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Colorado health officials back off plan to weaken coronavirus vaccine mandate for hospitals

The head of the Colorado Department of Public Health and Environment said the state would instead wait until a forthcoming federal mandate is finalized

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State health officials will not ask the Board of Health next week to loosen the mandate requiring all health care workers at licensed facilities to be vaccinated against the coronavirus.

In a letter sent Friday to facilities, Colorado Department of Public Health and Environment Executive Director Jill Hunsaker Ryan said CDPHE wants to wait until the rules around a federal vaccine mandate are finalized before it suggests changes to the state’s mandate. Ryan said the department wants to “harmonize with the federal rule.”

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“We believe this is the most responsible path forward at this time and this pause will allow us to consider the pending federal requirement,” she wrote.

The decision means that the Board of Health may not make any immediate changes to the existing mandate, which it first approved in late August. Its agenda for the Oct. 21 meeting lists a presentation on the vaccine mandate but no action items.

The mandate requires hospitals, nursing homes and other licensed care facilities to have 100% vaccination rates among workers. Medical exemptions are counted toward compliance, but religious exemptions are not.

Facilities with employees claiming religious exemptions must request a waiver from the rule. CDPHE has so far received 949 waiver applications, and Ryan indicated in her letter that facilities with high rates of exemptions will receive extra scrutiny.

Jill Hunsaker Ryan, who leads the Colorado Department of Public Health and Environment.

“Given that high rates of exemptions to vaccination could place patients and staff at risk for exposure to COVID-19, CDPHE will consider this issue when determining whether to grant a waiver and prioritize facilities that have a higher rate of exemptions for infection control inspections,” Ryan wrote. “It goes against the rule for staff to be unvaccinated and not have an approved attested exemption on file at the facility.”

Ryan’s approach outlined in the letter is a shift from earlier this month, when presentation slides indicated that a CDPHE branch supported easing the mandate and counting religious exemptions toward a facility’s compliance level. (A CDPHE spokesperson at the time said the option was one of several being discussed.)

Loosening the mandate would have brought the COVID vaccination requirements in line with what is already required for flu vaccination. It also would have reduced CDPHE’s workload in reviewing waiver applications. And, crucially, it would have spared hospitals, nursing homes and other health care facilities from having to fire some staff at a time when health care staffing is already strained. On Wednesday, 34% of hospitals told the state they expect to experience a staffing shortage in the coming week.

Hunsaker Ryan’s letter may cause further confusion at hospitals about what to do with unvaccinated workers. The hospital in Holyoke, for instance, had planned to let go three unvaccinated employees at the beginning of this month, then switched their status to administrative leave when discussion arose about easing the mandate. 

“While we appreciate the effort to align both mandates … this letter does make it challenging for our hospitals because the implementation guidance from the state continues to change,” Cara Welch, a spokeswoman for the Colorado Hospital Association, wrote in an email.

Welch said the hospital association supports vaccination but still believes the mandate should be changed to align with the flu vaccine mandate — which requires only 90% compliance among hospital staff.

In comments submitted to the Board of Health ahead of next week’s meeting, Doyle Forrestal, the CEO of the Colorado Behavioral Healthcare Council, also expressed concerns about the mandate and its impact on staffing.

“Now is not the time to reduce care or close programs serving Coloradans in need, but there is a real chance that this mandate will drive more staff vacancies,” he wrote. “(P)utting it as strongly as I can, I am very worried about the incredible potential impact to the workforce and ability to continue to deliver needed care.”

There is one area where the state will cut some slack, Hunsaker Ryan said in her letter: live-in home health care providers whose only patient or patients are those living in the same house — and are often their family members. Those caregivers will receive a temporary exemption from the vaccination requirement.

But she otherwise stuck firm on the need for health care facilities to comply with the mandate as written.

“Over the past year, it has been clear that one strategy gives Colorado the best chance to minimize the impact COVID-19 has on the health care system,” Hunsaker Ryan wrote. “That strategy is the vaccine.”


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