In Clark County
CHICAGO -- Patients can refuse a flu shot. Should doctors and nurses have that right? That is the thorny question surfacing as U.S. hospitals increasingly crack down on employees who won't get flu shots, with some workers losing their jobs over their refusal.
Several Clark County health facilities reported in September that their vaccination rates were over 90 percent.
"Where does it say that I am no longer a patient if I'm a nurse?" wondered Carrie Calhoun, a longtime critical care nurse at Alexian Brothers Medical Center in Elk Grove Village, Ill., who was fired last month after refusing a flu shot.
Hospitals' get-tougher measures coincide with an earlier-than-usual flu season hitting harder than in recent mild seasons. Flu is widespread in most states, and at least 20 children have died.
Most doctors and nurses do get flu shots. But in the past two months, at least 15 hospital employees in four states have been fired for refusing, and others have resigned.
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.
Why would people whose job is to protect sick patients refuse a flu shot? The reasons vary: allergies to flu vaccine, which are rare; religious objections; and skepticism about whether vaccinating health workers will protect patients.
Dr. Carolyn Bridges, associate director for adult immunization at the federal Centers for Disease Control and Prevention, says the strongest evidence is from studies in nursing homes, linking flu vaccination among health care workers with fewer patient deaths from all causes.
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. "Patients should demand that their health care provider gets flu shots -- and they 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.
At Alexian Brothers, unvaccinated workers granted exemptions must wear masks and tell patients, "I'm wearing the mask for your safety," Calhoun says. PeaceHealth Southwest Medical Center and the Vancouver Clinic have similar rules.
Calhoun says that's discriminatory and may make patients want to avoid "the dirty nurse" with the mask.
The hospital justified its vaccination policy in an email, citing the CDC's warning that this year's flu outbreak was "expected to be among the worst in a decade" and noted that Illinois has already been hit especially hard. The mandatory vaccine policy "is consistent with our health system's mission to provide the safest environment possible."
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.
Starting this year, the government's Centers for Medicare & Medicaid Services is requiring hospitals to report employees' flu vaccination rates as a means to boost the rates, the CDC's Bridges said. Eventually the data will be posted on the agency's "Hospital Compare" website.
Courts have endorsed forced vaccination laws affecting the general population during disease outbreaks, and have upheld vaccination requirements for schoolchildren.
"Most of the hospitals in my area are all implementing these policies," Calhoun said. "This conflict could end the career I have dedicated myself to."