Hospitals address vaccine mandate as legislature holds special session

As Florida lawmakers hold a special legislative session this week to push back against vaccine related mandates, local healthcare facilities and staff are grappling with a healthcare labor shortage that some say has been worsened by vaccine mandates.

The Centers for Medicare and Medicaid Services (CMS) published an interim final rule in November requiring Medicare providers to have all staff fully vaccinated by January 4, 2022. 

Around that same time, the Department of Labor’s Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard requiring private businesses with 100 or more workers to have all staff vaccinated by Jan. 4 or be tested weekly for the virus. 

This week’s session focuses on the OSHA mandates and not the CMS mandates. Florida lawmakers Monday began moving forward with bills that could be a first step in the state regulating worker safety and shedding involvement of OSHA’s involvement; however, hospital administrators say the CMS mandate is not dealt with as easily. 

“There is a difference in the OSHA mandates and the CMS mandates,” said Northwest Florida Community Hospital CEO Michael Kozar. “Gov. DeSantis came out against the OSHA mandates, but not the CMS mandates, and the reason is every hospital voluntarily participates with CMS. We sign up to be able to take Medicare and Medicaid patients in our facility. Because of that, CMS can put up directives as far as what they require hospitals to do in order to be able to treat Medicare and Medicaid patients.”

Kozar says while it’s true that healthcare providers participate as CMS providers on a voluntary basis, hospitals – especially those in rural areas like Holmes and Washington counties – are left with little choice.

“The CMS determines what conditions you must meet to treat, see, and get reimbursed for seeing these [Medicaid and Medicare] patients,” he said. “[Mandating vaccines] is not something we wanted to do or that we had planned to do. We need those reimbursements to operate, and we cannot put ourselves in a position to not be able to take care of Medicare patients in our community. If we don’t impose the requirements set forth by CMS, our Medicare patients would be underserved.”

Kozar said the hospital is encouraging staff who do not want to receive the vaccine to file for medical or religious exemptions if applicable.

The requirement is coming at a time when healthcare organizations nationwide are facing a labor shortage, a fact that Kozar says could add to the burden of already strained facilities.

“My goal is not to lose any employees,” he said. “That affects our operations, and we are still in a position where we are having to utilize travel nurses. We are facing shortages in other areas as well. It’s not my position to arbitrarily put [vaccine mandates] in place; I know how difficult it has been to staff our organization, and this can cause even more hardships on us.”

The hospital placed a mandatory flu vaccine protocol in place approximately 4 years ago, which required all staff to either have the flu vaccine or wear masks during peak flu season, Kozar states approximately 98 percent of staff participated in the flu vaccine.

Currently, approximately 67 percent of NFCH staff have received the COVID-19 vaccine.

Doctors Memorial Hospital CEO Dr. Huy Nguyen says while he is a believer in the medical benefits of the vaccine, he feels the mandates are overreaching and counterproductive.

“When I look to the horizon, I don’t see a COVID surge, but what I do see is a major healthcare labor shortage,” said Dr. Nguyen. “Hospitals aren’t just nurses and doctors; this affects CNAs [Certified Nursing Assistants], housekeeping, and other staff as well. The rationale for this policy is that we are under a public health emergency.”

“Had this rule come out in January or February of last year when we were going through the previous surge and vaccination was not widely pervasive, it would make more sense. But currently, we do not have a high COVID case load. This is like dropping the bomb on Hiroshima after the Japanese have already surrendered. Right now, we are not under a public health emergency. Interim federal rules can go into effect nearly immediately, so why not wait until we see a surge?”

Dr. Nguyen stresses that DMH will comply with the mandate because like other hospitals, the facility needs the CMS reimbursement – and local Medicare patients need access to services. 

“We have every right to raise our voice and questions pollical leadership and policy, but we are also obligated to adhere to the rule of law,” he said. “We cannot operate without Medicare and Medicaid reimbursement.”

“What’s interesting is that the courts are challenging the OSHA rules, and for CMS, it’s a little tougher. CMS rules tend to hold up in court. The reasoning is that access to care from a rural hospital is voluntary; you can opt out – but to operate and serve our community, we can’t opt out. That’s one flaw I find that is unreasonable. It isn’t truly based on voluntary participation.”

Dr. Nguyen went on to say there should have been more focus on educating that public about the vaccine.

“I wish more time had been spent time explaining the value of this vaccination and the science behind it rather than focusing on the political dimensions of it,” he said. “There is a lot of skepticism about it, but this technology is going to be a game changer in the development of other vaccines. In five years, we could see vaccines for things like cancer. Had there been more education about how it works, it could have changed a lot more of the perception and public skepticism.”

Dr. Nguyen reiterated that he is pro-vaccine.

“I’m passionate about the vaccine, but I’m equally skeptical about the logic for this mandate,” he said, explaining that he hopes residents will choose to be vaccinated.

“Get vaccinated. The data is so compelling. 98% of the people we admitted with COVID were unvaccinated. The mandate is political; the vaccine is not.”

Currently, a little over half of DMH staff have had the vaccine.

Tish Gibson, a former Bonifay Nursing and Rehab CNA, is among healthcare workers to walk away from their career after learning about the mandate.

“I was willing to wear a mask, gown up, and be tested weekly, but I do not want to take the vaccine,” said Gibson. “I don’t like that this is a mandate; it should be a personal choice. Many healthcare workers like myself feel that there simply isn’t enough know about the long-term effects to feel safe getting it. I really did love my job and my residents, but this mandate was a deal breaker for me, so I changed careers.”

Southern Healthcare, Bonifay Nursing and Rehab’s parent company, had not responded to a request for comment as of noon Tuesday.

The News Service of Florida contributed to this report.