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Vaccine drop-in during the grand opening of the St. Vincent Health hospital on September 8, 2021, in Leadville, Colorado. (Hugh Carey, The Colorado Sun)

Colorado health officials have proposed weakening the state’s coronavirus vaccine mandate for health care workers, meaning some employees at hospitals and nursing homes might be able to remain on the job while unvaccinated even if they don’t have a valid exemption.

The proposal comes after the deadline has already passed for workers to receive their first dose of vaccine, and it is causing chaos at some health facilities that have been having difficult conversations with workers who refused vaccination and would have to leave their jobs as a result.

The hospital in Holyoke, for instance, planned last week to hold a going away party for three workers who do not intend to be vaccinated. Their final paychecks had been processed.

But after the new proposal came to light, the hospital changed the employees’ status to place them on administrative leave.

“We received the information very late and I am unclear whether they will still allow those employees to stay,” Cathy Harshbarger, the CEO of the hospital, Melissa Memorial Hospital, wrote in an email to The Colorado Sun.

The proposed changes were floated last week during a meeting of the state’s Residential Care Strike Team, which works to prevent coronavirus outbreaks in health care facilities. Ultimately, it will be up to the state Board of Health to decide whether to approve the changes. The board is scheduled to meet Oct. 21.

Currently, 100% of hospital and nursing home staff must be vaccinated or have a valid medical exemption. Workers had until the end of last month to receive at least a first dose of vaccine.

Religious exemptions to the mandate are allowed under the existing rule but don’t count toward a facility’s compliance with the rule. Instead, facilities with employees claiming religious exemptions must file an application with the Colorado Department of Public Health and Environment asking for a waiver from the vaccination mandate. The state then has 90 days to review those applications.

As of Thursday, the state had received 101 waiver requests from facilities. The Colorado Hospital Association last week filed a waiver request covering every one of its members, citing the uncertainty brought on by the proposed changes to the mandate, association spokeswoman Cara Welch said.

“Our hospitals want to comply; they want to do the right thing,” Welch said. “They want their staff vaccinated, obviously. But there’s just so much going on right now.”

The proposed changes would require facilities to reach only 90% compliance with the vaccination mandate. Religious exemptions would also be counted toward a facility’s compliance rate, reducing the number of waiver applications for the state to review.

Presentation slides shared at last week’s Residential Care Strike Team meeting said the proposed changes are recommended by CDPHE’s Health Facilities and Emergency Medical Services Division, which regulates hospitals, nursing homes and other facilities. The proposal will bring the coronavirus vaccine rules in line with what has historically been required for flu vaccination and “leaves flexibility in the rule to accommodate for exemptions, as well as staff turnover,” one slide stated.

In an email, a CDPHE spokesperson confirmed that the proposal is under consideration but described it as one option being debated.

“It shouldn’t dissuade or slow facilities down from enacting the current emergency rule, which is in effect for 90 days and still carries the weight of law,” the spokesperson wrote. “We will be enforcing it.”

Facilities that do not comply with the vaccine mandate face escalating fines and could, in the worst case scenario, lose their licenses.

Rural hospitals struggle with staff vaccinations

Exactly how this is playing out at hospitals and nursing homes across the state varies.

For some facilities, the proposed amendments to the state mandate change very little because the hospitals have already imposed their own mandates.

The exterior of the University of Colorado Hospital on the Anschutz Medical Campus in Aurora, photographed on Oct. 18, 2019. The hospital is the flagship of the UCHealth system. (John Ingold, The Colorado Sun)

UCHealth, one of the state’s largest hospital systems, gave workers until Friday to be vaccinated. Of the system’s 26,500 employees, only 119 — less than 0.5% — did not get a vaccine or an exemption. Those workers are being fired, said Dan Weaver, UCHealth’s vice president for communications.

“Despite the loss of these employees, UCHealth’s COVID-19 vaccination requirement has helped to improve staffing,” Weaver wrote in an email. “With broad vaccination rates, fewer employees are testing positive for COVID-19 and needing to be out of work while they recover.”

But rural hospitals, which are often located in areas where coronavirus vaccination rates are low and skepticism toward the vaccines is high, have faced a much bigger challenge. Few have issued their own mandates. Michelle Mills, the CEO of the Colorado Rural Health Center, said she hadn’t heard of any rural hospitals in the run-up to last week’s deadline that had hit 100% compliance.

“So there is going to be some workforce shortages,” she said.

Those shortages could come at a time when Colorado hospitals are already slammed with coronavirus cases. More than 30% of the state’s hospitals anticipate a staff shortage in the coming week, according to state data.

But potential staff shortages are especially daunting for rural hospitals because they already struggle to attract workers and because they typically operate on such small financial margins that bringing on expensive temporary staff isn’t a sustainable option.

These challenges caused some local leaders across the state to call for Gov. Jared Polis to offer small hospitals a blanket waiver to prevent a rural health care crisis. Some of the loudest voices have been from Otero County, where county commissioners last week approved a resolution opposing vaccine and mask mandates, and the Arkansas Valley Regional Medical Center in La Junta told 11 News that as many as 26 nurses could leave.

Regardless of the state mandate, though, the federal government has also vowed to impose a vaccination mandate on hospitals that receive payment from Medicare or Medicaid — which is basically all of them. (The exact federal rule isn’t expected until later this month.) The presence of an overlapping federal mandate caused Polis last week to show little interest in loosening the state mandate.

“I think they are directing their attention in the wrong direction,” Polis said of those asking for a state reprieve for rural hospitals.

But the state deadline last week forced a month of difficult conversations within Colorado hospitals that now may have been unnecessary.

“Our sorrowful month”

A month ago, Harshbarger, the Holyoke hospital CEO, was near panic.

When she looked at her vaccination numbers after the Board of Health passed the mandate, she found that nearly half the hospital’s workforce of a little over 100 people was unvaccinated. If they didn’t get the shot or a valid exemption, they would be walking out the door and the hospital would have had difficulty maintaining all but the most critical services.

By the deadline last week, things were looking better. Some staffers chose to get vaccinated. Close to 20 filed for exemptions, either religious or medical. And three planned to leave their jobs over the mandate — and maybe leave the health care profession altogether.

The coronavirus pandemic changed the rhythm of life in northeast Colorado, including at Melissa Memorial Hospital in Holyoke, where hospital vendors and contractors in March were required to route through the admissions department. Some businesses deemed non-essential had to shut down during state stay-at-home orders. The community rallied with a fundraiser to make sure they still were around when the order lifted. (The Holyoke Enterprise)

But Harshbarger said the road to getting into compliance was paved with a lot of difficult conversations and turmoil during September, what she described as “our sorrowful month.” She said the mandate brought upheaval to the community. Workers started meeting to discuss their options. Harshbarger consulted a lawyer. Community leaders called on her to fight back against the mandate, while others insisted the hospital comply.

“It’s almost like it’s so intense in people’s fibers in how they feel about this that it’s catapulted into a whole different thing,” she said.

Eventually, Harshbarger said she settled on an approach: She would tell staff that it was their decision, and their decision would be respected, no matter what.

That doesn’t mean she would agree with those who wouldn’t get vaccinated — Harshbarger said she chose to get vaccinated because she believed it was her duty to the community as a health care worker. And it doesn’t mean the workers would agree with the consequences. But it would keep the community from breaking apart over the issue and would create a clear path forward.

On Thursday, she said, the hospital planned a going away party for the three workers it believed then would be leaving over the mandate.

“They’re leaving because they had a choice they made,” she said early last week. “And we’re going to honor that choice and honor the work they did here.”

And on Friday, she said, the hospital would begin to heal.

But that was before the proposed rule changes came down. She’s not sure what happens to the unvaccinated workers now.

“I asked them to give me some time to work with legal and see if they can stay,” she wrote in an email.

John Ingold is a co-founder of The Colorado Sun and a reporter currently specializing in health care coverage. Born and raised in Colorado Springs, John spent 18 years working at The Denver Post. Prior to that, he held internships at...