Iowa’s judiciary has merely become a passive observer, quietly consenting to a medical board’s discretionary penalties against physicians. For patients, this is a form of judicial and executive murder – death through medical deprivation.
I am calling on the Iowa Supreme Court to act. Not for me, but for the patients who have been denied care and for the physicians who have been punished for serving them.
For more than 19 months, the Iowa Supreme Court (ISC) has remained silent – its docket stagnating under the weight of a case whose urgency could not be clearer. During this time, they have not ruled on their own jurisdiction much less the substance of the case originally filed against the Iowa Boards of Pharmacy and Medicine in December 2022. At stake is more than professional reputation or regulatory interpretation. At stake is the ability of physicians to treat patients for COVID-19 (or any disease for that matter) using lawful, evidence-supported, off-label medications. And behind the ISC's refusal to hear or adjudicate this case looms a far deeper fracture: the erosion of our Constitutional Republic, with separation of powers, into a parliamentary government with the comingling of legislative and executive powers concealed within the creeping shadow of administrative Machiavellianism.
The Iowa legislature and the Boards of Medicine, Pharmacy, Dentists, Nurses and Physicians' Assistants have explicitly recognized the authority of Iowa physicians to prescribe off-label drugs in the treatment of COVID-19. Nonetheless, the Iowa Attorney General’s office continues to resist my attempt to require that physicians receive the Boards' official current statement released on September 11, 2020. Known as the “Updated Joint Statement,” this edict is intended to correct a sham statement which was previously and illegally sent to physicians and pharmacists without either Board's approval. The sham statement which was never approved by the Boards, was e-mailed to prescribers and pharmacists on March 26, 2020 with threats of disciplinary action for using off-label drugs to treat COVID-19. This sham statement was sent within days of President Trump calling hydroxychloroquine the “game changer.” This policy, which was never approved by the boards, is now being defended by the Iowa Attorney General even after the Boards cited above, through the formally approved joint statement, have expressed its policy is to not impede or chill Iowa's physicians' from using these lifesaving drugs. While the original unapproved sham statement (RCReader.com/y/unapproved.jointstatement.2026.03.06) was emailed to all licensees, the official statement (RCReader.com/y/approved.jointstatement.2020.09.11) was placed in obscurity on the Boards’ website where no licensee can even find it. This is akin to slandering someone on page one of a newspaper, and several months later burying a correction in tiny print on page 20.
[Publisher's Note: The statement was originally published at http://medicalboard.iowa.gov/document/updated-joint-statement-hydroxychloroquine-chloroquine-and-azithromycin and as of July 30, 2025 that page no longer resolves at the Updated Joint Statement from September 11, 2020. The RCReader.com Web site posted and linked to the .pdf of the now missing statement found at that page for Dr. Hartsuch's July 2024 article “If You Can Kill Your Baby, Why Can't You Kill Your Germs” at https://rcreader.nyc3.cdn.digitaloceanspaces.com/hartsuch/2020.09.11.IowaBoards.updated_joint_statement_-_hydroxychloroquine_chloroquine_and_azithromycin.pdf. Web.Archive.Org has saved this page 55 times from September 2020 through September 2023. After that, the archival library has no more snapshots of said Web page.]
Persecution Masquerading as Regulatory Oversight
The district court, which has chosen to give the Boards deference in all matters, including issues of free-speech, has ruled that the boards have the discretion when, to whom, and how it conveys this critical information. My position is that once agencies formulate policy, they have a ministerial duty to inform licensees of the new policy. If the sham policy was displayed on page one, the correction should also be displayed on page one.
Through the boards' concealment of its lawfully approved official policy to not impede “off-label” drug use to treat COVID-19, this official policy has never achieved force and effect. Even now my patients cannot get their prescriptions for “off-label” drugs to treat COVID-19. The sham policy continues to prevail throughout Iowa. In fact, personnel within the Board of Medicine have initiated un-predicated investigation of physicians for using “off-label” drugs to treat COVID-19 even after the new policy was passed. The Boards approved the “Updated Joint Statement” because I petitioned the Boards knowing full well that the sham statement had never been considered nor approved by the Boards. I presented a compelling case with scientific studies to prove that the use of hydroxychloroquine would save lives. With their authority granted by law, they agreed with me and issued the “Updated Joint Statement.” That should be the end of the issue, but the executive director refused to honor my request to e-mail out the updated statement to licensees in the same fashion the unelected executive branch agency did with the unapproved sham policy statement in March 2020.
The Iowa Attorney General and courts have blocked my petition for the redress of grievances by allowing these boards to say one thing and do another. In doing so, they have deprived COVID-19 patients of being treated with “off-label” drugs, contrary to the intent of the legislature and the medical Boards themselves. The results are suppressed therapies, ruined medical careers, and dying patients. This is not regulation. It is persecution masquerading as oversight. And the court’s refusal to act is not neutrality. It is complicity.
The Machiavellian Drift
What we are witnessing is not merely bureaucratic overreach. It is a philosophical shift away from American constitutionalism toward a Machiavellian model of governance – one where appearances matter more than ethics, where stability is prized above justice, where administrative action is concealed in shadow rather than displayed with transparency, and where truth is subjugated to expedience.
Niccolò Machiavelli, writing in The Prince, advised rulers to act with cunning and cruelty when necessary, to cultivate the image of virtue while subordinating morality to the survival of power. Today, Iowa’s administrative state appears to have embraced that model: investigating physicians without predicate, withholding essential information, and chilling medical speech – all while cloaking their actions in the language of “protecting public health.”
But this is not public health. This is policy-by-fear. The very function of medicine – its ability to respond to uncertainty with adaptive, patient-centered judgment – is being replaced with rote compliance to politicized doctrine. And the judiciary, designed to be the firewall against such abuse, now flickers with indifference. Like a county sheriff who idly witnesses a lynching – the courts are unmoved by reports of the number of COVID-19 victims who have been denied life-saving treatment.
American Constitutional Government: A Forgotten Compass
Contrast the Machiavellian administrative state with the American legal tradition, where government derives its legitimacy not from utility but from consent, where physicians are accountable to their patients, their science, and the law, and where patient consent is central to their own care. Today, patient care is merely dictated by faceless bureaucrats rather than personal physicians.
In Canterbury v. Spence, the D.C. Circuit made clear that informed consent hinges on what a reasonable patient would want to know rather than what a reasonable doctor would disclose. The Iowa courts should establish a similar reasonable standard governing the Boards' licensee regulations. The Boards should only be allowed to regulate as a reason patient would want rather than as regulators themselves wants. Shoudn’t the Iowa Supreme Court agree that patients want their physicians to know the official proclamations of the Board of Medicine regarding their care?
Iowa Code §17A.19, the legislature enshrined judicial review as the exclusive remedy for aggrieved parties facing agency action. Only when the courts engage judicial review as the law prescribes, can executive agencies' extra-legislative power grabs be constrained.
Yet today, the Iowa Supreme Court refuses to declare its jurisdiction, refuses to expedite review, and refuses to acknowledge the lethal consequences of its inaction. Patients have died. Physicians have been silenced. And the court remains unmoved. If this is not prejudice, what is?
The Penalty Disguised as Procedure
This case is not a licensing squabble. It challenges a bureaucracy imposed bill of attainder – a concealed criminal proceeding that imposes censorship, reputational and therapeutic penalties without due process. In Cummings v. Missouri, the U.S. Supreme Court warned against punishments imposed under the guise of civil regulation. The sanction is not imprisonment, but inhibition: the blockade of lawful treatment, the suffocation of consent, the erosion of public trust, and the silencing of physicians who would question "authoritative" COVID-19 narratives. Because this criminal penalty is guised as a civil case, the judge does not actively impose the punishment. Iowa's judiciary has merely become a passive observer, quietly consenting to a medical board's discretionary penalties against physicians. For patients, this is a form of judicial and executive murder – death through medical deprivation.
The Iowa Code defends a physician's right to treat regardless of disease. The (only) official correct statement of the board affirms that right. Yet the Attorney General seeks to conceal the affirmation, while board staff conduct investigations untethered from complaint or consequence. Without judicial review, administrators seize all government powers: legislative, executive, and judicial.
Who Watches the Watcher?
Medical boards claim authority to police clinical practice. But they are not doctors. They derive their authority by political appointment rather than years of study or from the patient themselves. They are unelected and Board members need not be physicians. They are immune from malpractice liability and shielded by sovereign immunity. They can investigate, accuse, and discipline. Without the Iowa Supreme Court taking action on my case, these boards will continue to answer to no one.
So we ask: Who watches the watcher? In Iowa law, the answer is clear: the judiciary. Iowa Code Section 17A.19 10. says, “The court shall reverse, modify, or grant other appropriate relief from agency action … .” The word “shall” imposes a duty on the court to act. But without action, the mechanism fails. The court becomes not a firewall, but a smokescreen.
It is time for the judiciary to assert its jurisdiction – not only for the physician, but more importantly, for the patient.
The Call to Fidelity
I have filed a motion for the court to expedite, which is not a plea for speed. It is a demand for fidelity – to statute, to ethics, to life. For two-and-a-half years, this case has been before the court, which has only displayed its prejudice by not asserting its jurisdiction, except in allowing the Boards to hide their official policies. Patients continue to die, doctors continue to be gagged. To remain silent is to harm. And to cloak judicial inertia in procedural form is to betray the structural duty of Iowa courts.
The court must choose: to remain in Machiavellian ambiguity, preserving institutional comfort at the expense of truth, or to reclaim its constitutional compass, where justice is not a strategy, but a first principle. When the courts refuse to act, the separation of powers collapses into a de facto parliamentary model – one where administrative dictate becomes law, judicial oversight fades into ritual, and the Constitution becomes an unrealized ideal.
I call on the Iowa Supreme Court to act. Not for me, but for the patients who have been denied care. For the physicians who have been punished for serving them. For the rule of law, which cannot bend without breaking.
The treatment of COVID-19 should not hinge on political utility. It should hinge on clinical wisdom, informed consent, and the courage of courts to defend both.
Let Iowa lead – not in inaction, but in clarity. Not in silence, but justice.
David Hartsuch has served medical patients in multiple states for more than 25 years the majority of which as an emergency physician, and has no history of disciplinary action or investigation. Hartsuch was an elected and served as an Iowa State Senator from 2007 to 2011. The illustration above was generated by Hartsuch utilizing Microsoft's Copilot, “a generative artificial intelligence chatbot developed by Microsoft, based on the GPT-4 series of large language models, launched in 2023 as Microsoft's main replacement for the discontinued Cortana.” When Hartsuch requested the chatbot to include in this illustration a desk with a doctor in shackles, Copilot declined to generate it, stating depicting of doctor with shackles did not conform with its policies.
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