Jan. 3, 2012 -- An Indiana hospital has fired eight employees, including at least three veteran nurses, after they refused mandatory flu shots, stirring up controversy over which should come first: employee rights or patient safety. The hospital imposed mandatory vaccines, responding to rising concerns about the spread of influenza.
Ethel Hoover wore all black on her last day of work as a nurse in the critical care unit at Indiana University Health Goshen Hospital. She said she was in "mourning" because she would have been at the hospital 22 years in February, and she's only called out of work four or five times in her whole career , she said.
"This is my body. I have a right to refuse the flu vaccine," Hoover, 61, told ABCNews.com. "For 21 years, I have religiously not taken the flu vaccine, and now you're telling me that I believe in it."
More than 15,100 flu cases have been reported to the Centers for Disease Control and Prevention since Sept. 30, including 16 pediatric deaths. Indiana's flu activity level is considered high, according to the CDC, which last month announced that the flu season came a month earlier than usual.
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When Hoover first heard about the mandate, she said she didn't realize officials would take it so seriously. She said she filed two medical exemptions, a religious exemption and two appeals, but they were all denied. The Dec. 15 flu shot deadline came and went. Hoover's last day of employment was Dec. 21.
Fellow nurse Kacy Davis said she and her colleagues were "horrified" over Hoover's firing, calling her their "go-to" nurse and a "preceptor."
"It was a good place to work," Hoover said. "We've worked together all these years. We're like a family."
The hospital said in a statement that it implemented the mandate to promote patient safety based on recommendations from the American Medical Association, the American Nurses Association, and the Centers for Disease Control and Prevention. It announced the mandate in September. Of the hospital's 26,000 employees statewide, 95 percent complied. That means 1,300 employees did not comply, but only eight were fired.
"IU Health's top priority is the health and wellbeing of our patients," said hospital spokeswoman Whitney Ertel. "Participation in the annual Influenza Patient Safety Program is a condition of employment with IU Health for the health and safety of the patients that we serve, and is therefore required."
The CDC recommends flu shots for everyone older than six months of age. Dr. William Schaffner, chair of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn., said hospital patients are especially vulnerable to flu complications because their bodies are already weakened.
"I cannot think of a reason for any health care professional to decline influenza immunization that's valid," said Schaffner, a former president of the National Foundation for Infectious Diseases, adding that people with egg allergies may have to avoid the flu shot to prevent anaphylactic shock, but even that hurdle has been remedied. The Food and Drug Administration approved an egg-free vaccine in November.
Schaffner said invalid excuses to avoid the shot include being afraid of needles and simply promising to stay home when they're sick. Patients now have the option of a vaccine nasal spray if they want to avoid needles. And since flu victims become contagious before they start to feel sick, they can get patients sick even if they stay home when they have symptoms.
Over the last several years, hospitals have been moving toward mandatory vaccinations because many only have 60 percent vaccination rates, Schaffner said. He is leading an effort for a similar mandate at Vanderbilt University Medical Center.
Nurses in particular tend to be the most reluctant to get vaccinated among health care workers, Schaffner said, citing his opinion.
"There seems to be a persistent myth that you can get flu from a flu vaccine among nurses," he said. "They subject themselves to more influenza by not being immunized, and they certainly do not participate in putting patient safety first."
In October 2011, Vanderbilt broke the world record for number of vaccines administered in an eight-hour period in an event called Flulapalooza. From 6:50 a.m. to 2:50 p.m., they vaccinated 12,647 people. By that evening, more than 14,000 people had been vaccinated, and there were no severe adverse reactions, he said.
But still, Alan Phillips, who represented several nurses at the hospital, says his clients had the right to refuse their flu shots under Title VII of the Civil Rights Act of 1964, which prohibits religious discrimination of employees. Religion is legally broad under the First Amendment, so it could include any strongly held belief, he said, adding that the belief flu shots are bad should suffice.
"If your personal beliefs are religious in nature, then they are a protected belief," Phillips said.
Phillips, who is based out of North Carolina, has made a name for himself fighting for employees' rights to get out of mandated flu shots, but he has never needed to go to court. Although he usually handles a couple dozen health care workers per year, he had 150 this fall in 25 states.
Dr. Damon Raskin, an internist with his own practice in the Pacific Palisades in Los Angeles, said hospitals should mandate flu vaccines as a matter of public safety. The flu can lead to complications like pneumonia and death, said Raskin, who is also affiliated with the Cliffside Malibu Addiction Rehabilitation Center.
"I think if the health care worker has some problem with religious faith then perhaps during flu season, they shouldn't do that job," Raskin said, suggesting that the worker do something administrative instead during flu season. "It's not fair to the patient. The people who are most at risk are in the hospital."