Draft Blog: Article Review: CAN YOU ASK YOUR HEALTH CARE CASE WORKER IF THEY ARE VACCINATED AGAINST COVID-19 AND DO THEY HAVE TO ANSWER BY RYAN BLENTHEN OF THE SEATTLE TIMES

 Article Review: CAN YOU ASK YOUR HEALTH CARE CASE WORKER IF THEY ARE VACCINATED AGAINST COVID-19 AND DO THEY HAVE TO ANSWER BY RYAN BLENTHEN OF THE SEATTLE TIMES

https://www.seattletimes.com/seattle-news/health/can-a-patient-ask-whether-the-health-care-workers-they-see-are-vaccinated-against-covid-and-do-they-have-to-answer/?amp=1&__twitter_impression=true

1. Introduction

Recently I read an interesting article for Kidney Patients concerning whether or not you are permitted to ask your healthcare provider/COVID-19 vaccine administrator if they had been vaccinated against the COVID-19 virus, and if in fact they are required to respond to your questions legally, ethically or morally.

In this age of a rising number of vaccines being given, https://www.ajmc.com/view/a-timeline-of-covid-19-vaccine-developments-in-2021, and yet many healthcare providers have indicated that they will not/have not taken the vaccine, https://www.health.harvard.edu/blog/why-wont-some-health-care-workers-get-vaccinated-2021021721967; https://www.ama-assn.org/delivering-care/public-health/dealing-covid-19-vaccine-hesitancy-among-health-care-workers.

According to CBS NEWS, almost half, 48% of healthcare workers have not received the vaccine. https://www.cbsnews.com/amp/news/health-care-workers-covid-19-vaccine-half-not-vaccinated/.

See Also:
https://www.washingtonpost.com/health/2021/03/19/health-workers-covid-vaccine/ (Poll from Washington Post and Kaiser Family Foundation found 52% of frontline healthcare workers had not received the 1st vaccine injection);

https://www.kff.org/coronavirus-covid-19/press-release/kff-post-survey-of-frontline-health-care-workers-finds-nearly-half-remain-unvaccinated/; https://www.wbtv.com/2021/04/09/vaccine-hesitancy-among-health-care-workers-raises-concerns/.

See Generally: https://www.capitalgazette.com/lifestyles/ac-cn-column-iris-krasnow-2021404-20210402-bccrtlhronbpbh5gdrn6b5l3hy-story.html;

https://www.reliasmedia.com/articles/147717-long-term-care-workers-refusing-covid-19-vaccines.

Given that roughly half of healthcare workers have not received the vaccine, do we as Kidney Patients, a susceptible group of potential COVID-19 patients, have a right/ obligation to ask our healthcare providers if they have been vaccinated? https://www.kidney.org/contents/be-prepared-kidney-patient-prep-coronavirus (Older adults and people with kidney disease or other severe chronic medical conditions seem to be at higher risk for more serious Coronavirus illness. Because of this increased risk for kidney patients, it is especially important for you to take actions to reduce your risk of exposure.);

https://www.healthline.com/health/kidney-disease/chronic-kidney-disease-and-covid; https://www.nature.com/articles/s41581-020-00349-4; https://cjasn.asnjournals.org/content/15/8/1087.

https://www.kidney.org/coronavirus/transplant-coronavirus(Kidney Transplant Patients); https://www.karger.com/Article/FullText/512329 (Kidney Transplant Patients); https://jasn.asnjournals.org/content/31/10/2413

If we do ask, do they have a legal, moral or ethical obligation to have either taken the vaccine or to disclose that they have not?

2. Do We Have The Right to Ask Our Healthcare Providers if They Have Been Vaccinated Against the COVID-19 VIRUS?

The writers on this topic seem to indicate that it never hurts to ask, yes patients can ask. https://abc11.com/caregiving-covid-vaccine-vaccination-vaccinated/10447597/; https://www.cdc.gov/vaccines/covid-19/hcp/answering-questions.html.

This is not the real issue here, the patient may ask, but the healthcare provider may not be legally obligated to answer.

3. Your Healthcare Provider is NOT Legally Obligated to Answer Your Questions About His/Her Private Healthcare Matters

According to the Blenthen article, your healthcare provider is under no legal obligation to answer questions about his/her Private Healthcare treatments and choice under the Health Insurance Portability and Accountability Act:

"It is a question patients might not get answered. State and federal laws like the Health Insurance Portability and Accountability Act, fondly known as HIPAA, protect the medical privacy of nurses and doctors, just as it does for patients... A patient doesn’t have the legal right to know if a health care worker has been vaccinated — just like anyone else protected by medical privacy laws. But a person can always ask the question of their nurse practitioner or whomever else they are interacting with.

“It’s not a right that a patient has to know. That is something that a health care provider may be comfortable in sharing but also may not,” said Dr. Thomas May, the Floyd and Judy Rogers endowed professor at Washington State University’s Elson S. Floyd College of Medicine...[t]he staff is not required to disclose their vaccination status, but can if they choose, said Susan Gregg, spokesperson for UW Medicine.

“It is private, protected health care information,” she said.

Kaiser Permanente Washington and Swedish Medical Center also leave it up to staffers if they want to let patients know they have been vaccinated. Swedish employees were told they can share their vaccination status but can cite HIPAA if they chose not to." Cary Evans, vice president of communications at Virginia Mason Franciscan Health, states on the

“They are not required to disclose this personal health information, which is shielded by federal law protecting patient privacy,” he wrote in an email. “It is each team member’s choice how they respond to question about their vaccination status.”

Because of the suspicion some people have in regard to COVID-19 and the vaccines, health care professionals might feel an obligation to be an example and let patients know that they are willing to do it, May said.

“A lot of physicians will think, ‘Well, I’m confident in the safety and I want to demonstrate that to my patients by being public with my vaccination status,’ ” he said.
Kayte Spector-Bagdad, J.D., MBe, an expert from the University of Michigan seems to agree, "HIPAA is one of the most misunderstood health laws in the country, says Spector-Bagdady, who has studied medical privacy extensively.

“Very few people actually understand what it means. They think it provides comprehensive privacy protections for health information in all circumstances, which it simply does not,” she explains. “HIPAA only governs certain kinds of entities – your clinician, hospital, or others in the health care sphere. It does not apply to the average person or to a business outside health care. It doesn’t give someone personal protection against ever having to disclose their health information.” In other words, just like any other patient, your healthcare provider does not have to disclose whether or not he/she has taken the vaccine.

4. But Does Your Healthcare Provider Have a Moral or Ethical Obligation to Disclose to the Patient if They Have Been Vaccinated Against the COVID-19 VIRUS?

As the Blenthen article makes clear, the healthcare provider may disclose whether or not they had the Coronavirus shot only if they choose to. The question remains, does your healthcare provider have a moral/ethical obligation to disclose to the patient, particularly to the kidney patient, if they had the COVID-19 poke?

A recent article, Iris Krasnow: Health care workers refusing COVID vaccines have forgotten, ‘First, do no harm’ | COMMENTARY, https://www.capitalgazette.com/lifestyles/ac-cn-column-iris-krasnow-2021404-20210402-bccrtlhronbpbh5gdrn6b5l3hy-story.html,
discusses the moral and ethical responsibilities to the patient concerning the patient and the healthcare provider's COVID-19 vaccination.

In this article, the author states that she was hospitalized and had round-the-clock, hands-on care. Many of her nurses disclosed that they had not taken the vaccine. In response, the author states:

"As I heal at home, I think of why we place our trust in our health care providers to make the right choices: They willfully, often passionately, entered a profession that revolves around this vow: “First, do no harm.” She also cites a series of experts on this issue:

"I am very frustrated about this,” said Dr. Victor Plavner, a partner in the family practice Maryland Primary Care Physicians. “The risk of catching and spreading the virus far outweighs any side effects of the vaccine. If you want to care for patients, you should care enough to get vaccinated and keep yourself and your patients out the ICU with a potential deadly illness.”

The author concludes:
"The nurses on my case were kind and capable, but hey? Who wants to feel like you might get sick instead of healed by those assigned to your hospital bedside?

The choice to be a health care provider during a pandemic that has killed 551,000 Americans should include a personal moral and ethical choice to get the vaccine — unless there is an underlying medical condition that prohibits the shots."

She writes:

The following is the concluding recommendation contained in an American Medical Council on Ethical and Judicial Affairs report adopted at the November 2020 AMA Special Meeting on Covid-19 vaccines among the medical community:

“Physician practices and health care institutions have a further responsibility to limit patient and staff exposure to individuals who are not immunized, which may include requiring unimmunized individuals to refrain from direct patient contact.”

When there’s a safe, effective vaccine to help prevent spread of a pandemic disease, physicians without a medical contraindication have an ethical duty to become immunized.

That is among the recommendations contained in an AMA Council on Ethical and Judicial Affairs report adopted at the November 2020 AMA Special Meeting. The council’s report, especially timely in light of encouraging news from SARS-CoV-2 vaccine trials during the COVID-19 pandemic, updates advice previously published in the AMA Code of Medical Ethics as opinion 8.7, “Routine Universal Immunization of Physicians.”

“Physicians and other health care workers who decline to be immunized with a safe and effective vaccine, without a compelling medical reason, can pose an unnecessary medical risk to vulnerable patients or colleagues, said AMA Board Member Michael Suk, MD, JD, MPH, MBA. “Physicians must strike an ethical balance between their personal commitments as moral individuals and their obligations as medical professionals.”

The ethical opinion adopted by the AMA House of Delegates says that doctors “have an ethical responsibility to encourage patients to accept immunization when the patient can do so safely, and to take appropriate measures in their own practice to prevent the spread of infectious disease in health care settings.

“In the context of a highly transmissible disease that poses significant medical risk for vulnerable patients or colleagues, or threatens the availability of the health care workforce, particularly a disease that has potential to become epidemic or pandemic, and for which there is an available, safe and effective vaccine, physicians have a responsibility to accept immunization absent a recognized medical contraindication or when a specific vaccine would pose a significant risk to the physician’s patients,” the new policy says.

“Physicians who are not, or cannot be, immunized have a responsibility to voluntarily take appropriate action to protect patients, fellow health care workers and others,” says the ethical opinion. “They must adjust their practice activities in keeping with decisions of the medical staff, institutional policy, or public health policy, including refraining from direct patient contact when appropriate.

“Physician practices and health care institutions have a responsibility to proactively develop policies and procedures for responding to epidemic or pandemic disease with input from practicing physicians, institutional leadership, and appropriate specialists,” says the updated opinion. “Such policies and procedures should include robust infection-control practices, provision and required use of appropriate protective equipment, and a process for making appropriate immunization readily available to staff. During outbreaks of vaccine-preventable disease for which there is a safe, effective vaccine, institutions’ responsibility may extend to requiring immunization of staff.

“Physician practices and health care institutions have a further responsibility to limit patient and staff exposure to individuals who are not immunized, which may include requiring unimmunized individuals to refrain from direct patient contact,” the ethical opinion concludes.

It would seem to this writer, that ethically, disclose of the failure of a healthcare provider would be the minimum ethicaI requirement.

5. Conclusion:

Because the CDC has classified the COVID-19 Vaccines as under an emergency use authorization, the vaccine has not been made mandatory by healthcare institutions and therefore, legally optional for the healthcare employee. https://www.capitalgazette.com/lifestyles/ac-cn-column-iris-krasnow-2021404-20210402-bccrtlhronbpbh5gdrn6b5l3hy-story.html,

HIPPA gives the healthcare employee the legal right to not voluntarily disclose to others, including the patient whether or not the employee has been COVID-19 vaccinated.

However, in light of the AMA'sHouse of Delegates ethical reccomendations that the healthcare provider has a a moral and ethical responsibility to get vaccinated, it should be a minimum ethical duty for the healthcare employee to disclose to the patient, including kidney patients, that they have not been vaccinated.