As the number of those infected with the H1N1 influenza virus throughout the U.S. rises, available vaccines continue to undercut the demand and hospitals are beginning to shift policies to manage the overflow of patients seeking care.
A panel met for the second H1N1 Flu Summit on Friday at the UH Law Center, where a discussion was held on how the law and the declaration of a national emergency affect how businesses, individuals and health care providers should manage the outbreak.
President Barack Obama declared a national emergency Oct. 24, giving U.S. Department of Health and Human Services Secretary Kathleen Sebelius the authority to issue waivers of federal requirements to hospitals, said Craig Conway, Research Assistant Professor at the Health Law and Policy Institute.
‘(EMTALA) requires hospitals to screen, stabilize (and) help patients who present to the emergency department with an emergency medical condition,’ Conway said. ‘(It also) allows a hospital to relocate to alternative or off-site facilities, (so) hospitals can transfer without restrictions.’
Conway said the concern about safety has led to a cautious approach to the vaccination program.
‘If you do the research, they all point to the swine flu outbreak in 1976, where the cases hit some soldiers at Fort Dix,’ Conway said. ‘As a result, around 40 million (people) nationwide were vaccinated, and a lot of people developed a nervous disorder, Guillain-Barr’eacute; (syndrome). The vaccine was recalled. There were deaths involved, lawsuits filed; claims resulted.’
With the new H1N1 virus, vaccine makers wanted to avoid a recurrence by making vaccines safer and by utilizing the Public Readiness and Emergency Preparedness Act triggered by the public health emergency declaration in April, Conway said.
The PREP Act provides legal immunity to manufacturers and releases liability of administrators, distributors and qualified persons who distribute countermeasures and designates a special fund to compensate afflicted individuals, Conway said.
The Centers for Disease Control and Prevention said that flu vaccinations are the key to slowing down the spread of pandemic flu, and health care workers are a priority because they have a high risk of exposure to patients who have the flu, as well as potentially transmitting the flu to patients, research assistant professor Cynthia Marietta said.
‘ Health care workers historically tend to have low immunization rates ‘- only 42 percent of them were vaccinated last year and statistics show that high staff-immunity rates correlate with low rates of institutional outbreaks, Marietta said.
The World Health Organization, the CDC and the state of Texas did not issue a mandate for vaccination, Marietta said.
‘The state of New York ‘hellip; is the only state which has issued a mandatory flu vaccination program for its health care workers,’ Marietta said.
‘(It) passed an emergency regulation this past August, basically requiring health care facilities to provide vaccinations to all health care personnel.’
‘ After the mandate was issued in New York, four lawsuits were filed by groups of nurses and unions and a permanent injunction was issued Friday.
The mandate was suspended when only 23 percent of anticipated doses were received, Marietta said.
‘Interestingly, the media has said that there is a monetary guillotine – there’s job termination if the health care worker does not get the vaccination, but that’s not what the regulation says,’ Marietta said.
‘These hospitals can impose the criteria, perhaps (of) termination if they don’t get the vaccination, but it’s not the actual New York regulation.’
Texas’ pandemic flu plan outlines the utilitarian philosophy that physicians and health care providers will be forced to shift the goal of the best possible care for each individual to ensuring the health and safety of as many people as possible, Director of Research and External Affairs for the Health Law and Policy Institute Patricia Gray said.
The nation has seen medical triage in disaster situations, most recently in Katrina, the experiences of which have helped direct some of the recommendations in pandemic flu planning, of which comprehensive national guidelines are lacking, Gray said.
‘The images from Katrina are likely to stay with us for a very long time,’ Gray said.
‘But this is really the first time in generations, aside from the 1976 outbreak, that we have really faced the prospect of triage in a disease outbreak situation.’
