavily on Louisiana, but you know, you see Louisiana doing things that, that other states, states are not doing that vaccine mandate. You see Orleans Parish doing things that other parishes aren’t doing. You know what, what consideration has gone to that to where Louisiana is, is pushing very hell hard as compared to our neighbors to, you know, Mississippi, Texas. I know that there’s a lot of politics involved in that, obviously, but, you know, what do you think the considerations were taken? so where we kind of are, are more pro-vaccine than, for lack of our expression, pro-choice per se, to compared to these, the surrounding states near

Dr. Joseph Kanter (00:36:53):
Us. You know, it does vary depending where you are in the state. And, you know, New Orleans is kind of it’s own entity here. Sure. But for, for good reason, number one, it bore the brunt of the first surge. It had the most casualties. People have a real visceral memory of what that’s like and know people who got sick and died. And the other thing is, New Orleans has a vulnerability in the tourism industry because so many people come in, they felt they need to protect themselves against that with an eye towards Mardi Gras. And I don’t think they’re wrong in that, you know, I don’t think that mandates are the only way to get to where we need to be. But I am frustrated that we’ve tried a lot of carrots so far mm-hmm. , and they have yet to get us to where we need to be. And as a society here, as a community, like I said, we’re going to be vulnerable Sure. To another surge that takes a toll on human life. It takes a toll on our economy. And if there’s a way to prevent that, I think we need to be pulling the levers that we can pull right now.

Greg Waddell, Esq. (00:37:43):
And maybe we could talk a little bit you made a reference to crisis standards of care. and I think folks, you know, particularly in the healthcare and hospital industries understand that. But, but for some of the folks out there that might not be is up on, on what that means, kind of kind of give us a little insight on, on what we mean by crisis standard of care. Because I think it’s important in the context of why vaccination is so important. because taking that step, really engaging in a crisis standard of care decision there’s, there’s a lot of, of really huge consequences to that.

Dr. Joseph Kanter (00:38:18):
Yeah. I mean it’s, it’s, it’s apro to talk about this the day after Halloween, cuz it really is nightmare situation. It’s essentially this state giving legal cover to hospitals and doctors to say, if you need to triage and decide who gets your care and who doesn’t based on the preset list of criteria, you have the legal cover to go about and do that. We’ve never really formally enacted it here. It’s typically thought up in terms of, okay, I’ve got 10 ventilators and 20 patients that need it. Right. How do I split it up? Okay, you’re too old, you don’t get one, you’re young, you get one, You already have diabetes, you don’t get one. Those type of horrendous decisions that no one wants to find themselves and a little more nuance. In this case, we’re not worried about ventilators now we’re worried about staffing resources, the ability to care for a certain number of patients.

(00:39:07):
But the fact that a number of states, Washington State, Idaho, Alaska, a couple other ones called Colorado have enacted these standards is, I mean, that is as bad as it gets. They’re ringing the bell that the hospitals literally cannot care for every patient that needs care. That’s, I mean, I can’t think of a time it’s been that bad, but it surprises me that we’re kind of just accepting that as almost, okay, that’s what’s happening now. That, that that’s not okay. And that should be a signal that we have to do everything. We can put yourself in the shoes of someone that needs to be hospitalized. If someone tells you you can’t be hospitalized because, sorry, this person next to you is just as sick, but probably has more life expectancy. That’s just a crazy proposition.

Conrad Meyer (00:39:48):
It’s, it’s crutch. I mean, I mean, nobody wants to who, who can make that? It’s so hard.

Greg Waddell, Esq. (00:39:53):
Or even the context where you’re injured, you know, not because of covid and you need to try and, and Right. You know, get to a hospital that’s, you know, well beyond its its capacity. you know, when you’re talking crisis standard of care, you have really, really maxed the community resources. Right. you know, in that area. Well,

Conrad Meyer (00:40:13):
Let’s be, let’s be clear right now. I mean, we’re not in a crisis standard right now, are we?

Dr. Joseph Kanter (00:40:17):
No, no. We got very, very, when we had over 3000 hospitalized COVID patients, we got very close. And I’ll give you an example. you know, I still practice our practice as an ER doc in town. And the hospital I work in, we routinely take transfers from other hospitals. Mm-hmm. I accepted a transfer of a heart attack patient who’s having a stemi. this patient had to bypass six cath capable hospitals to get to meet. It took a two and a half hour ambulance ride to get to meet because those hospitals were full. That’s by virtue of us being at max capacity if we were operating on a crisis standards. The answer might have been sorry to take you.

Conrad Meyer (00:40:53):
Sure, sure.

Greg Waddell, Esq. (00:40:53):
Oh wow. So to round that out, I mean, just how important getting that vaccination percentage up because that really is that a huge key in the puzzle of keeping our hospitals in a position where we can continue to provide, you know, access to care.

Dr. Joseph Kanter (00:41:09):
Right. And I think the point you’re making, Greg, is not just to covid patients, Right. It’s to people that have car accidents and heart attacks and all the other things that you don’t plan for. We’re not used in this country to not having first class medical treatment available at the drop of a hat. And that’s the risk that we put ourselves in. And we got really, really close here to not having that.

Conrad Meyer (00:41:30):
And I think I, I can understand from a mission and vision standpoint, from a, from a hospital that as caregivers and providers, you want to take the lead and show the public that hey, we’re, we’re, we’re vaccinated. You know for one really, you know, to make sure that they’re not carrying or vectors for the virus for patients. and but also too, just to be I guess the, the, I guess the front bearers, right? The bellwether to show the public, hey, you know, maybe, you know, this is not snake oil, this is not bad. We are doing it. and we’re doing it to show the strength. And I understand that. And also, lemme tell you, I understand a person’s right to decide that that about their choice. I get that. I do. And so when I look at the, the lawsuits and I see all the nurses, I mean, the very first one, Roy and I, the show on this, we did the one on the the hospital in Houston.

(00:42:28):
That was one of the first ones. Yeah. Method, They what, 160 or more nursing staff literally fired on the spot for non-compliance. And, and we’re seeing it carry over here. and I know you, you’re, you know, LDH is not gonna step in. I I understand that. and, but I’m just curious what, you know, how does, how does the hospital, you know, Greg, what are your thoughts on, on that from, from a mandatory p portion on, I mean, I know everybody wants to get vaccinated, everybody wants to do this, They want to get the the hospitals vaccinated. But, you know, where do you see the lawsuits going from the hospital association standpoint? I mean, how does it affect the, the, what are you hearing in your discussions, if you will, about mandatory and, and, and that, that are creating the staffing issue? Because from what I understand is, is, is is that when you have all these nurses walk out, you’re not gonna be calling staffing companies. There’s gonna be hard, you know, the stress on locums work must be unbelievable. So what are the discussions that you’re hearing about how this is being handled at the, at the top level?

Greg Waddell, Esq. (00:43:35):
I mean, I think that what, if you kind of look across the state, what you’ll see is, is a mix. We’ve had some large health systems come out with with their mandates. you know, we’ve read in the news they’ve been challenged in, in Lafayette, they’ve been challenged in Shreveport you know, various underlying legal arguments to those challenges. I think you’ve seen some other health systems that have tried to, you know use carrots in order to get you know, their vaccination rates up or done something other than you know, an outright mandate. we’ve seen some work around medically you know paid policies, whether you’re vaccinated or un vaccinated. but short of being that sort of you know, that mandate. So I think it really you know, has been really up to the hospital and, and where they’re at.

(00:44:24):
Some hospitals really haven’t had to resort to really either of those because they’ve really had a, a, a really high uptake you know, of, of folks who want to, you know, get to get the vaccine. Sure. So it hasn’t been this, you know, underlying tension. Sure. Staffing, you know, is, is, is a problem. I think the it was a problem before the pandemic. The pandemic’s only made the staffing Right. you know, that’ll, you’ll see that become a major you know work of the association trying to address some of the staffing issues, not just Louisiana that’s across the country. but I think that you’ve, you see the, the health systems that have come out and and done the mandate, I think they’ve, you know, I think they’ve looked at the, at the negatives associated with the impact on staffing. And at the end of the day said, Look, this is the right thing to do. We, we, we we gotta be vaccinated.

Dr. Joseph Kanter (00:45:12):
Yeah. You know, to date the Supreme Court has, has largely dismissed, you know, these concerns. And to my novice read, and the experts here can correct me if I’m wrong, Amy Coney Barrett kind of dismissed request for conjuncture on Indiana University’s bandaid, sort of my, I saw that. Dismissed New York’s. And then just last week, the whole court with the dissent of, of three of the conservative justices dismissed Maine’s mm-hmm. inquest for injunction against their healthcare mandate. So those are all in place now. It was an interesting interview with one of the CEOs of a hospital in Maine who is now moving forward with their statewide healthcare vaccine mandate. He said that he anticipates one to 2% loss of staff from the mandate, and he thinks he’s gonna make that up by less absenteeism. You know, when you’re fully vaccinated, you don’t have to quarantine after an exposure. So that was an interesting point of view. He thinks the section would come outta head in terms of absenteeism. Sure. After

Rory Bellina (00:46:03):
This, I know this is a question that we could talk, you know, three hours on, but I just wanna get your opinion. What do you think our biggest, and I’ll focus on Louisiana, what do you think has been Louisiana’s biggest hurdle in getting more people vaccinated? I mean, when we had the vaccine it was tiered and, you know, it was an elderly population and then it, it teared down in age and, you know, there was, if you look at the charts of vaccines, we had that nice incline and then it, it came down and I think it, it went up again when Delta happened cuz people were very concerned with that. But, you know, what do you think the overall concern is? Healthcare providers, parents, Just everyone in general. if you kind of summarize what you, what you’re hearing in Baton Rouge with the governor on, on what, why can’t we get more people vaccinated

Dr. Joseph Kanter (00:46:43):
For, from my point of view, it’s misinformation and it’s politicization. There’s a lot of bad information out there. Some of it is honest mistakes, some of it is, is deliberate. But the myths are, I mean, we, we’ve, I don’t even wanna repeat them, but Sure. They’re, they’re easy to fall victim to. And I would never have fought a family for falling victim to them. I’ve heard one one family account to me and they lost a loved one who did not get VA was on Iram hec and did not get vaccinated. And then literally on the woman’s death bed, her family is saying, we just didn’t know what to believe and was telling us something different. And that really pulled up my heartstrings. People fall victim of this stuff when it’s on your social media feed 24 7. It’s easy to fall victim to it, but then there are people that are taking advantage of Sure. This uncertainty of the crisis and trying to squeeze political gain and, and, and trying to push, push an issue, issue one way or the other. And to me that’s, that’s completely unacceptable. Sure. you know, it’s, it’s, it’s tough. And this is, if there ever was a bipartisan issue, this vaccine was developed first by Republican administration, now by democratic administration. Sure. it’s one of the modern miracles of science. I really wish that we could put the misinformation aside because families are really falling victim to it.

Conrad Meyer (00:47:50):
And I think, and, and, and when I looked at the cases, like for example the Lafayette cases of the case and Lafayette, Greg and, and then the Shreveport case, very interesting cuz now we have a split in the circuits. And so from a, from a legal standpoint, Louisiana, and I mean, I’m, I’m not, I’m not looking at Amy Coney Barrett and, and, and the Supreme Court, I’m looking at Louisiana. So as it stands, as we sit here today, there’s a split in the circuits right now. And I think there’s differences of opinion. So the second circuit just reviewed a case from Shreveport, this is from the Oscar Shreveport nurses, I believe, and correct me if I’m wrong, is that is the Austria. Right. And so basically the the judge dismissed at the district court level, the temporary restraining order, permanent preliminary injunction on a no cause of action exception.

(00:48:44):
And that went up to the second circuit. Second Circuit says no, no. Mm-hmm. You look at the pleading, you look at the face of the pleading, there is a cause of action. We’re gonna knock it back down to to the district court for further deliberations consistent with preliminary injunction. And and tro that was not what the third circuit and the district court said in Lafayette. I mean, it was just denied, denied all the way through. So my understanding is right now that the Shreveport basically is on hold and just wanted to get you know, the, the lawyer comment from Greg and the non-lawyer coming from Dr. Cantor. What do What do you think’s going on with the split in, in the circuits and what is your, what do you think, I know you’ve read the cases, so what, what are your thoughts on that?

Greg Waddell, Esq. (00:49:31):
Yeah, I mean, I look I guess I’m kind of just as surprised with the split as I was with the judge’s opinion with the ever metin. I mean, when, when I look at the cases, I, you know, I don’t see a strong legal argument that, you know, as an out will employer that whether it’s a hospital or any other employers shouldn’t have the ability to do that. now that’s, you know, Greg’s opinion and I’m certainly you know, certainly biased right. But you know, it, it’s surprising to me. It’s surprising we don’t have more consistency there.

Conrad Meyer (00:50:08):
well, do you see this going up all the way? I mean, is this, is this something that the Supreme, our Supreme Court is gonna hear you

Greg Waddell, Esq. (00:50:14):
Think? I mean, it seems to me like it’s gonna take some more out of the, out of the Shreveport district court if they really do have a hearing on, you know, on the actual merits and then see where that goes. Right. cuz we really haven’t had that so far. Right. I mean, the left yet, yet cases were, were basically just dismissed. so I don’t know, you might end up in the same spot. Right. Even in Shreveport after the, after the hearing you know, if they do have a hearing

Conrad Meyer (00:50:36):
Or whatever, these cases gonna be fast tracking no matter what. Cuz deadlines are coming up. So, I mean, no matter what happens, I mean, it’s gonna get fast track.

Greg Waddell, Esq. (00:50:41):
I think another sort of interesting wrinkle on this that we’ve been trying to keep up with are the states that are coming out with you know, going the other way and saying that you can’t mandate you know, the vaccines mm-hmm. . And so, particularly from the healthcare standpoint, if we do see you know, a rule mm-hmm. from cms, that makes it a condition of participation. and you’re sitting in a state that’s come out and said, you can’t mandate sure vaccines well, which, what do we do there? The

Conrad Meyer (00:51:07):
State? Well, that’s a different, I mean, not, Well now you’re throwing a wrinkle in there’s a little wrench in the engine. I mean, cuz of, of conditions of participation. I mean, you have to meet those That’s right. In order to have your license

Greg Waddell, Esq. (00:51:19):
And, and participate,

Conrad Meyer (00:51:20):
You’re to be a provider participating provider

Greg Waddell, Esq. (00:51:23):
For Medicare and

Conrad Meyer (00:51:24):
Medicaid. Medicare, Medicaid. Right. So

Greg Waddell, Esq. (00:51:25):
You, you know,

Conrad Meyer (00:51:27):
Potentially now you’re in conflict. Sure.

Rory Bellina (00:51:29):
And I’m sure these are frustrating to you, Dr. Can, because you know, when I see this split in these two circuits, which are pally, you know, close to each other, typically more conservative circuits you know what, what, what do you see becoming of this? Do you see more of fear of the vaccine or people saying, Oh, we’re right, that they’re wrong. You know, what concerns do you have as the state health officer that we now have this split and time will

Dr. Joseph Kanter (00:51:56):
Tell? It’s a distraction. I’ll tell you that because the conversation should be about what are your concerns about the vaccine, Why are you not getting it? Let me talk to you about what your fears are and that conversation has become, I don’t agree with mandates. Okay. But, but the real issue is what are your hesitations about getting the vaccine? I want that to be the focus, cuz that’s really what we’re trying to get after. I’ll tell you the, the precedent here is potentially profound. And, and I’ll give you an example. My, my mother-in-law is getting chemotherapy right now, and you know, she, so she’s immunosuppressed and she’s vulnerable. Her hospital guarantees her that the providers that she sees when she goes in are vaccinated against measles or vaccinated against pertussis, easily spreadable respiratory viruses. That would make her very, very, very sick. A hospital would potentially lose the ability to make those assurances, which is a common place assurance by hospitals. Vaccines have been required for healthcare providers for many, many years here. Right. If that ability would to be go away, that would have profound impacts on the care provided.

Conrad Meyer (00:52:55):
And I, and and you, you bring up a very interesting point. I I do, I do agree the discussion is hard. It’s been the discussion about the vaccines themselves, Right. It’s been politicized. I I mean if you, if you go back to the beginning of this, you know, the message was don’t wear masks. Wear masks, wear two masks, wear three masks. The message has been so mishandled in my opinion that it’s put the public on its hi, you know, you know, on its heels and sort of say, Well, wait a minute. What’s, what’s the right message here? And I, and I, and I agree with that because there’s not been a clear message and, you know, you’ve got, you know, studies that were, you know, people on the CDC coming out and, and they say one thing, then do another the study we want, you know, we want to give you the vaccine before we’ve had the study. We want him to do an EUA use. and we really haven’t done anything. I can see why people have fear. but now, I mean, we’re talking about in the country, right? I don’t know the numbers, but maybe you do, but over 180 million doses have been given. I mean, we have a population much

Dr. Joseph Kanter (00:54:07):
Four, 400 milligram or so.

Conrad Meyer (00:54:09):
400 we’re talking about, well, two doses. Correct. So I’m thinking two doses, but I’m looking in a population of 335 40 million people, we’ve gotten 400 million doses. Now, you know, some people have to talk about the VAs reporting system and then, boy, wow, is that really accurate? Is that being said? And what are we counting as covid versus non covid? But still, I mean, even if you, even if you take in all that into account and you look at the various reportings, you have 400 million doses. And, and so I mean, you know, it looks like that the effects are whatever adverse effects they are, I mean, extremely low, extremely low. So, so with that being said, I mean, do you feel the conversation or the message, right, the message or the focus right, has been lost on the vaccine? Is that, how do you feel about that?

Dr. Joseph Kanter (00:54:54):
I absolutely agree. And, you know, we have the most advanced comprehensive safety monitoring system in place right now for this vaccine than we have ever had in history of this country. Even

Conrad Meyer (00:55:06):
Measles and anything else,

Dr. Joseph Kanter (00:55:07):
Much more advanced than that. Anyone can report into it. They all get investigated. It’s a highly sophisticated system now. And I like having that conversation. I like talking to people about, you have concerns about the safety. Let me tell you what system is in place. Let me tell you what Vegs really is. Let me tell you what my agency does. Nobody’s

Conrad Meyer (00:55:24):
Talking about that. You know that That’s right. No one, right? No, I mean, I, I mean, all I hear about theirs is, is well, what’s counted and who’s doing this? And it’s miscounted, you know? So, so what, I mean, tell, tell, I mean, do you have, can you, you have the knowledge. Tell us about that. Wanna hear about that? Absolutely. I mean, just spend a few minutes real quick. What is ver how is this being counted? What’s being looked at so that people can feel the, you know, get back to the message on the focus of this?

Dr. Joseph Kanter (00:55:46):
Yeah. Great. So, so various stands for Vaccine Adverse Event Reporting System. It’s the CDCs Catchall First Step surveillance network. It’s designed to cast a very, very wide net so anyone can report an adverse event into it. Doctor can, a patient can, a family member can. And the idea is that you don’t need to have proof that it’s caused by the vaccine. Any adverse event gets put in there, you cast a wide net and then those cases get investigated. The majority of them get investigated and turned out that they weren’t related to the vaccine, but some of them are. Okay. It’s all transparent. So you can go online, look at the database and say they were 500 people that died within two weeks of getting the vaccine. True. Doesn’t mean that they died from the vaccine. You can’t take that. What some people have done is taken that, that big net and extrapolate and say the vaccine caused those deaths. Right. Sure. That’s just the first step in the

Rory Bellina (00:56:38):
Orion process. I had a sore arm after I got vaccines. So that counts as an adverse event that I is really to covid.

Dr. Joseph Kanter (00:56:45):
Right. Okay. Or, you know, we vaccinated about 88% of nursing home residents in, in the state nursing home residents are old and sick. Sure. And they get sick. And so all those events get put into bears. It doesn’t mean that the vaccine Sure. Caused it.

Rory Bellina (00:56:58):
Sure. Right. One question I had that we, we’ve talked, we said carried and stick a few times, and I wanted to get, you know, both of y’all’s opinion on this. We tried the, the, the process of offering it to certain populations, and then everyone you mentioned the lottery and, and giving away the money and restaurants are giving away free food and everything. But now we’re switching over to unfortunately, like the stick thing. You know, do you, do you like that? Does this administration, did they want to do this? I mean, what issues do you see? I I almost hear from people that they’re more mad that they’re being penalized and they’re, they’re digging their heels in and they’re saying, Well, if they’re gonna make me get it now, I’m definitely not gonna get it. I mean, what, what discussions has been had, you know, in Baton Rouge regarding that?

Dr. Joseph Kanter (00:57:41):
I don’t, like sure is the simple answer. And and to be fair, the state really isn’t playing with the stick right now. Okay. The state’s still sticking with the carrots, but the federal administration is, and I think their perspective is that at this point, it’s a national security issue. We’ve lost over 700,000 lives in the country. Try and compare that to the last war we were in. Yeah. And you know, much like no one likes the draft and the draft is an infringement on your liberty, but desperate times may call for it. I think that’s the way that they look at this. Like, sure, we’re gonna still be in this war and, and still be in this crisis unless we can get sure. More people to get vaccinated. And I think the feds think they’re between a rock and the hard place. And

Rory Bellina (00:58:23):
Greg, I assume it, it’s probably the same answer on the, on the hospital side, that hospitals didn’t want to implement these mandatory vaccines or else you’re gonna be terminated or you’re gonna have to wear a Knn 95 all day, or you’re gonna be shifted to a non-patient focused job duty. But, but they’ve had to because just people voluntarily aren’t doing it. I mean, do you think that’s the right approach or it’s just, it’s just where we are today?

Greg Waddell, Esq. (00:58:47):
I think it really has depended on, on the specifics going on in each facility and what they, what they felt like they needed to do or not do in order to, you know, get people to to make the choice to get vaccinated. and, and really I think that’s what everybody wants. I don’t, I don’t think anyone, I mean even the federal government, I’m sure if you asked them I’m their first choice probably wasn’t you know, a mandate. But at the end of the day that’s the decision they had to make.

Conrad Meyer (00:59:14):
So let me ask you this. I mean, let’s pull back for a minute. Okay. I like to zoom out and not zoom in. So let’s pull back. What are the lessons learned from a hospital delivery or healthcare delivery standpoint from dealing with Covid? We did this in Katrina, remember. I mean, we all looked at Katrina and the lessons learned. I mean, that’s when everyone’s like, Let’s put generators on the second floor now and well, let’s make sure we have enough gas and, and all the other, you know, emergency safety measures now from Katrina. So let’s look at, at Covid and what, what would you say would be the lessons learned from the healthcare delivery system on Covid? Because let’s say we have another communicable disease, you know, maybe a a a Mars or Sears, you know, something, you know, something that’s air who knows. Let’s say there’s some other crisis that comes down similar to covid. What have we learned from providers, from facilities from the Covid experience? Dr. Can, Yeah,

Dr. Joseph Kanter (01:00:15):
I’ll go up first and I’m curious to hear what Greg thinks as well. You know, it’s funny you say Katrina, because we actually feared much better during this pandemic, particularly the earlier months because of Katrina and the experience afterwards. After Katrina, we invested heavily in emergency preparedness, particularly our communication systems between hospitals themselves and between hospitals and the state. We actually have one of the leading communication systems in the country. And the state has real time visibility on hospital bed capacity and census throughout the state. I can log on to any moment in time and see how many patients are in

Conrad Meyer (01:00:47):
Hospital business. That’s amazing. How didn’t know that. Yep.

Dr. Joseph Kanter (01:00:49):
That’s great. And we’ve coached a lot of other states to get there. We had that in place going into this pandemic. So when things got tight with hospital capacity, we knew exactly where we were, where the gaps were.

Conrad Meyer (01:01:00):
And so I envisioned, I mean, like I envision like Katrina, we always have these emergency response rooms and things like that. So at ldh, do they have some sort of bunker with all the videos? I mean that, that you can monitor a crisis like this?

Dr. Joseph Kanter (01:01:12):
We do. Absolutely. Wow. And, and, and made these type of movements easier. I’ll tell you not, We evacuated about five or six tier one hospitals during Hurricane Ida in the middle of our surge. Right. Not a lot of states could have pulled that off. We pulled it off without really missing a beat. So in my mind the, the number one goal here is invest in emergency preparedness and don’t wait for the emergency to make those investments.

Conrad Meyer (01:01:37):
What was different though from this time? In other words, what were, are there any, could I agree with you, Katrina really helped prepare Yeah. A lot of us for this in a sense. But are there anything, is there anything in your mind that stands out different that, hey, I learned from Katrina, but Covid I also learned this is what we need to do. Is there anything that you could think of?

Dr. Joseph Kanter (01:01:59):
I, I’ll tell you, the duration of this emergency was challenging to us. And you, my team is so used to responding to hurricanes that, you know, you do it, you’re all in for a couple weeks and then you can relax a little bit. This has

Conrad Meyer (01:02:11):
Been, so you’re on the code gray team. Mm-hmm. always, always ,

Dr. Joseph Kanter (01:02:14):
life. you know, I need a more robust workforce in public health to be able to sustain this type of prolonged activation.

Conrad Meyer (01:02:22):
One question, and I’m gonna turn it to Greg. ppe, would you say that stock, I don’t wanna say stored stockpiling, but investing in adequate materials management supply chain for your facility, was that something that changed Post covid

Dr. Joseph Kanter (01:02:41):
Still still changing and still needs to do more? I mean, I was one of the docs early on that had to duct tape my gowns together cuz we Oh

Conrad Meyer (01:02:47):
Wow. Wow. We

Dr. Joseph Kanter (01:02:47):
Didn’t have any more, you know, we’re very reliant on international supply chains here. Sure. It’s national security. We gotta do a better job of preparing and stocking what we need. Gotcha.

Conrad Meyer (01:02:56):
Okay. And to your, to Greg, to your point, anything from, you know, post Katrina to post Covid lessons learned?

Greg Waddell, Esq. (01:03:03):
I feel like Dr. Kanter took my thunder to look . Cause

Rory Bellina (01:03:05):
I was really,

Greg Waddell, Esq. (01:03:06):
I was really gonna hit on the, on the data exchange between the hospitals and the state. I mean, what we’re doing in that, in that realm is, is more than we’ve ever done.

Conrad Meyer (01:03:15):
Is it only tier one hospitals though? I mean, I mean it, all of them. Everyone, every hospital. So even level two. Wow. What about rural facilities?

Dr. Joseph Kanter (01:03:24):
All of them. All of ’em.

Conrad Meyer (01:03:26):
Yep. So the rural hospital network also feeds into ld.

Dr. Joseph Kanter (01:03:29):
It all feeds. I’ll try. You gotta give Louisiana and credit when, when we’re due. Cause we’re not always due credit, but we are a national leader in our communication network with hospitals.

Rory Bellina (01:03:37):
Wow. Wow.

Conrad Meyer (01:03:38):
What about private hospitals? All

Dr. Joseph Kanter (01:03:40):
Of

Conrad Meyer (01:03:40):
’em. Oh, interesting.

Greg Waddell, Esq. (01:03:41):
And it’s been you know, it was a lot of work on, on the state side and the, and the hospital side to do that in a, in a very, very,

Conrad Meyer (01:03:48):
So you can, So just to be, just to be clear, I’m sorry. I mean to cut you off, just to be clear. So you can pull up on a screen any, anytime 24 7 and look at current rate, like open beds, vent patients whatever the data should those, those are real time.

Dr. Joseph Kanter (01:04:04):
Yep. And ppe, how much ppe they,

Conrad Meyer (01:04:06):
Wow,

Dr. Joseph Kanter (01:04:06):
Real, really, And I’ll tell you, and this was in part by investments from the hospital association. We partner with our hospital association in a way very few states are able to partner.

Conrad Meyer (01:04:15):
Wow. Interesting. I mean, that’s really incredible. I never do any of that.

Rory Bellina (01:04:18):
No, I didn’t either. And

Greg Waddell, Esq. (01:04:19):
A lot of that, I mean, I think was started, you know, after Katrina and certainly been used anytime you know, before the pandemic. you know, even with some of the responses to the hurricanes around bed capacities and those things. But, but never really to, we’ve taken another step here you know, in that data exchange and something I think that’s, you know, pretty exciting. Yep.

Rory Bellina (01:04:43):
I have a question for you, Dr. Can, since we’re, you know, we, I think we’re slowly approaching at the end of this. if you can go back in time, not, not the beginning of the pandemic, cause that’d be an unfair question, but if you can go back a little bit at time, you know, what would you have, what would you have done different or advise the governor to do different or, or what do you wish, if take the pressure off of you, what do you wish us the citizens of Louisiana? hindsight’s 2020 going back, you know, make some changes.

Dr. Joseph Kanter (01:05:10):
Yeah. Well, listen, I, I think the governor’s done a remarkable job is there’s, and I’ll tell you amongst governors, he knows more about covid and about emergency response than, than anyone. It really is, is surprising how, how sharp he is in this stuff. You know, in terms of the state. If there is a way to just make the vaccine work less political. And I, and I don’t know how that’s done. Perhaps we could have done a better job building stakeholders, reaching two legislators, building a bigger coalition. Okay. But I don’t think we anticipated the extent that the vaccine would be contentious. And I’ll remind folks when it first came out, and this is December, 2020. Mm-hmm. January, 2021. Our problem was how do we triage it and how do we make these tough decisions of okay, doctors and nurses get it teachers. Right. And it was a terrible decision. Right. We thought we would have sustained demand for it. And, and boy we were, we were wrong about that.

Rory Bellina (01:06:02):
Okay. Okay. So education, you think, you know, if we could have, if the state could have changed maybe the way that they, they educated it, that we could have, maybe we’d be at that 65% that you want us to be at.

Dr. Joseph Kanter (01:06:13):
Yeah, I think a bigger tent in terms of communications and stakeholders earlier on with the vaccine. Okay.

Rory Bellina (01:06:18):
That’s great.

Conrad Meyer (01:06:19):
Interesting. Interesting. Greg, any thoughts on, on, on lessons learned? If you can go back in time, what would the hospital association do differently, if anything? Or do you think it, or do you think, you know, things are in place now, you think that things are, are good, the status quo in terms of how things went down?

Greg Waddell, Esq. (01:06:37):
I think there’s always room for improvement in anything that we do.

Conrad Meyer (01:06:41):
I would agree with that.

Greg Waddell, Esq. (01:06:41):
There’s always looking back, I think we’re continuing to learn. I mean, I think if you look at even the medicine from mm-hmm. , the time the pandemic started, I think Dr. Cannon would agree that the medicine’s completely different from where we started to where we are now. and, and that’s, you know,

Conrad Meyer (01:06:57):
When you say the medicine, you mean therapeutics now, Even the options from there.

Dr. Joseph Kanter (01:07:00):
All of it. I’ll tell you again as an here doc, in the early months we were intubating early cuz we thought patients were gonna attire and it would improve. Sure. And then we found out, based on our experience, the national conversation found out that you actually wanna delay intubation as long as possible, which is not what you do for other diseases. So all types of treatment, you know, evolved. And it’s a nuanced conversation. You know, science doesn’t mean the right answer is always the right answer. It means you change based on what the data shows. And we certainly have changed practice throughout the course of this

Conrad Meyer (01:07:30):
Pandemic. Right. Interesting. All

Rory Bellina (01:07:31):
Right, well, I’ll, I’ll I’ll finish over with this going forward. You know what, obviously you want more people to get vaccinated, but kind of, you know, what would you like to, to leave us and, and our, and our listeners with, how could, you know, citizens, attorneys, physicians, whoever’s watching and listening to this kind of a closing thought and or a plea from you?

Dr. Joseph Kanter (01:07:51):
Sure. I, I, I clearly want people to be, to be vaccinated and to at least talk to a, a doctor or clinician or, or someone that knows the science. If you do have questions. My my other ask would be to folks who talk about this either publicly or with clients or, or whatever, just take the tenor down a little bit. You know, it doesn’t have to be so contentious. It doesn’t have to be so politicized. There’s a big middle ground there. I think if we work to just take the tenor down, it’ll service us better.

Conrad Meyer (01:08:18):
Okay. Agree. Well, guys, I wanna thank you very, very much. I think we, we’ve rounded out here. Yes. Dr. Cancer, it’s been a pleasure to have you on the show. Yes. Thank you for joining us Greg. Very much appreciated you and the hospital association and all the resources to come on the show. And hopefully all of the health lawyers who are watching and listening and, and the audience listening on the podcast can really enjoy this has been very, very, very informative. So thank you very much for that. Until next time we’ll catch you on Health Law Talk at Chehardy Sherman Williams.

Rory Bellina (01:08:59):
Thank you for listening to Health Law Talk presented by Chehardy Sherman Williams. For more information or to contact us, please visit our website, linked in the description below. Also, please be sure to subscribe to our podcast and follow us on Facebook, Twitter, LinkedIn, in YouTube, in the description below. Thank you for listening.