Hospitals crack down on workers refusing flu shots

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By LINDSEY TANNER
AP Medical Writer

CHICAGO (AP) – Patients can refuse a flu shot.
Should doctors and nurses have that right, too? That is the thorny
question surfacing as U.S. hospitals increasingly crack down on
employees who won't get flu shots, with some workers losing their jobs
over their refusal.

“Where does it say that I am no longer a patient if
I'm a nurse,” wondered Carrie Calhoun, a longtime critical care nurse
in suburban Chicago who was fired last month after she refused a flu
shot.

Hospitals' get-tougher measures coincide with an
earlier-than-usual flu season hitting harder than in recent mild
seasons. Flu is widespread in most states, and at least 20 children have
died.

Most doctors and nurses do get flu shots. But in
the past two months, at least 15 nurses and other hospital staffers in
four states have been fired for refusing, and several others have
resigned, according to affected workers, hospital authorities and
published reports.

In Rhode Island, 1 of 3 states with tough penalties
behind a mandatory vaccine policy for health care workers, more than
1,000 workers recently signed a petition opposing the policy, according
to a labor union that has filed suit to end the regulation.

Why would people whose job is to protect sick
patients refuse a flu shot? The reasons vary: allergies to flu vaccine,
which are rare; religious objections; and skepticism about whether
vaccinating health workers will prevent flu in patients.

Dr. Carolyn Bridges, associate director for adult
immunization at the federal Centers for Disease Control and Prevention,
says the strongest evidence is from studies in nursing homes, linking
flu vaccination among health care workers with fewer patient deaths from
all causes.

“We would all like to see stronger data,” she said.
But other evidence shows flu vaccination “significantly decreases” flu
cases, she said. “It should work the same in a health care worker versus
somebody out in the community.”

Cancer nurse Joyce Gingerich is among the skeptics
and says her decision to avoid the shot is mostly “a personal thing.”
She's among seven employees at IU Health Goshen Hospital in northern
Indiana who were recently fired for refusing flu shots. Gingerich said
she gets other vaccinations but thinks it should be a choice. She
opposes “the injustice of being forced to put something in my body.”

Medical ethicist Art Caplan says health care workers' ethical obligation to protect patients trumps their individual rights.

“If you don't want to do it, you shouldn't work in
that environment,” said Caplan, medical ethics chief at New York
University's Langone Medical Center. “Patients should demand that their
health care provider gets flu shots – and they should ask them.”

For some people, flu causes only mild symptoms. But
it can also lead to pneumonia, and there are thousands of
hospitalizations and deaths each year. The number of deaths has varied
in recent decades from about 3,000 to 49,000.

A survey by CDC researchers found that in 2011,
more than 400 U.S. hospitals required flu vaccinations for their
employees and 29 hospitals fired unvaccinated employees.

At Calhoun's hospital, Alexian Brothers Medical
Center in Elk Grove Village, Ill., unvaccinated workers granted
exemptions must wear masks and tell patients, “I'm wearing the mask for
your safety,” Calhoun says. She says that's discriminatory and may make
patients want to avoid “the dirty nurse” with the mask.

The hospital justified its vaccination policy in an
email, citing the CDC's warning that this year's flu outbreak was
“expected to be among the worst in a decade” and noted that Illinois has
already been hit especially hard. The mandatory vaccine policy “is
consistent with our health system's mission to provide the safest
environment possible.”

The government recommends flu shots for nearly
everyone, starting at age 6 months. Vaccination rates among the general
public are generally lower than among health care workers.

According to the most recent federal data, about
63% of U.S. health care workers had flu shots as of November. That's up
from previous years, but the government wants 90% coverage of health
care workers by 2020.

The highest rate, about 88%, was among pharmacists,
followed by doctors at 84%, and nurses, 82%. Fewer than half of nursing
assistants and aides are vaccinated, Bridges said.

Some hospitals have achieved 90% but many fall
short. A government health advisory panel has urged those below 90% to
consider a mandatory program.

Also, the accreditation body over hospitals
requires them to offer flu vaccines to workers, and those failing to do
that and improve vaccination rates could lose accreditation.

Starting this year, the government's Centers for
Medicare & Medicaid Services is requiring hospitals to report
employees' flu vaccination rates as a means to boost the rates, the
CDC's Bridges said. Eventually the data will be posted on the agency's
“Hospital Compare” website.

Several leading doctor groups support mandatory flu
shots for workers. And the American Medical Association in November
endorsed mandatory shots for those with direct patient contact in
nursing homes; elderly patients are particularly vulnerable to
flu-related complications. The American Nurses Association supports
mandates if they're adopted at the state level and affect all hospitals,
but also says exceptions should be allowed for medical or religious
reasons.

Mandates for vaccinating health care workers
against other diseases, including measles, mumps and hepatitis, are
widely accepted. But some workers have less faith that flu shots work -
partly because there are several types of flu virus that often differ
each season and manufacturers must reformulate vaccines to try and match
the circulating strains.

While not 100% effective, this year's vaccine is a good match, the CDC's Bridges said.

Several states have laws or regulations requiring
flu vaccination for health care workers but only three – Arkansas, Maine
and Rhode Island – spell out penalties for those who refuse, according
to Alexandra Stewart, a George Washington University expert in
immunization policikfriedenes and co-author of a study appearing this
month in the journal Vaccine.

Rhode Island's regulation, enacted in December, may
be the toughest and is being challenged in court by a health workers
union. The rule allows exemptions for religious or medical reasons, but
requires unvaccinated workers in contact with patients to wear face
masks during flu season. Employees who refuse the masks can be fined
$100 and may face a complaint or reprimand for unprofessional conduct
that could result in losing their professional license.

Some Rhode Island hospitals post signs announcing
that workers wearing masks have not received flu shots. Opponents say
the masks violate their health privacy.

“We really strongly support the goal of increasing
vaccination rates among health care workers and among the population as a
whole,” but it should be voluntary, said SEIU Healthcare Employees
Union spokesman Chas Walker.

Supporters of health care worker mandates note that
to protect public health, courts have endorsed forced vaccination laws
affecting the general population during disease outbreaks, and have
upheld vaccination requirements for schoolchildren.

Cases involving flu vaccine mandates for health
workers have had less success. A 2009 New York state regulation
mandating health care worker vaccinations for swine flu and seasonal flu
was challenged in court but was later rescinded because of a vaccine
shortage. And labor unions have challenged individual hospital mandates
enacted without collective bargaining; an appeals court upheld that
argument in 2007 in a widely cited case involving Virginia Mason
Hospital in Seattle.

Calhoun, the Illinois nurse, says she is unsure of her options.

“Most of the hospitals in my area are all
implementing these policies,” she said. “This conflict could end the
career I have dedicated myself to.”

 

Online:

R.I. union lawsuit against mandatory vaccines: http://www.seiu1199ne.org/files/2013/01/FluLawsuitRI.pdf

CDC: http://www.cdc.gov

 

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

 

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