A court ruling that blocked implementation of a federal COVID-19 vaccine mandate for health care workers in Nebraska and nine other states has some hospitals rethinking their own vaccine mandates.
The ruling, handed down Nov. 29 by a federal judge in Missouri, temporarily suspends an emergency rule that would have required workers at health facilities covered under Medicare and Medicaid to get at least a first dose of the vaccine by Monday.
The ruling does not prevent health care facilities from enforcing their own vaccine mandates, which several hospital systems in the Omaha and Lincoln areas decided to do before the federal mandate was handed down, but the two health systems that serve Lincoln are backing off of those mandates somewhat.
CHI Health, which owns St. Elizabeth and Nebraska Heart Hospital in Lincoln, as well as hospitals in Omaha and many other cities in Nebraska, said it is delaying its compliance date for at least a month.
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"In light of the changing legal landscape in federal courts, including the recent nationwide injunction on the CMS rule, we are suspending the (Dec. 6) deadline for compliance until at least January," Jeanette Wojtalewicz, interim president and CEO of CHI Health, said in a statement.
She said unvaccinated employees who were not granted an exemption will be allowed to keep working but will be required to wear masks and undergo regular COVID-19 testing.
Bryan Health said it is keeping its vaccine mandate in place, which requires all employees to either get vaccinated or apply for and receive an approved exemption, but it is backing off on plans to fire those who have not met the deadline.
Bryan had previously said 10 employees either resigned or were terminated after declining to get vaccinated, while another 300 were granted an exemption.
As of last week, there were 180 employees who have not gotten vaccinated and either did not ask for an exemption or were denied one, which accounts for just more than 3% of Bryan's total staff. Those employees were scheduled to face termination this weekend but will now be allowed to keep working, at least for the time being, a Bryan spokesman said.
Some health care systems, however, are not changing their policies, meaning unvaccinated workers face termination.
Madonna Rehabilitation Hospitals, which is based in Lincoln and also has operations in Omaha, said in a statement that it plans no changes and its "COVID-19 vaccine policy, compliance process and timeline remain the same."
"We're not planning any changes," said Taylor Wilson, senior media relations coordinator for Nebraska Medicine.
Methodist Health System also is not planning any changes to its vaccine mandate.
"The injunction does not change the status of our original health system mandate, enacted in August, which requires staff to be vaccinated or have an approved exemption on file," said Claudia Bohn, Methodist's communications and public relations director.
Other health systems that were part of the August announcement, including Madonna Rehabilitation Hospitals in Lincoln, could not be reached for comment.
The vaccine mandates for health workers have become a lightning rod for controversy and led Nebraska Attorney General Doug Peterson to join the lawsuit that ultimately got them suspended.
One of the biggest issues is that hospitals and other health care facilities, already understaffed, are facing the prospect of losing employees over the vaccine mandate.
"It all boils down to workforce," said Andy Hale, vice president of advocacy for the Nebraska Hospital Association.
Hale said health care providers already were facing workforce issues before the coronavirus pandemic, "but COVID really shined a light on a problem that we already knew was there."
The problem is more acute in rural areas, and is likely to get worse if the vaccine mandate goes into effect.
The large Lincoln and Omaha health care systems all had better than 90% vaccine compliance at the beginning of November, but many hospitals in rural areas, where vaccine hesitancy is higher, were facing the prospect of losing significant numbers of staff if the mandate went into effect.
York General Health Care Services CEO Jim Ulrich told the York News-Times last week that about 100 employees, or more than 20% of the staff, had yet to be vaccinated.
"We have the potential of losing a number of very valuable employees," he said.
Hale said he talked to some rural hospitals that feared they would be so short-staffed that they "really thought they were going to have to close down departments."
That sentiment was expressed in a list of declarations from various leaders of small Nebraska hospitals that was filed as part of the lawsuit challenging the federal health care vaccine mandate.
"The patients served by Valley County Health System will suffer from the potential closure of some departments as a result of the additional loss of hospital employees," CEO Nancy Glaubke said in the filing. "If we lose our imaging department we will have to divert many of our emergency patients to other facilities; the closest one is 45 miles away.â€
Even larger hospitals said they could face a decision on whether to have to close departments.
Eric Barber, CEO of Mary Lanning Healthcare in Hastings, said in the court filing that the hospital would be "forced to make decisions regarding closure of departments, reduction of services, inability to accept patients, increased wait times for services (and) inability to staff beds."
Barber said the hospital, which already has nearly 100 job vacancies, including more than 40 for nurses, "projects the potential loss of hundreds of employees as a result of implementation of the CMS vaccine mandate.â€
Brett Eggleston, CEO of Callaway District Hospital and Medical Clinics, went so far as to predict the end of the hospital altogether if the mandate is allowed to stand.
"The projected loss of staff as a result of implementation of the CMS vaccine mandate will almost certainly lead to closure of our facility," he said in the filing.
Hospitals aren't the only health care facilities dealing with staffing crises that could worsen due to vaccine mandates.
Many of the state's nursing homes and long-term care facilities, especially those in rural areas, would be covered under the vaccine mandate because they have residents whose stays are paid for by Medicaid or Medicare.
Some of those facilities had already mandated vaccines for their staffs, and Jalene Carpenter, president and CEO of the Nebraska Health Care Association, said she's "not heard of any of them changing course."
For those that were following the federal mandate, Carpenter said the association is advising them to stay prepared and "be ready to go in case the (injunction) is lifted."
According to figures from the association, 77% of Nebraska nursing home staff members were fully vaccinated as of Nov. 21, and another 2% were partially vaccinated.
Carpenter said the number of vaccinated staff members continues to climb each week, "and that is a positive."
The Greek alphabet of COVID-19 virus mutations
Alpha
First identified in the United Kingdom, and later found in the U.S. in December 2020, alpha is considered a variant of concern by the CDC, which noted it might have increased severity based on hospitalization and fatality rates.
Beta
First identified in South Africa, this was detected in the U.S. at the end of January 2021. This is also considered a variant of concern by the CDC.
Delta
First noted in India before being detected in the U.S. in March 2021, the CDC notes this variant of concern’s increased transmissibility. Researchers are watching the delta variant carefully as it continues to spread.
Dr. Emily Landon, chief health care epidemiologist at the University of Chicago, said recently that the delta variant is “even more contagious than the alpha variant.â€
Delta plus
What’s been referred to as “delta plus†is getting buzz. This has been reportedly detected in South Korea, India and the United States, and some believe it may be more transmissible than the original delta variant. Experts are watching and waiting, but some note it hasn’t yet gained momentum here. Also known as AY.1, it is included under the World Health Organization’s list of variants of concern.
Gamma
Brazil was the first place this was detected, and it’s also been recorded in Japan. The CDC considers gamma a variant of concern; it was first detected in the U.S. in January 2021.
Epsilon
Although the Epsilon variant is included on the Illinois health department’s website, a spokeswoman said it would be soon taken off the “variants of concern†list as it is not considered one by the CDC. The CDC lists the Epsilon variant, which includes multiple mutations, as a variant of interest.
Eta
The World Health Organization and CDC defines this as a variant of interest and noted it has been documented in multiple countries.
Iota
The WHO and CDC consider this a variant of interest. It was documented earliest in the U.S.; according to the CDC, the first detection was in New York.
Kappa
This is also a variant of interest according to the WHO and CDC, with its earliest documentation in India in October 2020.
Lambda
Initially spreading in Peru in December 2020, the lambda variant has so far been found in states including Texas and South Carolina. It is considered a variant of interest by the World Health Organization.