Was this Houston doctor right or wrong?

6,799 Views | 29 Replies | Last: 3 yr ago by PatAg
oragator
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9:05p, 2/10/21
Didn't see it posted...

Quote:

The Texas doctor had six hours. Now that a vial of Covid-19 vaccine had been opened on this late December night, he had to find 10 eligible people for its remaining doses before the precious medicine expired. In six hours.

Scrambling, the doctor made house calls and directed people to his home outside Houston. Some were acquaintances; others, strangers. A bed-bound nonagenarian. A woman in her 80s with dementia. A mother with a child who uses a ventilator.

After midnight, and with just minutes before the vaccine became unusable, the doctor, Hasan Gokal, gave the last dose to his wife, who has a pulmonary disease that leaves her short of breath.

For his actions, Dr. Gokal was fired from his government job and then charged with stealing 10 vaccine doses worth a total of $135 a shun-worthy misdemeanor that sent his name and mug shot rocketing around the globe.

the judge dismissed the case emphatically, but the prosecutor says he is still going to bring it to a grand jury.

The Vaccine Had to Be Used. He Used It. He Was Fired.
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DadHammer
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9:17p, 2/10/21
AG
It's stupid to waste vaccine.
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Capitol Ag
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9:59p, 2/10/21
AG
What he did was no different then when pharmacies give remaining doses to shoppers in the store. No one has prosecuted them.

He was 100% correct to do what he did. Waist of time and tax payer money. I hope he finds a new place to practice out of soon.
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Reveille
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10:54p, 2/10/21
AG
This doctor absolutely did the right thing! Wasting doses of a vaccine in a pandemic is crazy. He asked health care workers first and could not find any that needed the vaccine. Protocols should be put in place by the facility to have people be able to come wait in the parking lot on a stand by list for doses left over at the end of the day. There will likely be no shows all the time and a few extra doses left over. If anyone is to blame it the place he worked for not having any protocols in place for doses that would expire. Simply wasting them seems crazy when millions of people are waiting to get vaccinated. The judge is right dismissing the charges.

20 years ago I gave college age kids free meningitis vaccines when they were going to expire in the next few days. They were $250+ per dose and not required for college back then just optional. Rather then throw them away I gave them away hoping to potentially save life. What he did is no different he just had a few minutes verses a few days.

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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FratboyLegend
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12:11a, 2/11/21
If the quoted account is accurate, or frankly even half-accurate, then this is an unquestionable good-faith effort on the MD's part during a statewide gubernatorial Declared Disaster and is therefore a legal non-issue.

This is the legal equivalent of prosecuting somebody for using confiscated water to fight a fire. It's absolutely preposterous.
#CertifiedSIP
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94chem
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10:23a, 2/11/21
Not wishing to help anyone unnecessarily, but there are certain places in our great state where you are more likely to get vaccinated without excessive wait times, regulations, and punitive measures enforced on caregivers and recipients. I encourage people to find those places and report back.
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
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texag84
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11:36a, 2/11/21
AG
Hell, the doctor is a hero!
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astros4545
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11:41a, 2/11/21
AG
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it
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aginlakeway
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In reply to astros4545 • 11:56a, 2/11/21
AG
astros4545 said:
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it

That's accurate. It's ineffective after a certain time frame. Most vaccines are. Most drugs are as well.
"I'm sure that won't make a bit of difference for those of you who enjoy a baseless rage over the decisions of a few teenagers."
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AggieUSMC
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12:22p, 2/11/21
AG
He was right. He was acting in good faith. The vaccine is more useful in the arm of someone than in the trash. The judge agreed.

This DA and his former employers should be slapped upside the head.
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Reveille
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In reply to astros4545 • 12:23p, 2/11/21
AG
astros4545 said:
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it
Once the vial is thawed you have 6 hours to use all the doses or else it must be discarded. It can not be refrozen once thawed.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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BigOil
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In reply to Reveille • 12:55p, 2/11/21
AG
Reveille said:
astros4545 said:
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it
Once the vial is thawed you have 6 hours to use all the doses or else it must be discarded. It can not be refrozen once thawed.


Curious what the basis is for this? Exposure to oxygen chemically alters the vaccine? Temperature increase over that time creates a change? Serious ask.
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94chem
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In reply to BigOil • 1:22p, 2/11/21
BigOil said:
Reveille said:
astros4545 said:
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it
Once the vial is thawed you have 6 hours to use all the doses or else it must be discarded. It can not be refrozen once thawed.


Curious what the basis is for this? Exposure to oxygen chemically alters the vaccine? Temperature increase over that time creates a change? Serious ask.


It doesn't actually work that way. It's just that they have to have a cut-off at some point. It doesn't turn into a pumpkin. It likely has a first order exponential decay that begins the moment it is thawed, and the activity reaches a threshold minimum for 5% of the measured vials at 6 hours. Or they may have built in an extra buffer, like 5% after 12 hours. It would be interesting to know what the real time limit is, but that info may be proprietary.
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
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94chem
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1:25p, 2/11/21
It's the same as what is done for tire speed ratings, pressure vessel ratings, etc. There's probably a guiding document in pharma. For example, the max operating pressure for an autoclave is actually set at 1/4th of the rupture pressure.
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
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Old Buffalo
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1:35p, 2/11/21
AG
There are always at least three sides to every story.

Person A's view
Person B's view
The truth
“The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.”
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wbt5845
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1:38p, 2/11/21
AG
I hate lawyers.
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Gizzards
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8:29p, 2/14/21
AG
The Harris County DA, Kim Ogg, is atrocious. She will gladly try to prosecute this physician while refusing to go after real criminals.
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WoMD
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8:46p, 2/14/21
A small clinic in the Bay Area was shut down a month or so ago for doing the same thing. One of the volunteer doctors reported the clinic owner to the board...

People suck.
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Atreides Ornithopter
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In reply to 94chem • 10:36p, 2/14/21
AG
94chem said:
BigOil said:
Reveille said:
astros4545 said:
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it
Once the vial is thawed you have 6 hours to use all the doses or else it must be discarded. It can not be refrozen once thawed.


Curious what the basis is for this? Exposure to oxygen chemically alters the vaccine? Temperature increase over that time creates a change? Serious ask.


It doesn't actually work that way. It's just that they have to have a cut-off at some point. It doesn't turn into a pumpkin. It likely has a first order exponential decay that begins the moment it is thawed, and the activity reaches a threshold minimum for 5% of the measured vials at 6 hours. Or they may have built in an extra buffer, like 5% after 12 hours. It would be interesting to know what the real time limit is, but that info may be proprietary.


So you want the first dose out of it. Not the last
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94chem
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In reply to Atreides Ornithopter • 10:15a, 2/15/21
Shai-Hulud said:
94chem said:
BigOil said:
Reveille said:
astros4545 said:
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it
Once the vial is thawed you have 6 hours to use all the doses or else it must be discarded. It can not be refrozen once thawed.


Curious what the basis is for this? Exposure to oxygen chemically alters the vaccine? Temperature increase over that time creates a change? Serious ask.


It doesn't actually work that way. It's just that they have to have a cut-off at some point. It doesn't turn into a pumpkin. It likely has a first order exponential decay that begins the moment it is thawed, and the activity reaches a threshold minimum for 5% of the measured vials at 6 hours. Or they may have built in an extra buffer, like 5% after 12 hours. It would be interesting to know what the real time limit is, but that info may be proprietary.


So you want the first dose out of it. Not the last


In theory yes, but probably not in reality. Logically, it all hits 98.6 as soon as it enters the body, so it must have some extended shelf life at room temp. I'm guessing there's a significant buffer built in, and the real problem is that they can't refreeze it. Maybe they freeze it using special freezers or produce it at low temp and never let it warm up. Re-freezing could cause damaging crystals or other phenomena. It just doesn't make sense that the shelf life of the thawed sample is the real issue. Just trying to think using my training. I have no knowledge of the specifics.
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
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BiochemAg97
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7:32a, 2/17/21
AG
These are RNA vaccines. You need a way to get the RNA into cells in the body, so the RNA is most likely encapsulated into a lipid bubble. Likely can't refreeze because freeze thaw cycles will rupture the bubbles. It isn't an all or nothing but more cycles is more destroyed bubbles and less RNA getting into cells.

Also, there are enzymes (RNases) that specifically degrade RNA that are ubiquitous in the environment. When dealing with RNA, special care must be taken to ensure you have RNase free stuff. For the vaccine, each time a needle goes into the vial, there is probably some RNase introduced. There is likely a lot of effort in the vaccine design to prevent degradation by RNase, but it won't protect forever.

Bottom line, the companies have done studies to look at the stability of the vaccine. There is likely a safety margin so 6 hrs isn't a magic switch. And conditions will effect the actual timeframe, like room temp is different when the heater is set at 68 to conserve power is very different from when the AC is set at 78. However, once you pass the 6 hr mark, the physician has no way of knowing if the vaccine is good or bad.

That said, giving someone an expired vaccine is probably a lot worse (legally, ethically, medically) than giving to someone "not on the list".
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TxAg82
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10:16a, 2/17/21
AG
https://www.click2houston.com/news/local/2021/02/15/power-outage-leaves-health-officials-scrambling-to-administer-coronavirus-vaccine-doses/

I expect many more firings in Harris County for doing exactly what this doctor was fired for.
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oragator
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4:33p, 10/21/21
I happened to come across an update here.
The prosecutor did bring it to the grand jury, who wouldn't take it to trial.

So now he's suing. To which I say, good for him.

https://www.cbsnews.com/news/hasan-gokal-covid-lawsuit-harris-county-public-health-district/
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TXTransplant
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4:45p, 10/21/21
That "minutes before the vaccine became unusable" is drama porn that the author of that article put in to make it more dramatic and drive clicks.

It's not a bomb that explodes when the clock hits zero. As others have said, the timeframe represents a window when you would administer the most effective dose. It doesn't go bad or become poisonous or toxic after that; some fraction of the active ingredients would have just degraded to the point that effectiveness is reduced.

And wouldn't be ethical to inject people with a vaccine that has reduced potency and let them believe they got the full dose.
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The Agly Duckling
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8:29p, 10/21/21
OP, if the article is accurate, the doctor did exactly the right thing, and God Bless him for it.
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JCA1
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In reply to TXTransplant • 7:09a, 10/22/21
AG
TXTransplant said:
That "minutes before the vaccine became unusable" is drama porn that the author of that article put in to make it more dramatic and drive clicks.

It's not a bomb that explodes when the clock hits zero. As others have said, the timeframe represents a window when you would administer the most effective dose. It doesn't go bad or become poisonous or toxic after that; some fraction of the active ingredients would have just degraded to the point that effectiveness is reduced.

And wouldn't be ethical to inject people with a vaccine that has reduced potency and let them believe they got the full dose.


Are there SOPs stating that after a certain time frame the vaccine cannot be administered? Was he bumping up against this deadline? I admittedly don't know but if so, the language in the article isn't too off base.
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TXTransplant
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In reply to JCA1 • 7:31a, 10/22/21
I'm sure there is. And I'm probably reading that article with my own biases.

But the author could have just said that the period of use was about to expire and the vaccine wouldn't be as effective, so the doctor wouldn't be able to use it. I'm sure there have been millions of doses that has happened with.

I just personally feel like that article is unnecessarily over-dramatic.
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texag84
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12:33p, 10/22/21
AG
Meanwhile they want prosecute thieves, assaults, etc.
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Sea Speed
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In reply to texag84 • 8:55p, 10/22/21
AG
texag84 said:
Meanwhile they want prosecute thieves, assaults, etc.


To be fair it doesn't sound like they are prosecuting this guy either.
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fc2112
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In reply to oragator • 9:31a, 10/23/21
oragator said:
I happened to come across an update here.
The prosecutor did bring it to the grand jury, who wouldn't take it to trial.

So now he's suing. To which I say, good for him.

https://www.cbsnews.com/news/hasan-gokal-covid-lawsuit-harris-county-public-health-district/
Good for him - punish the oppressors.
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PatAg
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In reply to astros4545 • 5:58p, 10/23/21
AG
astros4545 said:
So with one minute until expiration, the vaccine is good

Then one minute after, the vaccine is worthless

got it
I'm sure you thought you were making some witty comment to show off how smart you are.
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