Local, national health care providers crack down on employees refusing flu shots

Across the nation, some hospital employees who refused to be vaccinated against the flu have been fired, as health care providers move toward stricter policies aimed at ensuring patient safety.

The trend has sparked debate over employee rights even as much of the country, including North Dakota and Minnesota, battles an earlier-than-usual influenza outbreak that has spiked hospitalizations and caused the deaths of 20 children.

Altru Health System, based in Grand Forks, mandates flu shots and, in recent years, some employees have lost their jobs because they’ve refused to get vaccinated, said Rick Gessler,

human resources manager.

Sanford Health, based in the Dakotas, “strongly advocates” that all of its employees get an annual flu shot but does not mandate it, according to a statement sent to The Herald.

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 records.

In Rhode Island, one of three 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.

A survey by researchers at the federal Centers for Disease Control and Prevention found that in 2011, more than 400 U.S. hospitals required flu vaccinations for their employees and 29 hospitals fired unvaccinated employees.

Personal choice

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 Indiana University 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 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.

Altru mandates shots

At Altru, a policy that went into effect in 2009 makes getting a flu vaccination “a condition of employment,” said Gessler.

“Flu is a significant enough health issue that we want to make sure we’re caring for people and not contributing to the exposure,” he said.

He declined to say how many Altru employees have been let go or if any have been released since the most recent flu vaccines were made available last fall.

“I can tell you we have involuntarily terminated employees who’ve failed to comply with the flu vaccine policy since the policy has been enacted,” he said.

“Many times, we’ll often give the opportunity to resign their position,” unless there are issues that warrant otherwise.

Altru requires full- and part-time employees, as well as volunteers and students to be vaccinated unless they present valid reasons why they should be exempted, he said. New employees are informed of the policy when they’re hired.

Employees may seek exemption if they have an allergy to eggs, had a bad reaction to the vaccine in the past, or have religious beliefs that forbid vaccination. Requests are reviewed by Altru’s chief nursing and medical officers.

Anyone who has had Guillain-Barre’ syndrome would also be exempted, said Shannon Hansen, infection control coordinator for Altru Health System.

An employee whose immune system has been compromised or who has had a recent surgery or is seriously ill may be exempted, she said.

Gessler recalled at least one objection to the vaccine based on religious beliefs.

“We looked on the website and saw they were advertising the flu shot to their parishioners,” he said.

But for those who can document that their religion “specifically holds to no vaccinations, they would be protected.”

Recently, the CDC has relaxed some of its recommendations concerning allergies to eggs, Hansen said. “Now, they’re saying if you can eat scrambled eggs, you can tolerate the flu shot.”

‘Community immunity’

Altru’s tougher stance on flu vaccinations is part of a larger picture, officials say.

“It’s important that we get ‘community immunity,’” Hansen said. “The more people you can get vaccinated, the more it protects our patients.”

The CDC encourages “cocooning” patients, she said, meaning “that everyone around them be vaccinated, too.”

The approach is critical for those who are in contact with infants younger than 6 months — the flu vaccine is not approved for children in this age group — and people older than 65 whose immune systems are less able to fend off disease, she said.

“In the elderly, flu shots are only 30 to 35 percent effective,” Gessler said. “Their immune systems are naturally compromised, so it’s important that staff is immunized.”

Shots are intended to keep the elderly out of the hospital and reduce deaths, Hansen said. “That’s the value of the vaccine.”

Dr. Carolyn Bridges, associate director for adult immunizations at the CDC, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health 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.

“It should work the same in a health care worker versus somebody out in the community.”

The CDC reports nearly half of those who’ve been hospitalized for influenza-related illness so far this flu season are elderly. Younger people fare better.

The vaccine is 90 percent in “the middle and healthier populations,” Hansen said. With few exceptions, the CDC recommends “universal vaccination” for everyone older than 6 months.

‘99.9 percent vaccination rate’

As soon as the vaccine is available each fall, Altru offers immunizations to everyone in the organization at no charge, he said. The deadline for this flu season vaccination was Dec. 1.

“We try to make it really easy to get the vaccine,” Hansen said. Employees can receive shots in their departments. They can also get them at local businesses or through another employer.

Employees who are vaccinated outside of Altru need to provide documentation that they’ve received the shot, Gessler said.

Altru’s policy has evolved over time. “For many years, it was voluntary,” Hansen said. “We had a 50 percent vaccination rate.” Later, the health system required employees to be vaccinated or submit a form stating that they declined, she said. At that time, the vaccination rate was 75 percent.

“We decided it is so important to patient safety” that a new, stronger policy was adopted in 2009, she said. The current rate of vaccination is 99.9 percent.

“In 2009, we probably had 60 to 100 requests for exemption, and we granted 40-some,” she said.

Rumors that the flu vaccine causes sickness may have prompted some people to seek exemption, but Gessler sees any incidences that might suggest that as coincidental. “Empirically and clinically, there’s no evidence to support that.”

With the large number of people in the organization, chances are that some will get sick after being immunized, he said.

At Altru, fewer than 100 people, out of 3,800 employees, seek exemption, Hansen said. “That number is a moving target.”

At Sanford, where vaccination is not required, steps have been taken to increase the number of employees who get the shot, according to Dr. Paul Carson, chief medical officer for Sanford Health Fargo region and infectious disease specialist. Those efforts include improved access to the vaccine and increased communication stressing the importance of getting vaccinated.

Sanford’s vaccination rates have increased in the past two years. This year’s rate is at 71.8 percent “for employees in the entire Sanford enterprise,” he said.

“Our ultimate goal is to see 90 percent of our employees who are engaged in direct patient care immunized against influenza each year.”

Sanford officials have discussed the option of mandatory flu vaccines but “have preferred to try and achieve higher rates of immunization through education and increased opportunity,” he said.

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

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

A government health advisory panel has urged hospitals with a vaccination rate of less than 90 percent to consider a mandatory program. Several national organizations have taken a stand in favor of mandatory flu vaccination, Hansen said, including those who represent medical, nursing and infection control professionals.

“It’s all about patient safety,” Gessler said, “whether it means spreading infection (or) the behavior of health professionals.”

“We’re proud of the fact that we do this for our patients,” Hansen said.

The Associated Press contributed to this article. Call Knudson at (701) 780-1107; (800) 477-6572, ext. 1107; or send e-mail to pknudson@gfherald.com.

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