Thursday, May 31, 2012

Michigan Legislature Aims to Restrict Public Health

Now that Memorial Day has passed in the United States and I've had some time to get over last week's emotion-draining post, it seems like a good time to take a look at what lies ahead. What developments are in the works? Where is public health headed? We can expect the pertussis outbreaks in the U.S. to continue to spread, very likely including more pertussis deaths. We will likely see cases of measles imported from Europe. And we'll see public health officials work hard to prevent and contain outbreaks of disease.

Legislators, on the other hand, may need a bit of prodding.

In Michigan, it appears that the legislature is taking steps to make it harder for health care facilities to protect the health of their patients. A group of 11 republicans and 1 democrat have introduced legislation that aims to dictate to hospitals and other health facilities and agencies what they can and cannot do with regard to ensuring their staff are not a potential source of influenza infection.

As it currently stands in the state of Michigan, health care facilities have a fair bit of leeway in how they handle their own staff when it comes to vaccination requirements. They can allow their staff to make their own decision regarding influenza vaccines, require them to wear protective masks while on duty, or mandate that they be immunized or stay away from work.

But this legislation (HB 5605) would change that. The bill, as written, would thankfully have relatively limited impact, as it only addresses influenza vaccinations. Consisting of two parts, the bill has both good and bad elements to it. First, the good:
(2) if, during influenza season, an employee does not demonstrate to the health facility or agency that he or she has received an influenza immunization for the current influenza season, the health facility or agency may require that employee to wear a surgical mask or take other overt action when in direct contact with the health facility's or agency's patients.
This gives health care facilities the legal authority to mandate that their staff wear protective gear to minimize the risk of influenza transmission, should the employee not receive the flu vaccine. This is good, since it means that employees who refuse immunization and who also refuse to wear a mask (which, admittedly, is less than comfy) can rightly be asked to not come in to work. Protecting health facilities from possible litigation in this manner is great!

But the bill also manages to tie the hands of health providers:
(1) a health facility or agency shall not require an employee to receive an influenza immunization as a condition of employment, promotion, or change in employment status, as a condition of granting staff privileges, or as an express or implied condition of a benefit or privilege of employment.
 The job of a health facility is to care for patients. Part of that mission is to prevent, wherever possible, additional illnesses arising as a result of being in the health care environment itself. They sterilize surfaces, maintain (or should maintain) proper hand hygiene among staff, use sterile tools and instruments and so on. Many also require their staff be immunized against certain pathogens to further minimize the risks to their patients. This bill, however, would outright ban health care providers from requiring their staff to take a reasonable precaution like immunization.

Certainly, there are those for whom the influenza vaccine may be contraindicated. They should not be required to be immunized, as doing so would directly and demonstrably threaten their health, and should instead be required to wear a protective mask during flu season. However, barring such a contraindication, I do not see a reasonably objection to requiring those who are able to be immunized to get the vaccine. Personally, if I discovered that one of my health providers was not willing to take safe and responsible steps to prevent their getting me sick, I wouldn't want them anywhere near me, and I'd question why they are working in a health facility at all.

As I mentioned before, the scope of the law is quite narrow, thankfully. But if passed, it would create a rather troubling precedent. If a hospital cannot require staff to be immunized against influenza, then this bill could be used to argue that employees should not be required to be immunized against Hepatitis B or meningitidis or receive any of the other recommended vaccines for health care workers, either.

One of the co-sponsors of this bill, Rep. Rick Olson (R-Saline), is quoted as saying that he is "not a strong believer in mandatory things. If it's against someone's religious beliefs or something like that, there are people who just don't believe in things like that." This strikes me as a flimsy justification for banning health care facilities from taking measures to protect their patients. One wonders if Rep. Olson would similarly support a parent's religiously held belief to deny medical treatment for their child, when failure to treat with proper medicine is fatal (e.g., Christian Science objections to using insulin to treat diabetes).

N95 respirator
Surgical mask
While masks might help reduce the spread of influenza in the health care setting, surgical masks appear to be less effective than N95 respirators, and both are prone to failure due to lack of proper fit. Vaccination is much more reliable, and so health care policies should be flexible enough to allow mandated vaccination coupled with mask and hand hygiene protocols.

People who choose to go into medicine should uphold as their primary objective ensuring their patients' health. Willfully falling short of that goal is grossly irresponsible; if you are not willing to do what it takes to minimize the risks to your patients, especially when the risk is yourself, then you are in the wrong field. Hospitals, nursing homes, hospices, public health agencies and similar facilities should have the right to make protecting their patients a condition of employment. Stripping them of that right weakens our health care system and endangers the people who are most vulnerable.

If you are a Michigan resident, contact your representatives and encourage them to oppose this legislation. You can find your representatives' contact information here.

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