Oregon’s vaccine mandate is likely to cause longer waits for health care

Health care workers in Oregon, who were among the first to be vaccinated against Covid-19, have some of the highest vaccination rates ahead of the mandate taking effect Monday.

Dentists are out in front: 98% are inoculated. Medical doctors, psychologists and physical therapists all have rates above 90%.

But chiropractors are near the bottom: Only 60% are fully vaccinated.

The mandate could affect patients across Oregon, depending on the facility and location. Rural areas, where resistance to Covid-19 vaccines runs the highest, are likely to see the greatest impact.

Hospital systems shared their circumstances with the Capital Chronicle in the days ahead of the mandate’s impact.

One hospital system – Legacy Health – announced changes in service. Lab services will be closed in Lake Oswego and West Linn; mammograms and ultrasound services will be suspended at the Woodburn Health Center, and in Tualatin, the company will consolidate ultrasound and X-rays at the Legacy Meridian Park Medical Center.

Legacy said the mandate boosted the percentage of employees vaccinated to 95%. About 680 Legacy employees are currently on leave for not meeting the vaccine requirement. A statement said that 100 plan to get shots and will return to work when they are fully inoculated. The others will be fired.

“For employees who choose not to get vaccinated and will have their employment terminated on Oct. 19, we appreciate the difficulty of this decision. We are grateful to them for their service to communities,” the statement said.

The company didn’t provide details on what jobs those people hold. Even a 5% reduction in a hospital’s workforce could disrupt services. 

At Asante, which has three hospitals in southern Oregon, the mandate will “impact services and interdepartmental operations,” according to an online statement by Amanda Kotler, a vice president of nursing.. 

Nearly 90% of the company’s 6,100 employees are vaccinated. Those who aren’t in compliance on Monday will not be at work, said Lauren Van Sickle, the company’s spokeswoman. 

“There may be longer wait times in certain areas such as emergency room or outpatient services,” Van Sickle said in an email.

Another regional hospital system, PeaceHealth, with four hospitals in Lane County, reported a 95% vaccination rate among it’s 5,400 Oregon employees. Those who didn’t get the shots were put on leave on Sept. 1 and could be fired. 

A spokesman didn’t address a question about the impact on patient services. 

Providence Health & Services and Oregon Health & Science University in Portland and the St. Charles Health System in Bend also declined to predict the effect on patients. 

“We won’t know how many members are on leave or laid off until the week of Oct. 18,” said Tracy Brawley, an OHSU spokeswoman.

At OHSU, 96% of 22,000 staff, students and volunteers are fully or partly vaccinated. By last week, the institution approved about 25 medical and religious exemptions.

Providence has a compliance rate of 96%. That still leaves more than 1,000 out of its 23,000 employees out of compliance.

“Providence remains confident that we are well positioned to continue serving the needs of our patients,” said Gary Walker, a company spokesman.

At St. Charles, which operates four hospitals, 94% of staff are vaccinated. Those who decline to get a shot and don’t have an approved exemption will be terminated.

“We will consider them to have voluntarily resigned their position with the health system,” said Lisa Goodman, St. Charles’ spokeswoman. 

At Samaritan Health Services, with five hospitals from Albany and Corvallis to the coast, 90% of staff are vaccinated. Those who are not inoculated or haven’t requested an exemption by Monday will effectively lose their jobs as well. If they get vaccinated or seek an exemption after that they’ll be able to apply for an appropriate position.

Kaiser Permanente, on the other hand, has largely adjusted its ranks. Nearly 99% of its 11,000 employees are vaccinated or have an exemption. About 1,000 employees asked to opt out, and most of those requests were approved, said spokesman Michael Foley. 

The 1.5% of staff who did not respond were placed on administrative leave Oct. 1. They have until Dec. 1 to comply.

Foley said patient care will continue as usual even with the departures.

The impact of the mandate is likely to have a bigger impact on patient services in rural Oregon, experts said. One industry source who lacked authorization to speak on the record said that Blue Mountain Hospital in John Day is worried about its ability to clean rooms. None of its housekeepers is vaccinated. Officials at the hospital, which has 34 beds and emergency department services, didn’t respond to a request for comment.

Saint Alphonsus Medical Center in Ontario, located in Malheur County with a 54% vaccination rate among health care workers, reported a 94% rate of compliance. A hospital spokesman declined to elaborate. Good Shepherd Health Care System in Hermiston, however, said it was on track to be fully compliant, and Columbia Memorial Hospital in Astoria said only 11 of its 725 employees will lose their jobs because they had not complied..

“The vaccine mandate will not impose any significant hardship on our ability to care for the community,” its CEO Erik Thorsen said in a statement.

Mandate likely to affect some clinics

It’s unclear what impact the mandate will have on private clinics across the state but if federally funded clinics are an indication, some rural services could be hampered.

Oregon has 34 such health clinics attending to a half a million patients every year. The clinics serve low-income residents on the Oregon Health Plan, the state’s version of Medicaid and seasonal and migrant farmworkers who are uninsured, said Marty Carty, government affairs director of the Oregon Primary Care Association, which provides technical assistance and policy support.

The association found in a survey of its members last month that rates of non-compliance ranged from 4% at a clinic in the Portland area to 27% in eastern Oregon. 

“There is no case where our members have said they will close a site or something dramatic will happen,” Carty said.

The mandate also seems certain to affect mental health patients, along with addicts and people needing developmental disability services. Heather Jeffries, executive director of the Oregon Council for Behavioral Health, said some regions are expecting a 7% to 15% loss of employees. 

“Do keep in mind this is on top of current vacancies stimulated by exhaustion/fatigue and impacts of non-competitive wages in our sector,” Jeffries said in an email.

Jeffries said that starting Monday, patients will have even more difficulty finding help in outpatient and residential settings..

“This lack of workforce is being felt at all levels of care,” Jeffries wrote. “Less access to services will cause longer wait times.” 

That means that even more people in a mental health crisis will turn to emergency departments for help.

More flexibility in long-term care

In the long-term care industry in Oregon, which employs about 33,000 people, only about 72% are vaccinated. Rates vary from 80% in the Portland area to 60% in eastern and southern Oregon, and they vary among facilities.

Not all of the long-term care providers have reported their compliance rate either, according to Oregon Health Authority data.

It’s unclear what will happen on Monday to staffing in the facilities.

Fred Steele, the long-term care ombudsman, had hoped that the mandate would curtail outbreaks and deaths from Covid-19 in facilities. He said that some facilities still don’t follow proper protocols to protect residents. He had hoped the state would police the mandate but the Oregon Health Authority is leaving that up to employers. 

If someone files a complaint, Oregon Occupational Safety and Health will investigate.

“If we don’t enforce the vaccine mandate, we will continue to see outbreaks and the impact of the virus on residents and staff and their facilities,” Steele said. 

Leading up to the mandate some smaller facilities in rural Oregon have closed or consolidated because of problems hiring enough employees.

The Oregon Department of Human Services has offered $500 retention bonuses to staff in nursing facilities, which employ nearly 13,000 people. “My hope is that we’ll see vaccination rates go up,” Director Fariborz Pakseresht told the Capital Chronicle.

He said that with exceptions, the long-term care industry could be looking at a 5% to 10% noncompliance rate and resulting vacancies.

“They are trained to manage that,” Pakseresht said. “Still, there is going to be some pain. There are a number of staff that will not get vaccinated, period.”