Shot for Flu—Or You're Through

Virginia Mason employees object to mandatory inoculation.

If you work for Seattle's Virginia Mason Medical Center and you don't want to get a flu shot, on New Year's Day you won't be working for Virginia Mason. Or so states an internal message to staff dated Aug. 23. The hospital's intranet has been buzzing ever since with messages between employees who object to flu inoculation on personal, religious, or medical grounds. There doesn't seem to be much the employees can do about it, either. They've asked the American Civil Liberties Union to intervene, but it seems that Washington is something called a "will-to-work" state, which means that if you don't want to comply with an employer's work rules, you can always leave, can't you?

Virginia Mason's nurses are exceptions to the general fiat. Last year, they refused the hospital's demand to shoot up or leave by pointing out that the order was in violation of their contract. Virginia Mason Vice President Patti Crome says that discussions with the nurses are "ongoing" this year. Washington State Nurses Association spokesperson Anne Tan Piazza says that's not strictly accurate: "What they are doing is challenging in court the NLRB's decision on our behalf," she said, referring to the National Labor Relations Board. Tan Piazza emphasizes that nurses are strongly in favor of vaccination. "What we are not in favor of is a policy of 'get vaccinated or get fired.' We think education is better than coercion every time."

Issuers of the policy defend it as simply the right thing to do. Tens of thousands of people die of influenza every winter, shots are an effective way of reducing flu's spread, and hospitals are particularly prone to epidemic infection because of the age and vulnerability of patients. Virginia Mason's average age is 68, and many have impaired immune systems. Objectors to the policy point out that only a small percentage of employees are ever in close contact with patients and that a steady stream of visitors renders moot any protection shots might give.

Virginia Mason administrators admit that they took legal counsel before issuing their edict. Although national authorities like the Centers for Disease Control and Prevention only "strongly recommend" flu inoculations for health care workers, seven states have recently passed laws requiring it, though they allow employees to opt out by signing an "informed declination."

Virginia Mason is offering no such out. Its official notice to the staff states that those objecting to the policy may file a written explanation of their views and discuss their grounds with hospital authorities. Employees say that they've been told that that's not enough—that they're also required to get a statement from their personal physician, who can issue a pass only in a case where "prior medical conditions" exist. To prove the latter, objectors would have to open their private medical records to inspection. That is supposed to be against the law.

Speaking of law: It's being suggested that Virginia Mason is at least as concerned about patient litigation as it is about patient safety. Nobody has successfully sued a hospital for an infection acquired in one, but with deadly bugs like Staphylococcus aureus becoming perennial residents in the nation's houses of healing, it's only a matter of time until someone does. With a blanket inoculation policy, hospitals like Virginia Mason would be able to claim that whoever gave the patient influenza, it wasn't someone on the team.

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