Some San Diego Hospitals Lagging Behind State Flu Vaccination Goal, While Others Exceeding
When Ed Hollingsworth’s students had a problem, he said they could always turn to him. The former theater and math teacher said he has helped kids deal with a variety of problems, from escaping an abusive parent to removing a hand stuck in a bowling ball.
But Hollingsworth, 71, deemed teaching in a germ-filled classroom far too risky for his compromised immune system since his cancer diagnosis.
“I don't dare expose myself to all that anymore,” he said.
Flu season is especially worrisome because the illness can cause severe complications for the immunocompromised like Hollingsworth or others with underlying health conditions. While researchers are rushing to create a novel coronavirus vaccine amid a global health emergency, one already exists for influenza. Yet a KPBS review of state records shows more than 100,000 California hospital employees who help care for the sick are still not receiving it.
The state health department encourages hospitals to vaccinate at least 90% of health care personnel against the illness by next flu season, but a report released in December shows half of the state’s facilities aren’t on track to meet that goal, including several in San Diego. Employees can refuse a flu vaccination for any reason as long as they decline in writing, but most county health departments require unvaccinated hospital workers to wear a mask.
Retired teacher Hollingsworth, who is in a clinical trial for treatment, said the health risks kept him away from the job he loves — but he was surprised to learn vulnerable patients like him could be exposed to the same dangers, depending on the hospital.
“Their obligation is to protect us,” said Hollingsworth, who has advocated on patient safety issues.
The recently released data from last flu season show five San Diego hospitals are falling short of the state’s goals. The county’s lowest-ranking facility — Alvarado Hospital Medical Center — reported 78% of medical staff received the vaccination over the annual period that stretched from October 2018 to March 2019.
Still, local institutions are faring better than about 85 other California facilities, including a Los Angeles County hospital with 29% of staff vaccinated. Eighteen other San Diego facilities are on track to meet the goal of 90% vaccination or have already achieved it, including Rady Children’s Hospital, which has the highest rate in the state.
Megan Medina, who manages infection control at Rady, attributes the facility’s 99% vaccination rate to its strict policy on exemptions. San Diego County doesn’t require hospital employees who refuse the vaccine to elaborate on their reasons, but Medina said Rady employees can decline only for medical reasons.
“We have a pretty rigorous process in order to get an exemption,” Medina said.
That excludes 25 employees with personal belief exemptions that were grandfathered in, but that’s down from 123, she said.
Rady’s policy differs from other local and state hospitals, many of which allow exemptions for personal reasons. That includes Scripps Mercy Hospital Chula Vista, which had an 86% vaccination rate — one percentage point below what’s considered on track to meet the goal by the 2020-21 flu season.
Dr. Craig Uejo, medical director of occupational health at Scripps Health, said the facility is just shy of being on track to reach the vaccination goal partly because physicians don’t always provide proof they’re vaccinated.
“If they don't send it to us, unfortunately, then we consider them unvaccinated,” Uejo said. “So it's not the greatest accounting methodology.”
Doctors aren’t direct hospital employees due to state law, but California still includes them in a hospital’s overall vaccination rate.
Uejo said physicians may treat patients at many facilities but only provide proof of flu vaccination to one of them — leaving other facilities without the needed documentation.
If you remove Scripps Chula Vista’s licensed independent practitioners, which includes physicians, from the equation, the state report shows 91% of the hospital’s direct employees are vaccinated. Just more than half of San Diego hospitals are in the same scenario.
Uejo said vaccination rates for this current 2019-20 flu season, which will be included in the state’s next report, will likely be higher for all employee groups. The deadline to achieve 90% vaccination is by the end of the 2020-21 flu season, which begins later this year in October.
KPBS requested interviews with the four other local facilities not on track to meet the goal as of the 2018-19 flu season, but Alvarado (78%), Paradise Valley (84%) and Kindred (84%) hospitals only provided emailed statements.
A spokesman for Alvarado and Paradise Valley hospitals, part of Prime Healthcare, said staff are working to achieve the state’s goal and have already seen an improvement in the hospitals’ vaccination rates this flu season. At Kindred, a spokeswoman said the hospital encourages its staff to receive the free flu vaccinations it offers and requires those who don’t to wear a mask.
A Sharp HealthCare spokesman attributed the rate of 86% at Sharp Coronado Hospital and Healthcare Center to poor documentation of physicians’ vaccinations. John Cihomsky said in a phone interview Sharp worked harder this season to verify vaccinations among doctors and saw the facility rate at Coronado increase this flu season to 92.5%.
A senior official at the California Department of Public Health or CDPH, which publishes the annual report, said it’s on the hospitals to verify the vaccinations of every person who works there, yet there are no state penalties associated with below-goal figures. Lynn Janssen, with the department’s healthcare-associated infections program, said the purpose of the report is to inform consumers.
“CDPH’s role is to put this information out so that people like you can call hospitals on ‘Why haven't you increased your influenza vaccination?’” Janssen said.
Figures can fluctuate year to year at individual hospitals, but Janssen said the statewide average has increased — several years ago 72% of California’s hospital workers were vaccinated compared to 85% in 2018-19 — although department officials expected higher figures than what this most recent report shows.
“We wish it was more rapid,” Janssen said.
San Diego County Public Health Officer Dr. Wilma Wooten said the county’s local health department doesn’t target specific hospitals falling below the goal. She said her office provides education on the importance of flu immunization and circulates an order each year directing all facilities to have vaccination policies in place. The directive also requires masks for unvaccinated employees.
“We are doing the same thing across the board every year and encouraging our facilities to comply,” she said.
Wooten said she was not aware that some hospitals, including those who reported vaccination rates below state goal, permitted exemptions for personal beliefs until contacted by KPBS.
“That's something we need to explore and determine why that is,” Wooten said.
However, many hospitals with the highest rates in the state also allowed exemptions for personal reasons.
Los Angeles County has 57 hospitals that are not on track to meet the goal, plus two others that did not report any data. Dr. Dawn Terashita, an associate director of communicable disease control at L.A. County Department of Public Health, said the department conducts site visits at the worst-performing facilities each year and customizes strategies to overcome barriers. She said one example would be increasing the number of teams that bring influenza vaccinations to employees while they’re working, especially for those on the night shift.
“Based on these projects, we've had very good results as far as increasing health care worker flu vaccination rates,” Terashita said in a phone interview.
The Los Angeles health department also created a task force to find other ways to improve and is reconsidering personal belief exemptions. She said some L.A. hospitals have already done so, “although they’re definitely in the minority.”
Hollingsworth, the retired teacher undergoing cancer treatment, is comfortable visiting the Moores Cancer Center at UC San Diego Health’s facility in La Jolla. The medical center is tied with a handful of other facilities for the state’s second-highest flu vaccination rate of 98%. But Hollingsworth’s wife, Marian, said she feels for patients visiting other facilities where more hospital health-care workers may use their right to decline the shot.
“I respect that, but I also expect them to be concerned and respect our rights to not be exposed to something that could prove fatal,” said Marian Hollingsworth, also a patient safety advocate.
Meanwhile, the Hollingsworths are controlling what they can at home. They asked visitors to get a flu shot before staying at their house. That even applied to their 26-year-old son who, along with his bandmates, visited around the holidays. The band, Satin Nickel, performed at the Casbah.
Hollingsworth said he felt like the crowded nightclub would be a risk, but he didn’t want to miss his son’s show.