Vaccine mandate injunction a temporary relief for hospitals
Photo by Whitney Liegakos / St. Luke Community Healthcare
Annette Olsson receives her COVID-19 booster from St. Luke Nurse Wendy Last Star.
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The Biden Administration’s efforts to mandate COVID vaccines for healthcare workers ran into a roadblock last Tuesday when a federal judge in Louisiana issued a nationwide preliminary injunction against the implementation and enforcement of the rule.
Local healthcare administrators, who had been scrambling to meet the deadline, breathed an almost audible sigh of relief.
According to St. Luke Community Healthcare CEO Steve Todd, the mandate amped up stress for healthcare providers across the state. “Because of the COVID surge and because of staff shortages, healthcare delivery has been very, very challenging,” he said. “And then you add this to it.”
“This has been a really tough couple of weeks on many healthcare workers, and it is nice to have a reprieve – especially at this time of the year,” said Devin Huntley, COO at Providence St. Joseph Medical Center in Polson.
The rule, authorized by the Centers for Medicare and Medicaid Services (CMS) on Nov. 5, stipulated that all unvaccinated healthcare workers at facilities that participate in Medicare or Medicaid programs needed to have their first dose of COVID-19 vaccine by Dec. 6 and be fully vaccinated by Jan. 4. Medical and religious exemptions were available.
The CMS edict, however, directly clashed with House Bill 702 signed into law last spring by Gov. Greg Gianforte that makes it illegal for employers or businesses, including healthcare institutions, to require proof of vaccine in Montana.
“The big change for us is that we will no longer be in a position where we will be ‘mandated’ to put our caregivers on unpaid administrative leave at midnight on the sixth of December,” Huntley said.
The medical center continues to encourage staff to get vaccinated, or apply for exemptions, especially since the injunction is still preliminary in nature. “We don’t know when or if the mandate may come back, nor do we know what deadlines might be imposed,” he added.
The CMS has appealed the Fifth District Court’s injunction, but pending the outcome of that appeal, House Bill 702 “remains the law of the land in Montana,” wrote the Montana Hospital Association in a press release.
Todd estimates that about 90% of St. Luke’s staff is vaccinated or has received a medical or religious exemption. As for the remaining 10%, “we don’t know where they’ll end up,” he said.
As far as he knew, every hospital in Montana had planned to comply with the CMS rule, because refusing to do so would have imperiled millions of dollars in Medicare and Medicaid reimbursements.
For St. Luke alone, that amounts to around $42 million. “It’s a big, big number,” he added. “We just can’t afford to ignore that one.”
On the other hand, complying could have meant losing staff at a time of enormous pressure on the healthcare system. St. Luke, for example, has around 430 employees. If 10% had opted not to get vaccinated, the institution could have lost a critical component of its workforce.
“You can ill afford to lose one staff member, let alone 40,” Todd said. “The impact would be huge.”
At St. Joseph, federal dollars account for approximately 70% of the hospital’s revenue. “I can tell you there aren’t many – if any – hospitals that could keep their doors open for long without Medicare/Medicaid payments coming in to the institution,” said Huntley. “In fact, I can’t think of any business that could lose up to 70% of its revenue and maintain operations for long.”
Complicating matters further is the national shortage of healthcare workers, a scenario exacerbated by the ongoing pandemic and employee burnout.
“In a time of such a staggering workforce shortage we truly don’t want to lose a single caregiver,” said Huntley.
Although St. Luke was recently named “best small hospital in the state to work at” by the Montana Hospital Association, Todd says the institution is not immune to workforce challenges. These include a housing shortage in the Mission Valley, the recent surge in COVID-19, and shortages of “just random stuff because of supply chain issues.”
Despite all these complexities, administrators say their teams worked valiantly during the latest pandemic surge, fueled by the Delta variant.
“We have such a tough team here,” Todd said. “Our clinical team really came together – they did all the things they had to and worked excessive extra shifts to make sure patients and community members were taken care of. An amazing amount of selflessness went into that.”
The hospital was at, or near, capacity for extended periods of time, but never opted to “divert” patients due to lack of beds or staff, although several facilities in the region were forced to do so. In some cases, however, critical patients that typically would have gone to Kalispell or Missoula were sent to Billings or even out of state for care.
With COVID numbers dropping somewhat, “There’s some breathing room now, but it was definitely a huge stretch when the surge hit us,” Todd said.
Lake County posted seven new and 96 active COVID cases on Friday, compared to nearly 30 new cases a day in mid-November and 70 or more daily when the surge began to build in September.
Statewide, there were 318 new cases and 187 hospitalizations listed by the Department of Public Health and Human Services Dec. 3; that compares to 1,132 new cases and 458 hospitalizations posted mid-surge, on Oct. 26.
Still, Delta continues to spread, a new Omicron variant is on the loose, and the holidays – a time of increased travel and indoor togetherness – are upon us.
Todd remains hopeful that “boosters, the fact that more people have gotten vaccinated as a result of the surge, and the fact that we’re getting pediatric patients vaccinated” may all contribute “to that tipping point of herd immunity.”
Meanwhile, he says, with the recent Delta surge in the rearview mirror, “it’s important to be mindful that we could face another one. We just have to be careful.”
