One Montana hospital went into lockdown and called police after a woman threatened violence because her relative was denied her request to be treated with ivermectin.

Officials of another Montana hospital accused public officials of threatening and harassing their health care workers for refusing to treat a politically connected covid-19 patient with that antiparasitic drug or hydroxychloroquine, another drug unauthorized by the Food and Drug Administration to treat covid.

And in neighboring Idaho, a medical resident said police had to be called to a hospital after a covid patient's relative verbally abused her and threatened physical violence because she would not prescribe ivermectin or hydroxychloroquine, "drugs that are not beneficial in the treatment of covid-19," she wrote.

These three conflicts, which occurred from September to November, underline the pressure on health care workers to provide unauthorized covid treatments, particularly in parts of the country where vaccination rates are low, government skepticism is high, and conservative leaders have championed the treatments.

"You're going to have this from time to time, but it's not the norm," said Rich Rasmussen, president and CEO of the Montana Hospital Association. "The vast majority of patients are completely compliant and have good, robust conversations with their medical care team. But you're going to have these outliers."

Even before the pandemic, the health care and social assistance industry — which includes residential care facilities and child day care, among other services — led all U.S. industries in nonfatal workplace violence, according to the Bureau of Labor Statistics. Covid has made the problem worse, leading to hospital security upgrades, staff training and calls for increased federal regulation.

Ivermectin and other unauthorized covid treatments have become a major source of dispute in recent months. Lawsuits over hospitals' refusals to provide ivermectin to patients have been filed in Texas, Florida, Illinois and elsewhere. The ivermectin harassment extends beyond U.S. borders to providers and public health officials worldwide, in such countries as Australia, Brazil and the United Kingdom. Even so, reports of threats of violence and harassment like those recently seen in the Northern Rocky Mountains region have been relatively rare.

Ivermectin is approved to treat parasites in animals, and low doses of the drug are approved to treat worms, head lice and certain skin conditions in humans. But the FDA has not authorized the drug to treat covid. The agency says that clinical trials are ongoing but that the current data does not show it is an effective covid treatment and taking higher-than-approved levels can lead to overdose.

Likewise, hydroxychloroquine can cause serious health problems and the drug does not help speed recovery or decrease the chance of dying of covid, according to the FDA.

In Missoula, Montana, the Community Medical Center was placed on lockdown and police were called on Nov. 17 after a woman reportedly threatened violence over how her relative was being treated, according to a Police Department statement. Nobody was arrested.

"The family member was upset the patient was not treated with ivermectin," Lt. Eddie McLean said Tuesday.

Hospital spokesperson Megan Condra confirmed on Wednesday that the patient demanded ivermectin, but she said the woman was not there for covid, though she declined to disclose the patient's medical issue. The main entrance of the hospital was locked to control who entered the building, Condra added, but the hospital's formal lockdown procedures were not implemented.

The scare was reminiscent of one that happened in Idaho in September. Dr. Ashley Carvalho, who is completing her medical residency training in Boise, wrote in an op-ed in the Idaho Capital Sun that she was verbally abused and threatened with both physical violence and a lawsuit by a patient's relative after she refused to prescribe ivermectin or hydroxychloroquine.

"My patient was struggling to breathe, but the family refused to allow me to provide care," Carvalho wrote. "A call to the police was the only solution."

An 82-year-old woman who was active in Montana Republican politics was admitted to St. Peter's Health, the hospital in Helena, with covid in October. According to a November report by a special counsel appointed by state lawmakers, a family friend contacted Chief Deputy Attorney General Kris Hansen, a former Republican state senator, with multiple complaints: Hospital officials had not delivered a power-of-attorney document left by relatives for the patient to sign, she was denied her preferred medical treatment, she was cut off from her family, and the family worried hospital officials might prevent her from leaving. The patient later died.

That complaint led to the involvement of Republican Attorney General Austin Knudsen, who texted a lobbyist for the Montana Hospital Association who is also on St. Peter's board of directors. An image of the exchange was included in the report.

"I'm about to send law enforcement in and file unlawful restraint charges," Knudsen wrote to Mark Taylor, who responded that he would make inquiries.

"This has been going on since yesterday and I was hoping the hospital would do the right thing. But my patience is wearing thin," the attorney general added.

A Montana Highway Patrol trooper was sent to the hospital to take the statement of the patient's family members. Hansen also participated in a conference call with multiple health care providers in which she talked about the "legal ramifications" of withholding documents and the patient's preferred treatment, which included ivermectin and hydroxychloroquine.

Public Service Commissioner Jennifer Fielder, a former Republican state senator, left a three-minute voicemail on a hospital line saying the patient's friends in the Senate would not be too happy to learn of the care St. Peter's was providing, according to the special counsel's report.

Fielder and the patient's daughter also cited a "right to try" law that Montana legislators passed in 2015 that allows terminally ill patients to seek experimental treatments. But a legal analysis written for the Montana Medical Association says that while the law does not require a provider to prescribe a particular medication if a patient demands it, it could give a provider legal immunity if the provider decides to prescribe the treatment, according to the Montana State News Bureau.

The report did not offer any conclusions or allegations of wrongdoing.

Hospital officials said before and after the report's release that their health care providers were threatened and harassed when they refused to administer certain treatments for covid.

"We stand by our assertion that the involvement of public officials in clinical care is inappropriate; that individuals leveraged their official positions in an attempt to influence clinical care; and that some of the exchanges that took place were threatening or harassing," spokesperson Katie Gallagher said in a statement.

"Further, we reviewed all medical and legal records related to this patient's care and verified that our teams provided care in accordance with clinical best practice, hospital policy and patient rights," Gallagher added.

The attorney general's office did not respond to a request for comment but told the Montana Free Press in a statement that nobody at the state agency threatened anyone.

Rasmussen, the head of the Montana Hospital Association, said St. Peter's officials have not reached out to the group for assistance. He downplayed the attorney general's intervention in Helena, saying it often happens that people who know medical leaders or trustees will advocate on behalf of a relative or friend.

"Is this situation different? Certainly, because it's from the attorney general," Rasmussen said. "But I think the AG was responding to a constituent. Others would reach out to whoever they know on the hospital board."

He added that hospitals have procedures in place that allow family members of patients to take their complaints to a supervisor or other hospital leader without resorting to threats.

Hospitals in the region that have watched the allegations of threats and harassment unfold declined to comment on their procedures to handle such conflicts.

"We respect the independent medical judgment of our providers who practice medicine consistent with approved, authorized treatment and recognized clinical standards," said Bozeman Health spokesperson Lauren Brendel.

Tanner Gooch, a spokesperson for SCL Health Montana, which operates hospitals in Billings, Butte and Miles City, said SCL does not endorse ivermectin or other covid treatments that haven't been approved by the FDA but doesn't ban them, either.

"Ultimately, the treatment decisions are at the discretion of the provider," Gooch said. "To our knowledge, no covid-19 patients have been treated with ivermectin at our hospitals."

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.