LOWVILLE — The maternity department at the Lewis County Health System is the first casualty of staffing challenges made worse by health care workers prioritizing remaining unvaccinated for COVID-19 over their jobs with the hospital.
Because of a number of vacant positions in the department already, the resignations of six staff members this week combined with the looming possibility that seven other unvaccinated people in maternity may follow suit made it clear to the Health System’s leadership that they needed to hit “pause” on services provided by that department.
“We are unable to safely staff the service after Sept. 24. The number of resignations received leaves us no choice but to pause delivering babies at Lewis County General Hospital,” Chief Executive Officer Gerald R. Cayer said. “It is my hope that the (state) Department of Health will work with us in pausing the service rather than closing the maternity department.”
In addition to the maternity ward, there are five other departments whose services may be curtailed in some way if a significant number of staff members decide to leave their employment rather than be vaccinated for COVID-19.
The “pause” will begin on Sept. 25, two days before the final deadline for healthcare worker vaccination across the state for those who chose to continue their employment.
Mr. Cayer, who spoke at a news conference on Friday afternoon in the county board room, said 30 people have resigned from their health care roles since the vaccine was mandated on Aug. 23, 20 of whom worked in clinical positions like nurses, therapists and technicians, totalling 70% of the resignations so far.
“Essential health services are not at risk because of the mandate,” Mr. Cayer said at the top of his prepared statement. “The mandate ensures we will have a healthy workforce and we are not responsible for (causing COVID-19) transmission in or out of our facilities.”
There have also been 30 formerly unvaccinated health care workers at the facility who have had at least one shot to prevent a severe case of COVID-19 and lower the transmissibility of the disease and its highly contagious delta variant since the mandate was issued.
The health system previously had one of the lowest vaccination rates across the state but is now “above average,” Mr. Cayer said, with 464 members of the staff, 73%, at least partially vaccinated.
Mr. Cayer said when he is asked if he supports mandatory vaccinations for health care workers and others, he answers, “Unequivocally, yes.”
“The COVID-19 vaccines are effective and when combined with masking, health care workers, patients, residents, visitors and the larger community are provided the highest level of protection,” he said. “We as employees have an obligation not to put those that we care for or our coworkers at risk.”
Regardless of that perspective, however, there are still 165 of the approximately 650 employees who are unvaccinated and have yet to declare their intention to stay or go. About 73% of this group provide clinical services, Mr. Cayer said in a separate interview.
In the nursing home at the health system, there has only been one resignation so far, but there are 48 people who have not yet taken action.
The potential to lose even more staff in the next two weeks is playing out on a backdrop of increasing numbers of people contracting the virus and a return to severe enough cases to require hospitalization which has not been seen for months.
“Lewis County has the highest seven-day and 14-day positivity rates in the state of New York over the past three days,” said health system Chief Medical Officer Dr. Sean Harney.
The seven-day average infection rate in the county is 7.6%, while the 14-day average is 5.7%.
Across the north country, the seven-day average is 6.1% with the 14-day average at 5.5%. “Positivity rates for Lewis County and the north country are heading in the wrong direction,” Mr. Cayer said.
As a result, with a rolling average over 5%, visitation restrictions at the institution had to be put in place again on Wednesday.
In addition to resignations and a number of unstaffed positions, COVID contaminations among staff members are also creeping up, it was announced in the meeting.
There are currently five staff members who are quarantined and another five in isolation.
The health system chiefs said they have been trying to encourage vaccinations and foster transparency with the staff through outreach conversations.
Dr. Harney has been holding educational sessions and meeting with staff members individually and Mr. Cayer held a “town hall” type meeting with staff members to get and give feedback on the topic beyond the basic email communications.
“We truly have worked hard to educate, encourage, cajole (and) support individuals to get comfortable with receiving the vaccine but we are not passing judgment on any single person who says it’s not right for them,” Mr. Cayer said. “We don’t want to lose anyone. We would like everyone to get vaccinated but we also understand we live in a country where you get to choose certain things and if you choose not to be vaccinated then now, you can’t work in health care. We just simply respect; we thank for service; and we each move forward.”
The workers that have been participating in discussions often ask to be tested weekly and wear masks instead of being vaccinated, as is usually an option with flu vaccines, or for religious exemption from the COVID-19 vaccine, neither of which are an option under state regulations.
Mr. Cayer said the health system had been lobbying with the state Department of Health to implement these and other changes in the vaccination regulation, which will be revisited in 90 days, but has had no success.
While religious exemptions were originally designated by former Gov. Andrew Cuomo as part of the initial regulation, ultimately the exemption was removed from the final version. Employees interested in the exemption were asked to fill out request forms in case the exemption was reinstituted.
The two health system chiefs confirmed, when asked, that all current health care workers have at least the measles, mumps and rubella combination vaccine and the Hepatitis-B vaccine as mandated for all health care workers. No religious exemptions are available for those vaccines either.
A medical exemption is available for certain medical conditions, for example those that suppress immunity or require medications that suppress immunity, with documentation by a physician or nurse practitioner. Each health care facility was responsible for coming up with their own criteria and application process.
“The fact that we have only granted three waivers to date I think speaks to a tool that’s fair, concise and accurate,” Mr. Cayer said explaining the “very science-driven selection process” he and his team used to craft the waiver process.
The overall impact of continuing resignations even if they come at the current rate will depend on the roles of those leaving their jobs and the departments they are leaving.
Dr. Harney said the impact on various departments will depend on the decisions of a “handful of key individuals in certain clinical areas.”
“The vaccination mandate has taken our eyes off the real challenge and that is there is a critical health care staffing challenge,” according to Mr. Cayer. “We have been recruiting for nurses for years and for OB/GYNs, for years. We are not alone. There are thousands of positions that are open north of the (state) Thruway (stretching from Albany to Rochester).”
Mr. Cayer is now working with the chief nursing officer to determine what nurses in administrative roles can be re-positioned to key clinical roles that have been vacated before other “pauses” have to be enacted.
People who are resigning to avoid vaccination or are terminated because they refuse to be vaccinated will not be eligible for unemployment payments and anyone not giving two weeks notice, as required under their employment agreements, will not receive “accrued benefits” Mr. Cayer said, like paid vacation days.
CSEA in Albany is the health care worker union for the health system, often referred to as the “bargaining unit,” the leaders of which were very supportive of the mandate when it was issued by then-Gov. Cuomo and current Gov. Kathleen C. Hochul’s approach, Mr. Cayer said, however, “locally some of the leaders feel differently,” creating another “tension point” that needs to be worked through. He said he does not know that it has had an impact on employee decisions to vaccinate or leave.
Moving forward, COVID-19 vaccinations will be required to be hired at the health system, but the door is not closed on those that have chosen to leave.
“We’ve been very clear,’ Mr. Cayer said, “Anyone who has resigned that changes their mind will be welcomed back.”
The Health System is one of only two county-owned hospitals left in the state and is the largest employer in the county.
In addition to the state vaccination mandate, President Joseph R. Biden announced on Thursday a federal mandate for facilities that accept Medicare or Medicaid.