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, Gokal was fired from his government job and then charged with stealing 10 vaccine doses worth a total of $135 (€111) – a shun-worthy misdemeanour that sent his name and mug shot rocketing around the globe.
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“It was my world coming down,” Gokal said in a telephone interview on Friday. “To have everything collapse on you. God, it was the lowest moment in my life.”
The matter of Gokal is playing out as pandemic-weary Americans scour websites and cross state lines chasing rumours, all in anxious pursuit of a medicine in short supply. The case opens wide to interpretation, becoming a study in the learn-as-you-go bioethics of the country’s stumbling vaccine rollout.
Late last month, a judge dismissed the charge as groundless, after which the local district attorney vowed to present the matter to a grand jury. And while prosecutors portray the doctor as a cold opportunist, his lawyer says he acted responsibly – even heroically.
"Everybody was looking at this guy and saying, 'I got my mother waiting for a vaccine, my grandfather waiting for a vaccine,'" the lawyer, Paul Doyle, said. "They were thinking, 'This guy is a villain.'"
Volunteer work
Gokal (48) immigrated from Pakistan as a boy and earned a medical degree at SUNY Upstate Medical University in Syracuse. After working at hospitals in Central New York, he moved to Texas in 2009 to oversee the emergency department at a suburban Houston hospital. His volunteer work has included rebuilding homes and providing medical care after Hurricane Harvey in 2017.
In recent years, Gokal split his time between two area hospitals. But when the pandemic hit in early 2020, he lived for a month in a hotel and an apartment rather than risk infecting his wife, Maria (47), who has pulmonary sarcoidosis, a disease in her lungs that leaves her winded after even minimal activity.
“I was petrified to go home and bring Covid to my wife,” he said. Fortunately, he said, the Harris County Public Health department recruited him in April to become the medical director for its Covid-response team. The job paid less, but he was eager to protect his wife by limiting his exposure to the coronavirus in emergency rooms.
On December 22nd, Gokal joined a conference call in which state health officials explained the protocols for administering the recently approved Moderna vaccine. The 10 or 11 doses in a vial are viable for six hours after the seal is punctured.
Gokal said the advice was to vaccinate people eligible under the 1(a) category (health care workers and residents in long-term-care facilities), then those under the 1(b) category (people over 65 or with a health condition that increases risk of severe Covid-related illness).
After that, he said, the message was: “Just put it in people’s arms. We don’t want any doses to go to waste. Period.”
On December 29th, a mild Tuesday, Gokal arrived before dawn at a park in the Houston suburb of Humble to supervise a vaccination event intended mostly for emergency workers. In part because of minimal publicity, the pace was slow, with no more than 250 doses administered. But this was the county’s first public event, he said. “We knew there would be hiccups.”
Time limit
At about 6.45pm, as the event wound down, an eligible person arrived for a shot. A nurse punctured a new vial to administer the vaccine, which activated the six-hour time limit for the 10 remaining doses. The chances of 10 eligible people suddenly showing up were slim; by now, workers were offsetting the darkness with car headlights.
But Gokal said he was determined not to waste a single dose. He said he first asked the event’s 20 or so workers, who either refused or had already been vaccinated. The paramedics on site had left, and of the two police officers, one had been vaccinated and the other declined the doctor’s offer.
Gokal said he called a Harris County public health official in charge of operations to report his plans to find 10 people to receive the remaining doses. He said he was told, simply: Okay.
He said he then called another high-ranking colleague whose parents and in-laws were eligible for the vaccine. They weren’t available. The hours were counting down.
The doctor figured that if he returned the open vial to his department’s almost certainly empty office at this late hour, it would go to waste. So as he started the drive to his home in a neighbouring county, he said, he called people in his cellphone’s contact list to ask whether they had older relatives or neighbours needing to be immunised.
“No one I was really intimately familiar with,” Gokal said. “I wasn’t that close to anyone.”
The search
When he reached his home in Sugar Land, waiting outside were a woman in her mid-60s with cardiac issues, and a woman in her early 70s with assorted health problems. He inoculated both. Eight doses to go.
The doctor got back in his car – his wife insisted on going with him – and drove to a Sugar Land house with four eligible people: a man in his late 60s with health issues; the man’s bed-bound mother, in her 90s; his mother-in-law, in her mid-80s and with severe dementia; and his wife, her mother’s caregiver.
He then drove to the home of a housebound woman in her late 70s and administered the vaccine.
“I didn’t know her at all,” he said.
Three doses remained, but three people had agreed to meet the doctor at his home. Two were already waiting: a distant acquaintance in her mid-50s who works at a health clinic’s front desk, and a 40-ish woman he had never met whose child relies on a ventilator.
As midnight approached, Gokal said, the third would-be recipient called to say that he wouldn’t be coming: too late. Tired and frustrated, Gokal said that he turned to his wife, whose pulmonary sarcoidosis made her eligible for the vaccine.
“I didn’t intend to give this to you, but in a half-hour I’m going to have to dump this down the toilet,” he recalled telling her. “It’s as simple as that.”
He said his hesitant wife asked whether it was the right thing to do.
“It makes perfect sense,” he said he answered. “We don’t want any doses wasted, period.”
With 15 minutes to spare, Gokal gave his wife the last Moderna dose.
The next morning, he said, he submitted the paperwork for the 10 people he had vaccinated the previous night, including his wife. He said he also informed his supervisor and colleagues of what he had done, and why.
Fired
Several days later, the doctor said, that supervisor and the human resources director summoned him to ask whether he had administered 10 doses outside the scheduled event on December 29th. He said he had, in keeping with guidelines not to waste the vaccine – and was promptly fired.
The officials maintained that he had violated protocol and should have returned the remaining doses to the office or thrown them away, the doctor recalled. He also said that one of the officials startled him by questioning the lack of “equity” among those he had vaccinated.
“Are you suggesting that there were too many Indian names in that group?” Gokal said he asked. Exactly, he said he was told.
Elizabeth Perez, the director of communications for Harris County Public Health, said the department was unable to comment on its protocols, the December 29th vaccination event or the Gokal case.
On January 21st, about two weeks after the doctor’s termination, a friend called to say that a local reporter had just tweeted about him. At that very moment, one of his three children answered the door to bright lights and a thrust microphone. Shaken, the 16-year-old boy closed the door and said, “Dad, there are people out there with cameras.”
This was how Gokal learned that he had been charged with stealing vaccine doses. Harris County's district attorney, Kim Ogg, had just issued a news release that afternoon with the headline: "Fired Harris County Health Doctor Charged With Stealing Vial Of Covid-19 Vaccine."
It alleged that Gokal “stole the vial” and disregarded county protocols to ensure that vaccines are not wasted and are administered to eligible people on a waiting list. “He abused his position to place his friends and family in line in front of people who had gone through the lawful process to be there,” Ogg said.
But Gokal said that no one from the district attorney’s office had ever contacted him to hear his version of events. And when his lawyer requested copies of the written protocols and waiting list referred to in the complaint, a prosecutor told him by email that there were no written protocols from late December; nor had a written waitlist yet been found.
Case dismissed
Days later, a criminal court judge, Franklin Bynum, dismissed the case for lack of probable cause.
“In the number of words usually taken to describe an allegation of retail shoplifting, the state attempts, for the first time, to criminalise a doctor’s documented administration of vaccine doses during a public health emergency,” he wrote. “The court emphatically rejects this attempted imposition of the criminal law on the professional decisions of a physician.”
Both the Texas Medical Association and the Harris County Medical Society recently issued a statement of support for physicians like Gokal who find themselves scrambling "to avoid wasting the vaccine in a punctured vial".
“It is difficult to understand any justification for charging any well-intentioned physician in this situation with a criminal offence,” the statement said.
Dane Schiller, the district attorney’s director of communications, declined to answer questions about the case. He said in an email that when the matter is presented to a grand jury, “representatives of the community can vote on whether an indictment is warranted”.
Meanwhile, Gokal said, he continues to pay a price for not wasting a vaccine in a pandemic. His voice broke as he counted the toll. He lost his job. His wife struggles to sleep. His children are worried. And hospitals have told him not to come back until his case is resolved.
He spends his time volunteering at a nonprofit health clinic for the uninsured, haunted all the while by the realisation that no matter what, it will still be out there: the story about that Pakistani doctor in Houston who stole all those vaccines.
“How can I take it back?” that doctor asked. – New York Times