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Most Maine hospitals hesitate to start smallpox shots

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posted on Mar, 2 2003 @ 03:39 PM
Hospitals hesitate to start smallpox shots

BANGOR - Most hospitals in Maine are stopping short of the state's call to vaccinate teams of medical workers against smallpox. Instead, they are taking a wait-and-see approach, concerned that the known risks and liabilities of the vaccine program outweigh the benefit of vaccinating against a bioterrorist attack, a possibility that many find unlikely.

Although the director of Maine's Bureau of Health maintains she's "very pleased with the response so far," her original plan - adopted from the federal Centers for Disease Control and Prevention's guidelines - seems distant now.

Dr. Dora Mills originally planned to have about 100 state public health workers vaccinated by early February and some 3,000 hospital and other health workers vaccinated by the end of March. According to the plan, in the event of a smallpox outbreak, teams of these inoculated workers would be available to fan out across the state and administer the vaccine to the general population within a few days.

Mills now says just 600 inoculated workers are needed for statewide immunization, but the way things are going, even that number may be hard to recruit. So far, no state workers have been inoculated, but a handful is scheduled to receive the vaccine next week.

Only about a dozen of Maine's 39 hospitals had responded to an Office of Public Health Emergency Preparedness request for information by a Feb. 24 deadline. Most indicated they are willing to recruit and medically prescreen a core team of volunteer staff, but they will not actually have them inoculated unless there is an outbreak.

Dr. Erik Steele, head of emergency preparedness at Eastern Maine Medical Center in Bangor, said the hospital will begin the process of recruiting, educating and screening between 30 and 50 volunteers from its staff but will not proceed with inoculations unless there is a smallpox outbreak.

"We will go all the way, but not vaccinate at this time," Steele said. "Clearly, if there is a smallpox event somewhere in the world, it will push us to take the next step, but we're all hanging on the hope it won't happen, and the knowledge that if it does happen, life changes forever."

The Aroostook Medical Center in Presque Isle said it is following EMMC's lead, and will begin the recruitment process shortly. A few employees have expressed interest in being vaccinated, according to nursing administrator Jane Dailey, but no one wants to feel forced into receiving it.

Thomas Moakler, CEO of Houlton Regional Hospital, sent a terse letter to the health bureau saying, "We have decided not to participate in this initiative at this time."

In an interview, Moakler said he thinks most small hospitals are in the same boat - too few staff to commit to the program, too many concerns about side effects and liability issues, and too much skepticism about the need for the inoculation in the first place.

"Deep down inside, most people here feel the likelihood of an outbreak is small," he said. "And even if it did happen, we'd still have time."

The smallpox vaccine can be effectively administered within three days after exposure, he noted.

Hospitals statewide cite unresolved issues of liability and compensation in the event that a worker becomes seriously ill or disabled, misses a significant amount of work, infects another person at home or at work, or dies as a result of the procedure.

They also have concerns that, with an existing shortage of nurses and other staff, even mild adverse reactions to the vaccine might pose a real problem to their bottom lines.

And because inoculated workers can infect unhealthy people easily, CDC guidelines suggest they should stay away from vulnerable patient populations for up to a month after receiving the vaccine, further complicating the impact on staffing.

The federal government's assurance of extending protection from liability suits to hospitals remains open to interpretation, according to the Maine Hospital Association. And the Maine Workers' Compensation Board has not issued a statement of intent to provide coverage to workers who experience long-term complications.

Left holding the financial bag and doubtful that the risk of a smallpox outbreak justifies the dramatic step of subjecting workers to the vaccine, most hospitals are biding their time.

The exception is Maine Medical Center in Portland, which plans to inoculate 120 people. Chief Medical Officer Dr. Stan Russin said that as the largest medical institution in Maine, MMC is well-situated to assume leadership.

"Given our role in the state, we have an obligation to be part of this effort," he said. "If we decided not to participate, there's really no one else to carry the weight."

The large hospital is better able to bear the financial and operational burdens of temporary staff reductions, he said, and because its workers' compensation program is self-administrated, the plan has been altered to extend full benefits to any worker who suffers serious problems as a result of the vaccine. MMC has assured its staff that necessary medical care will be provided free of charge to any worker as well as to family members who may become ill from the vaccine.

Mills lauded MMC's leadership and said the state will press on with its expectation of inoculating hundreds of health workers within the next few months.

Nationwide, about 7,500 American civilians have received the vaccine since the smallpox threat arose, according to CDC statistics. So far, two cases may have resulted in "moderate to severe" adverse reactions.

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