While a deluge of COVID-19 patients continues to burden Kentucky’s short-staffed health care system, hundreds of hospital workers across the state have refused to comply with their workplace vaccine requirement, and some are being fired.
Roughly a dozen hospitals and hospital systems announced last month, buoyed by unanimous support from state and federal health care associations, that they would amend their policies and add COVID-19 vaccines to the list of already-required inoculations staff must have in order to care for patients. Participating hospitals include:
Appalachian Regional Healthcare CHI Saint Joseph Health Baptist Health Pikeville Medical Center St. Claire Healthcare Med Center Health UofL Health Norton Healthcare King’s Daughters Health System Mercy Health — Lourdes Hospital St. Elizabeth Healthcare Deaconess
Though the vaccine mandate announcement was made in a unified voice alongside Gov. Andy Beshear, each hospitals’ enforcement of the requirement varies. The Herald-Leader surveyed each hospital, and though it was couched as a requirement, only some have made it a condition of employment.
The initially agreed-upon deadline for many was September 15, but some have extended it and few have yet to disclose what percentage of their staff fulfilled the requirement, or what will happen to staff who didn’t. Some have confirmed they will offer weekly testing as an alternative, while others are moving more swiftly to write-ups and, in some cases, immediate firings.
By the end of the day Wednesday, for instance, 23 staff had refused vaccination and were fired at St. Claire Regional Medical Center, one of the hospitals hardest hit by the most recent and severe surge in coronavirus cases. Fifteen personnel were approved for a religious or medical exemption. At the time the mandate was announced in early August, 30% of staff were unvaccinated, CEO and President Donald H. Lloyd said in a statement.
At the Morehead hospital, 23 staff “equates to less than 1% of our total workforce. That was a mix of full time, part time and PRN staff members,” hospital spokeswoman Amy Riddle said Wednesday night. “Their employment ended at the conclusion of today’s shift.”
Similarly, Baptist Health has informed employees they will be terminated for refusing to comply with the new policy. Workers were required to be partially vaccinated by September 15 and fully vaccinated by October 31. Like St. Claire, when hospitals announced their mandates in August, 70% of the system’s 23,000 staff were inoculated.
“We know that many more employees have [since] been vaccinated, but new numbers are not yet available,” Baptist Health Chief Operating Officer Patrick Falvey said.
At UK HealthCare, where staff had to submit proof of vaccination by the end of the day on September 15, those who didn’t comply were told they would receive a written warning and be subject to “progressive disciplinary action, up to and including termination,” a hospital spokeswoman said.
In an internal email on Tuesday, Dr. Mark Newman, vice president of health affairs, reminded staff, “After Sept. 15, any unvaccinated employee will receive a written warning and be placed on a surveillance testing protocol. Details of the corrective measures associated with this vaccination requirement will be shared later this week.”
Close to 15,000 staff fall under UK’s mandate. The Lexington health system had not confirmed by Thursday morning how many staff refused their shots.
“We will be able to provide more comprehensive information regarding UK HealthCare employees who have met the vaccination requirement and those who will be required to begin the weekly COVID testing protocol next week,” spokeswoman Kristi Willett said in an email.
While a “majority” have chosen to get the vaccine, she said, “due to several thousand [verification of vaccination] documents being uploaded in the past couple of days as the deadline approached, final numbers are not yet available.”
Med Center Health in Bowling Green, one of the first hospitals to announce a vaccine mandate in late July, fired 180 employees who refused vaccination by September 1, hospital spokeswoman Corie Martin confirmed in a September 3rd email. “At the same time, we have welcomed 178 new, vaccinated team members who will be joining us within the next week.”
When pressed, Martin would not say how Med Center replaced nearly 200 staff so quickly amid a statewide shortage of health care workers. “We have moved on from this narrative,” she said September 14. “Our administration does not have any further comment on our vaccine requirement beyond the statements we have issued. We are focused on taking care of our patients.”
Other hospitals, including CHI Saint Joseph Health and Norton Healthcare, made clear vaccination was a condition of employment, but Norton did not provide details about the number of staff terminated, and CHI Saint Joseph extended its vaccination deadline to November 1.
“CHI Saint Joseph Health has made the COVID-19 vaccine a condition of employment for all employees,” hospital spokeswoman Mary Branham said. “Medical and religious exemptions are available to those who wish to apply for one. A team of individuals, comprised of both clinical and non-clinical representatives, will review the requests. Exemptions may be made for a medical contraindication or for a sincerely held religious belief.”
Norton spokeswoman Maggie Roetker said Wednesday morning, “99% of employees are compliant, and we expect that number to increase slightly today.”
As such, “at this time, it is premature to speak about non-compliant processes. If necessary, we will communicate with non-compliant employees and their leaders tomorrow.”
Though it was initially couched publicly as a mandate, not all hospitals are enforcing it as one.
At Mercy Health — Lourdes Hospital in Paducah, administrators announced the vaccination requirement, but without a public deadline. Earlier this month in an email, Mercy Health spokeswoman Nanette Bentley said, “We are still in the process of setting our policies and processes for vaccination, so I don’t have answers to your questions.”
When asked whether the hospital was tracking vaccination status of staff, she said, “I don’t have anything further to add.”
At King’s Daughters Medical Center, which operates a hospital in Ashland and Portsmouth, Ohio, as well as a series of outpatient centers across Eastern Kentucky, a little over 79% of the system’s 4,464 staff are vaccinated, leaving roughly 925 staff who aren’t. But they won’t be terminated or necessarily face punitive action.
“We have a path for team members who choose not to be vaccinated where they need to be tested weekly to ensure the safety of patients and other team members,” hospital spokesman Tom Dearing said in an email.
“If they don’t do that, they are not scheduled to work until they do. All testing, including their time to do it, is on our time. Anyone who doesn’t get tested can use their accumulated leave. If that is exhausted, they are placed on administrative leave. No one has been terminated.”
While some staff are being punished or fired for violating their hospital’s policy, thousands more have avoided that fate and opted to get vaccinated. At Med Center Health, for example, 1,000 employees agreed to be immunized after the hospital announced it would be enforced as a requirement.
Mass vaccination, coupled with the culling of staff who refuse the shot, means in most major hospital systems in Kentucky, nearly 100% of staff will soon be immunized. Most health care systems requiring the vaccine did offer the option of religious or medical exemption, but of the 12 hospitals the Herald-Leader polled, only St. Claire provided exact numbers of how many exemptions had been granted, as many are still being considered.
Appalachian Regional Health and Pikeville Medical Center did not respond to multiple requests for information.
St. Elizabeth Healthcare in Northern Kentucky declined to answer questions about its vaccine mandate because of ongoing litigation. On September 3, 40 employees filed a lawsuit against the hospital in U.S. District Court in Covington, challenging the requirement. Of the hospital’s approximate 11,200 employees, 40% were unvaccinated, the 93-page filing said.
The lawsuit seeks to “not only stop the mandate, but to stop the discriminatory testing being required for asymptomatic health care workers and those who do have an exemption.”
“The covid and vaccine issue in this country has been one of fraud upon the public from government, pharmaceutical, social media, maintstream media, corporate America, health care and political parties,” the 40 workers wrote in the filing. It inaccurately asserts that coronavirus vaccines are “dangerous and ineffective” and characterizes St. Elizabeth administrators as “intentionally misleading health care workers” into thinking the vaccine, more than 5.8 billion doses of which have been administered worldwide, is safe and helps stop the spread of infection.
The filing repeatedly refers to the vaccine as “experimental,” saying their employer gave them an “ultimatum: if you want to keep your job, continue to feed your family, and avoid bankruptcy, you must be injected with the experimental COVID-19 vaccine.”
‘It’s a trade off’
Requiring vaccination is not a new concept in health care settings, where staff for decades have been required to show proof of inoculation against certain communicable diseases, such as Hepatitis B.
“Hospitals have had vaccine policies for a long time,” Kentucky Hospital Association President Nancy Galvagni said on Wednesday. “When people take a job at a hospital, it’s a condition of employment to have a tuberculosis test, to have the flu vaccine.”
Hospitals chose to mandate coronavirus vaccines for several reasons, but first and foremost, to protect patients, which is always the “guiding principle,” Galvagni said.
Additionally, by having 100% of staff vaccinated, it prevents the need for isolating after exposure. Unlike unvaccinated individuals, those who are fully vaccinated do not have to quarantine when they’re exposed to the virus, which helps to “avoid having those gaps in coverage,” she said, making it a worthwhile trade-off in the long run.
But it’s no secret Kentucky’s health care systems have contended with serious staffing shortages that pre-date coronavirus; the pandemic and its tremendous strain on the system has just exacerbated it, Galvagni said. On Thursday, Beshear said 69% of the state’s 96 acute care hospitals reported critical staffing shortages. Roughly half of the state’s intensive care unit beds are occupied by COVID-19 patients. On Wednesday, only 7% of the state’s staffed ICU beds were open, according to KHA, and 63% of hospitals with ICUs had no available beds.
“No hospital wants to lose their staff, and even the hospitals that have termination policies would likely take back any staff if they change their mind” about getting vaccinated, she said. “On the other hand, we have had staff out on quarantine and isolation that aren’t able to provide care. That’s the trade-off.”
Dr. David Dougherty, an infectious disease specialist in Lexington, agrees that the benefits of mass immunization outweigh the cost of losing staff in the short term; achieving 100% compliance has to take priority because it’s the best way to protect both patients and staff.
But getting there is “tricky,” he said.
“It’s tricky because we have staffing shortages. We don’t want to be short-staffed,” but losing staff in order to ensure a safer work environment is worth it.
Additionally, if hospitals are going to enforce it as a mandate, it needs to be a “condition of employment,” he said.
“What is a vaccine mandate if you’re just signing a piece of paper, or if there’s a way to opt-out” beyond just seeking a medical or religious exemption, Dougherty said. “It kind of has to be a condition of employment, or else it’s truly not a mandate.”
‘We are failing them’
Soon after Kentucky hospitals publicized their mandates, the Biden Administration announced it was requiring all workers in Medicare and Medicaid-certified health care facilities to be vaccinated against COVID-19, though no deadline for reaching that goal has been set yet. This federal rule not only applies to hospitals, but long-term care facilities like nursing homes. In Kentucky nursing homes, a little over 53% of staff are fully vaccinated, according to the Centers for Medicare and Medicaid Services.
These providers, like hospitals, are contending with severe staff shortages and overall worker retention. State health care associations, including KHA and the Kentucky Association of Health Care Facilities and Center for Assisted Living, agree that all staff should be vaccinated. But mandates are a double-edged sword; like some hospitals are already witnessing, not all workers will agree to be vaccinated. Some will choose to be fired, and administrators worry that will compound the shortage.
Staffing in long-term care facilities “is at a crisis point,” said Betsy Johnson, industry lobbyist and President of KAHCF/KCAL.
While “getting vaccinated is the safest thing to do for yourself and others,” she said, “the truth of the matter is, we can’t afford to care for these elders without staff.”
Johnson, alongside Galvagni, detailed their dire industry staffing shortages before a legislative committee in Frankfort earlier this month. They made a case for lawmakers to set aside American Rescue Plan Act dollars for health care facilities to, for example, provide pandemic bonuses to help with staff retention.
Some Republican lawmakers on the Interim Joint Health and Welfare Committee said they understood their plight but suggested health care facilities avoid enforcing vaccine mandates. If they really wanted to retain staff, why would they drive out needed workers who may refuse the shot?
Sen. Stephen Meredith, R-Leitchfield, said health care facilities should put staff vaccine mandates “on the back burner,” and said requiring health care workers to get vaccinated or be fired “is not respectful.”
“Our issue right now is shortage of personnel,” he said at the September 3rd meeting. “And while, yes, we require vaccinations for other things in our health care facilities, I’m not sure now is the time to do that. Reducing the number of personnel by forcing a mandate is not going to help the situation at all.”
Lawmakers balked at the request to allocate ARPA money to hospitals and health care facilities, choosing instead to pass a measure allowing paramedics to work in hospitals and allocate more than $69 million in federal relief money for vaccination campaigns, testing supplies and monoclonal antibody treatment.
The decision to not provide financial support to the state’s beleaguered health care systems “is very concerning to me when we’re seeing the most significant workforce crisis we’ve ever seen,” Johnson said this week.
The binary choice shouldn’t be choosing whether to enforce health care staff vaccinations or not, people interviewed for this story agreed. Vaccination compliance has to be a necessity, they said, and supporting health care systems to that end should be the goal.
“When we are not thinking about workforce solutions, we are doing a disservice to the most vulnerable populations in this state, the people who have no choice but to trust that we’re doing everything we can to make sure they’re cared for,” Johnson said. “And currently, we are failing them.”