Florida hospitals don't require, and often aren't even aware of, staff COVID-19 vaccinations
Florida's largest public and private hospitals have no immediate plans to require employees to get vaccinated for COVID-19 and, in many cases, can't or won't say how many of their front-line staffers have been inoculated against the deadly virus.
The state's health center workers — many of whom are subject to flu shot requirements — commonly do not even have to disclose their vaccination status, even if they work closely with patients at high risk of complications, a USA TODAY Network-Florida review of public and private hospital policies has found.
As a result, patients using scores of Florida hospitals have no way of knowing whether doctors, nurses or anyone else they interact with, have been vaccinated. And even those hospitals that have estimates on vaccination rates commonly say they don't know the status of half of their employees.
Take the Lee County-based Lee Health hospital system, one of the state's largest public health care organizations and the site of Florida's first known COVID-19 death. Its representatives say they do not know the vaccination status of more than 40% of its 13,500 employees. Shots are not required or even need to be reported, though they are mandated annually for far less deadly influenza viruses.
Florida's largest hospital operator, the Tennessee-based HCA Healthcare, also does not require its employees to be vaccinated for COVID-19 but does for the flu, according to a company spokesman. HCA, a for-profit that operates 52 hospitals across the state, would not disclose whether administrators know how many of its employees were COVID-19 vaccinated or if they are required to report it.
"Our hospitals follow guidance outlined by the CDC regarding protocols for vaccinated and unvaccinated individuals in our facilities," HCA spokesman Harlow Sumerford said in a short written statement.
Nearly all of the one dozen health care organizations in Florida that reporters contacted in June don't require vaccinations — all citing the newness of the vaccines. One known exception is Johns Hopkins Medicine, which operates Johns Hopkins All Children's Hospital in St. Petersburg. It announced earlier this month that it would require all medical and non-medical staff to be vaccinated by Sept. 1.
The USA TODAY Network reached out to the state's largest hospital operators, those that are publicly run and even some small single-institution organizations. Together they operate more than a third of the state's roughly 300 hospitals.
Of those that provided estimates of staffers fully vaccinated, rates ranged from 51% to 67%.
(A separate, national USA TODAY investigation of 276 hospitals tracked vaccination rates of 53% to 72% at large networks and 51% to 91% at some of the nation's large public hospitals.)
The lack of strict vaccination rules, and the lack of transparency about them from private operators in Florida, comes in a state whose Republican governor signed an executive order against any vaccine mandates and recently pardoned Floridians who violated local COVID-19 safety ordinances.
Federal regulations do not prohibit employers from requiring vaccinations, according to the Equal Employment Opportunity Commission.
Still, hospitals nationally are slowly starting to make such requirements, though such policies have been met with fierce resistance from vaccine-skeptical employees. The most famous case involves Houston Methodist Hospital, whose recent mandates prompted a federal lawsuit by 117 employees who refused to get vaccinated.
A judge threw out the complaint last week, siding with the hospital and clearing the way for hospitals elsewhere to enact such requirements. Ultimately 153 employees were fired or resigned as a result, according to The Associated Press.
But expect continuing resistance, said Amesh Adalja, a physician and senior scholar at the Johns Hopkins Center for Health Security. Many healthcare workers, including highly in-demand nurses, still refuse to get the shots and may not be convinced about vaccine safety for some time.
"I imagine many hospitals are nervous about getting into a battle with nurses on this," Adalja said. "I talked with the chief medical officer in my hometown hospital in suburban Pittsburgh who said that if the non-vaccinated nurses walk they'd have to close units, because it's such a significant portion."
One recent poll speaks to the current sentiment: Kaiser Health News and The Washington Post found that just over half of all front-line healthcare workers had been vaccinated and that roughly a third were unsure whether they'd ever get the shots.
Vaccine hesitancy and acceptance vary wildly, depending on the job. According to a separate American Medical Association survey, 96% of U.S. doctors said they have been vaccinated.
"It's unfortunate that other medical professionals, like nurses and other allied health workers who saw firsthand what COVID-19 does, are reticent to get this vaccine," Adalja said. "So I'd encourage hospitals to mandate it and face the consequences. Because this is a battle worth fighting."
Florida hospital representatives interviewed for this story say they are encouraging employees to get vaccinated.
But, they said, they are hesitant to require them as a condition of employment because all of the vaccines are still under "emergency-use" federal approval and are thus still, technically, considered experimental. The Centers for Disease Control and Prevention has concluded the vaccines are safe and extremely effective in preventing hospitalization and death from COVID-19, including its known variants.
"While we do mandate the flu vaccine, the COVID-19 vaccines are still new and under emergency use authorization," said Lee Health spokesman Jonathon Little. "As more data and information are available on these vaccines, we will have further discussions with epidemiology experts and health system leaders on what are the most appropriate steps for Lee Health."
At least 845 of Lee Health's 13,500 employees have tested positive for COVID-19 since the start of the pandemic, of which 53 contracted the novel coronavirus while doing work-related activities, according to information released under Florida's open records law.
Three are believed to have died, though administrators have said they don't know for sure if there were more related fatalities.
Despite the risk to healthcare workers and their patients, none of the main lobbying groups for hospitals, doctors and/or nurses are calling for mandates.
National Nurses United, the nation's largest nursing union with 7,000 Florida members, refused to comment for this story. The Florida Hospital Association released a statement saying it won't comment on individual hospital vaccination policies, even though it encourages people to get their shots.
The American Medical Association's president, Gerald E. Harmon, released a statement putting it this way: "While vaccines are highly effective public health tools, vaccine mandates are a blunt instrument and may carry the risk of eroding trust and undermining public health goals."
Don't know, or won't reveal, vaccination levels
A number of large, private hospital operators simply won't say if they know how many medical workers and support staffers are vaccinated, or even if they're required to report their shots.
HCA, which operates health centers in nearly every region of Florida, declined to answer the question when asked several times. Its spokesman, Sumerford, said that the healthcare organization is "strongly encouraging" staffers to get vaccinated but declined to say whether HCA is tracking them or has a general idea of how many have gotten shots.
AdventHealth, which operates 26 hospitals and ERs in seven counties surrounding Orlando, is not planning to require employees to get the COVID-19 vaccine while they remain under emergency use authorizations by the FDA, according to hospital spokeswoman Beth Kassab.
Kassab did not comment on whether they would change that plan if any of the vaccines become officially FDA approved. She also would not provide statistics on how many employees had received the COVID-19 vaccine in the Central Florida Division.
“I don’t have a breakdown of numbers to give you,” Kassab said in an email.
This was the same with others contacted for this story, including the three-hospital, 1,579-bed Broward Health; the six-hospital, 1,146 bed Bayfront Health; and the 15-hospital, 3,783-bed BayCare Health System, which.
The St. Petersburg-area located BayCare is tracking vaccinations, according to spokeswoman Viola Hysenlika. She did not provide figures.
“We’re still in the process of collecting the data since team members have been vaccinated during both internal and community-based vaccination events,” Hysenlika said.
Halifax Health, which operates three hospitals in Volusia County, initially declined to comment on its vaccination estimates. The organization recommends, but does not require, vaccination among their employees, according to President and CEO Jeff Feasel.
When pressed, hospital spokesman John Guthrie put the figure at 51%. Meanwhile, hospital leadership keeps pushing workers to get the shot
“I personally have received two COVID-19 vaccinations, as recommended, of the Moderna vaccine,” Feasel said in an emailed statement. “The majority of the leadership team has chosen to be vaccinated as well.”
Hospitals reporting large gaps in staff vaccinations
Now, roughly seven months after COVID-19 vaccines were first made available to healthcare workers, hospitals across the state that did provide some figures and/or estimates of vaccinations reported large gaps in vaccinations.
The publicly operated Sarasota Memorial Healthcare System, which requires employees to report their vaccination status, had among the highest known vaccination numbers of the hospitals contacted for this story.
Spokeswoman Kim Savage said last week that the organization's overall staff vaccination rate was 65%. About 90% of its 1,000 physicians and medical staff have at least one of two required shots, Savage added. The health care system has held its own vaccination clinics to encourage employee compliance.
"We will continue encouraging vaccination at other community and retail vaccination sites for new employees and those who were initially hesitant," Savage said in an email.
The private Naples-based NCH Healthcare System, Collier County's largest hospital operator, said that more than 65% of its staff — including physicians, contractors and vendors — has been fully vaccinated. But spokesman Shawn McConnell says that reporting is not required.
Like other hospitals, NCH does not require employees to get shots. But McConnell said that could eventually change.
"NCH is currently discussing the decision to mandate vaccines once FDA approval for the vaccines is granted, however, a final decision has not been made at this time," he said.
Flagler Health+, which operates Flagler Hospital in St. Johns County, estimates that 55% of its employees have been vaccinated. St. John's County, home to historic St. Augustine, is consistently ranked as one of Florida's healthiest (and wealthiest) counties.
Spokeswoman Gina Mangus said the healthcare system provides an education program in order to support informed decision-making when it comes to vaccines.
“The voluntary COVID-19 policy was established at the inception of vaccine availability, in collaboration with our inter-professional COVID-19 vaccination team and our ethics committee,” Mangus said in an emailed statement. “As with all of our policies, we will continue to monitor, evaluate and make adjustments should they be deemed necessary.”
All hospitals contacted for this story maintain that patient safety is not being compromised, even if large shares of their employees aren't vaccinated.
Front-line workers are required to wear masks at all times and COVID-19 patients are quarantined under standards set by the Centers for Disease Control and Prevention, they say.
Mary Briggs, a spokeswoman for the Lee Health hospital system, said all hospital employees caring for COVID-19 patients are provided with special protective gear. But, like other hospital systems contacted, it won't require staff to alert others if they have not been vaccinated.
Lee Health, for instance, requires a "Flu Proof" sticker for badges of employees who receive mandatory influenza vaccine shots every year. Employees are allowed to opt out for medical and/or religious reasons. Before COVID-19, those not flu-vaccinated had to also wear masks in inpatient areas. Now everyone does.
Still, the federal Occupational Safety and Health Administration earlier this month published new rules to protect workers from COVID-19, a threat it called a "grave danger." They include rules on social distancing, mask-wearing and allowing employees time to get vaccinated.
They stop short of requiring vaccinations, however. But more hospitals are likely going to do that on their own, said Adalja, the senior scholar at the Johns Hopkins Center for Health Security.
"What I think will happen is more hospitals will start to do this, especially after you had the court decision in favor of Houston Methodist (a hospital that started requiring them)," he said. "I think that will embolden them."
He added: "I would encourage them to just have the courage to just do it," he said. "Truth is on the side of the vaccine, not on the vaccine-hesitant health care workers."
— Nikki Ross, a reporter for The Daytona Beach News-Journal, contributed to this report
Frank Gluck is a watchdog reporter with The News-Press and the Naples Daily News. Connect with him at firstname.lastname@example.org or on Twitter: @FrankGluck