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Smallpox Plan Divides Hospitals

Fifteen in the county refuse vaccinations for employees. Nine accept; most are undecided.

February 06, 2003|Charles Ornstein and Denise M. Bonilla | Times Staff Writers

A growing number of hospitals in Los Angeles County -- 15 as of Wednesday -- have opted out of a new nationwide smallpox vaccination program for emergency medical workers.

Some hospitals cited a lack of people volunteering to take the vaccines, which is part of a federal effort to prepare for possible bioterrorism. Other medical facilities said they need more time to study the vaccine's health risks and liability issues.

Nine of L.A. County's 83 eligible hospitals have submitted the names of employees willing to receive inoculations -- and most of those are small. An additional 52 hospitals have indicated that they would participate but did not hand over names as of Monday, when the county wanted them. Seven hospitals have not responded.

Among the 15 institutions that have decided not to offer the vaccine are three of the county's largest: Providence St. Joseph Medical Center in Burbank, St. Mary Medical Center in Long Beach and Huntington Memorial Hospital in Pasadena.

"It's somewhat disappointing," said Carol Gunter, assistant director of the county's Emergency Medical Services Agency. "Everyone realizes that it's just taking a lot longer to get this process going than what was expected, because of the unknowns, because of the unanswered questions."

Because so few hospitals have turned in volunteers' names, the county Department of Health Services will continue to accept such submissions.

"We had expected that it would go a little faster than it appears to be going," said Dr. Jonathan Fielding, the county's public health director.

Health-care labor unions have encouraged members not to volunteer for the inoculations because the federal government has not created a fund to compensate workers who might suffer side effects or miss work because of complications.

The vaccination of up to 450,000 emergency health workers nationwide is part of President Bush's three-phase plan to prepare for any intentional release of the smallpox virus by terrorists or rogue nations. In subsequent phases, the vaccine will be offered to police officers, firefighters and paramedics, and finally to the public.

Los Angeles County could be a bellwether for the nation because it is the second nonmilitary site to begin vaccinations. Connecticut, the first, also has had a slow start.

Providence Health System, with hospitals in Burbank and Mission Hills, concluded that "the risks of offering the vaccine far outweigh the benefits at this time," spokesman Dan Boyle said.

According to previous studies, about one to two people per million die of complications caused by the vaccine, which is harvested from calves' bellies. As many as 52 people per million experience life-threatening complications, including encephalitis, and 1,000 more suffer reactions such as serious rashes.

Verdugo Hills Hospital has decided not to participate because of some opposition to the vaccine among the staff, said Linda Greenwood, an infection control nurse at the hospital.

"Because it is voluntary, we felt we could wait at this point," she said. "We would always be open to participating. Maybe in the second round of vaccinations we would reconsider."

Smallpox, which is highly contagious, was eradicated worldwide in the 1970s, but the Bush administration fears that secret stockpiles may be held by Iraq and North Korea.

Tom Skinner, a spokesman for the U.S. Centers for Disease Control and Prevention, would not say if hospital resistance threatens the program's goals. But he said the federal government is working to resolve hospitals' concerns, including a plan to compensate any workers who suffer serious side effects.

"What we're interested in is the states implementing this program as fast as possible, but more importantly as safe as possible," Skinner said.

In Southern California, the hospital industry's trade group is concerned about the growing chorus of no's and has invited county health officials to discuss the matter with hospital chief executive officers at a meeting later this month.

"More hospitals in Los Angeles need to participate in this program," said Jim Lott, executive vice president of the Hospital Assn. of Southern California.

Methodist Hospital in Arcadia has submitted a list of 60 employees, ranging from housekeeping staff to physicians, who are willing to be vaccinated.

"We feel it's part of our mission of the hospital to serve our community," said Catherine Kaliel, nurse manager of the hospital's emergency department. "I've been very pleased with the turnout."

Outside Los Angeles County, the California vaccination program is being handled by the state Department of Health Services. It is expected to start later this month.

In Orange County, said Dr. Bruce Haynes, the county's medical director of emergency medical services, two of the 25 hospitals that treat emergency patients have indicated a strong likelihood that they will not participate and 10 to 15 are "still on the fence."

The hospitals have until next week to tell the county whether they will participate.

"If people understood that there really was going to be an attack and it was important to the country's security to be vaccinated," Haynes said, "I think they'd step up and be vaccinated."

In the event of an actual smallpox outbreak, he said, "I think they'd be vaccinated so quickly that it would make your head swim."

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Times staff writer David Haldane contributed to this report.

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