Health care providers able to withhold their vaccine status from patients | News


Health care providers able to withhold their vaccine status from patients | News

When trying to decide if her 7-year-old granddaughter, Alice, could be seen in person by her health care team, the first thing Sarah Wacker asked was whether they’d all been vaccinated.

Alice needs weekly physical and occupational therapy to treat her multiple sclerosis. When the pandemic hit, these essential in-person treatments were no longer safe. So they switched to Zoom.

“I have to be safe for Alice,” Wacker said. “I’m not going to take her to an environment and risk exposure when the person taking care of her isn’t worth the risk.”

Luckily, Alice’s therapists were among the first health care workers in the state to be vaccinated against COVID-19 in January. That allowed Alice to be treated mostly in person since February.

Essential in-person health care visits for immunocompromised patients took on an extra level of personal risk with the pandemic. But not every Missourian will get an answer from their health care provider as Sarah did about vaccination status — and they’re not entitled to one, either.

Even when patients are at high-risk for severe COVID-19, they do not have any explicit right to know they are interacting with unvaccinated health care providers. On top of that, some Missouri hospitals aren’t trying to track which employees are vaccinated and which are not. The state’s Department of Health and Senior Services does not track vaccination rates of health care workers in Missouri.

“We don’t have the right to know whether or not someone has gotten vaccinated, but we can certainly ask for the information and make decisions based on what we’re given,” said Caitlin Donovan, senior director of public relations for the Patient Advocate Foundation, based in Washington.

Health care workers abide by ethical principles such as beneficence and non-maleficence, which translate to do no harm and do what’s best for the patient, O’Connor said.

“What weighs more, the greater good or self-determination?” O’Connor said. “I think you have to weigh those and see that those trump, maybe, health care workers’ personal decisions.”

As the coronavirus pandemic continues, the burden of staying healthy falls onto the patient, who most likely doesn’t know it’s their responsibility to inquire about such matters, Donovan said.

“It also assumes that you’re savvy enough and have the energy to even think about these things and address them that a lot of patients don’t,” Donovan said.

When evaluating risk of spreading the virus, it comes down to a few factors, said Alfred Kim, a rheumatologist at Barnes-Jewish Hospital in St. Louis. You first need to get COVID-19 to spread it. If health care workers are taking precautions in their personal lives such as avoiding crowds and indoor environments, coupled with diligent masking, their risk of acquiring the virus is reduced. But it’s not eliminated.

“I think that’s a really hard thing to overall control,” Kim said.

Asymptomatic COVID-19 infections make it even harder for health care workers and patients to assess risks.

“Everyone knows that when they’re sick, they really should not be taking care of patients. But if they are asymptomatic … that could still be a vector for spread,” Kim said.

Some patients used telehealth appointments to protect themselves, but not all medical needs can be addressed well via camera. Properly tracking Alice‘s symptoms and the progression of her multiple sclerosis requires her doctor to feel her muscles, which is impossible via Zoom. Alice’s in-person physical and occupational therapy appointments were not the same on Zoom, so something that Alice once enjoyed turned into a source of tension.

“That created a meltdown every time,” Sarah said. “[Alice] would cry every time.”

The telehealth appointments also strained the typically positive relationship between Alice and Sarah, who has been Alice’s caregiver and legal guardian for the past six years.

“I felt like I was disappointing her because it was a situation where I brought her to tears, but I’m also trying to do what’s best for her,” she said. “Navigating through it was emotional for both of us.”

There wasn’t really another option. Alice takes Rituximab, which suppresses her immune system. Multiple sclerosis is rare in children. Fewer than 5,000 children are diagnosed with the condition in the U.S., according to the National Multiple Sclerosis Society. Dealing with a novelty virus on top of a rare condition for children wasn’t something Sarah took lightly.

With Alice’s health already fragile in a pre-pandemic world, Sarah felt adding any unnecessary risks would be foolish.

Mandating vaccination

Requiring that health care employees be vaccinated would remove the worry for patients, but it’s a complicated issue, O’Connor said.

Parakkal Deepak, an inflammatory bowel disease specialist at Barnes-Jewish Hospital in St. Louis, doesn’t agree that it’s complicated. He believes it’s time to mandate the vaccine for health care workers.

“I think we’re sort of operating from a standpoint where we’re sort of assuming that all, if not, most health care workers are being vaccinated, right? Which is not actually true,” Deepak said.

Unvaccinated health care workers are a concern for a large chunk of the state population that has an underlying medical condition. The CDC identified counties nationwide with residents who are at increased risk for a severe COVID-19 infection or hospitalization. Over a third of Missouri’s population is obese, according to the United Health Foundation.

With that in mind, it’s even more important for health care workers to be vaccinated against COVID-19, Deepak said.

While the COVID-19 vaccines are still under the emergency use authorization clause, CoxHealth in Springfield is reluctant to require the vaccine for its employees, said Amanda Hedgepeth, vice president of hospital operations.

A public policy attorney at Husch Blackwell in Jefferson City, Lowell Pearson, said the emergency use authorization isn’t the issue.

“With our clients in our law firm, there is a very strong trend of not (requiring the vaccination),” Lowell said. “While I think employers have the legal right to do it, most of them are choosing not to.”

While some hospitals are tracking their employee COVID-19 vaccinations rates, the data is for internal benchmarks and not used for patient safety decisions like where or where not to assign an employer who interacts with patients.

Around 57% of CoxHealth employees have been vaccinated, Hedgepeth said. While that’s more than half, CoxHealth is still trying to encourage more employees to get the shot.

“I think we need to make sure that employees feel like they have enough information and enough science and enough time … to feel comfortable being able to get the vaccine,” Hedgepeth said. “So I think that day will come forth. I just don’t see that in the next couple of months.”

MU Health Care could not say exactly how many of its employees have been vaccinated because shots could have been administered to employees and students of MU’s School of Nursing or School of Medicine, which are separate entities from MU Health, said Eric Maze, a communication strategist at MU Health. Of the 13,040 COVID-19 vaccinations distributed by MU Health, 6,869 went to MU Health Care employees. Nearly 90% of those employees have completed the two-shot Moderna or Pfizer vaccination, Maze said.

MU Health Care also doesn’t keep records of employees who got vaccinated outside the MU system such as at a state mass vaccination site or private pharmacy. Also citing the emergency use authorization, MU Health Care does not require employees to be vaccinated or disclose their status internally.

State Rep. Suzie Pollock is one of the many health care professionals in the state who has not been vaccinated and makes no secret of the fact. When she’s not in Jefferson City, Pollock works as a cardiovascular invasive specialist where she preps patients for cardiovascular surgery at Mercy Hospital. Pollock declined to specify which hospital she works for among the 12 hospitals Mercy operates in Missouri.

Mercy Hospital did not make anyone available for an interview for this story after the Missourian’s repeated requests for comment about the hospital’s employee COVID-19 vaccination rate and related hospital policy.

Pollock is not vaccinated and definitely not worried. If a patient asked, she says she would disclose her status.

“I’ve had COVID, and it wasn’t that bad,” she said. “I survived, and I think I can survive it again and if not, I know where I’m going when I die. I’m not scared of death.”

Pollock does not trust the safety of the vaccine because she says its production was rushed and believes it can cause infertility in women. There is no evidence to support these claims.

Health care workers can be just as vulnerable to virus and vaccine hoaxes and myths, said Devon Greyson, health communication expert at the University of Massachusetts-Amherst.

(The state’s vaccine navigator tool features a Rumor Control tab to address these exact misconceptions about the COVID-19 vaccine.)

“No corners have been cut in developing a COVID-19 vaccine. Scientists have had a jump on developing the COVID-19 vaccine, using their experience from previous coronavirus vaccine efforts…,” according to the site.

It’s disappointing that Pollock is buying into this misinformation given her position of power as a lawmaker and a trusted health care worker, O’Connor said.

“Where is the accountability there? Because on the individual level, these individual providers are making bad decisions based on emotional reactions,” Donovan said.

Medical professionals have an ethical obligation to not spread this misinformation themselves, according to Greyson.

“Spreading doubts and concerns when there isn’t actual evidence to back it up and it’s in contradiction of the best evidence, it’s pretty concerning and arguably irresponsible if you’re a health care professional even if you’re just hanging out with friends at poker night,” Greyson said.

“Health care providers are regular people, too,” Greyson said. “Their attitudes generally reflect the population from which they come.”

Counties that voted for former President Donald Trump in the 2020 presidential election are more likely to be vaccine hesitant, according to Axios. All but three of Missouri’s 114 counties voted for Trump.

Some patients’ fears about asking about their health care providers’ vaccination status stem from the politicization of the virus and the vaccine.

“The issue about vaccine safety, just like masking, has become completely politicized,” Arthur Caplan, the director of division of medical ethics at New York University’s School of Medicine, said. “So people aren’t really just reading the information, they’re not paying attention to things like data that’s coming out of England or Israel about the safety of the vaccines and how well they work. They’re just in the middle of a political fight about ‘Don’t tell me what to do.’”

This makes it harder for patients to inquire about their health care team’s vaccination status and patient advocates aren’t necessarily up to the task to step in for the patient in this type of scenario, O’Connor said.

“I don’t think it’s the patient advocacy industry’s fault for not having the right resources or tools,” O’Connor said. “I think there’s a lot of room for improvement and room for patient advocates to play a part in it.”


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