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New York Hospitals Face Possible Mass Firings as Workers Spurn Vaccines

In Buffalo, the Erie County Medical Center plans to suspend elective in-patient surgeries and not take intensive-care patients from other hospitals because it may soon fire about 400 employees who have chosen not to get vaccinated against the coronavirus.

Officials at Northwell Health, New York’s largest provider of health care, estimate that they might have to fire thousands of people who have refused to get vaccinated.

And while the vast majority of staff members at New York City’s largest private hospital network, NewYork-Presbyterian, had been vaccinated as of this week, more than 200 employees faced termination because they had not.

These are just a fraction of the workers at risk of losing their jobs or being put on unpaid leave after Monday, when a state directive requiring hospital and nursing home employees in the state to have received at least one shot of a virus vaccine takes effect.

As of Sept. 22, state data shows, around 84 percent of New York’s 450,000 hospital workers and 83 percent of its 145,400 nursing home employees had been fully vaccinated. But tens of thousands of people are estimated not to have gotten a shot despite being threatened with losing their jobs. The holdouts say they fear potential side effects from the vaccines, have natural immunity or believe that the mandate violates their personal freedom.

On Thursday, Gov. Kathy Hochul said that the Monday deadline was firm and that her administration was developing emergency plans to cover for those who are laid off, going so far as to look into recruiting temporary workers from the Philippines or Ireland.

“What is looming for Monday is completely avoidable, and there’s no excuses,” Ms. Hochul said, pleading for those who have not done so to get vaccinated.

In New York City, health care workers are not the only ones who face an imminent deadline to be vaccinated or face termination. A requirement that virtually everyone working in the public schools — well over 150,000 people — be vaccinated takes effect at midnight on Monday.

Mayor Bill de Blasio’s administration has been temporarily blocked from enforcing the vaccine mandate for nearly all adults in public school buildings after a federal appeals court granted a temporary injunction on Friday. City officials said they expect the mandate will ultimately be upheld but it is not clear if the issue will be resolved before the Monday deadline.

Although about 90 percent of the system’s educators and 80 percent of support staff members have gotten at least one shot, thousands of workers have not. That could cause staff shortages in some schools.

Educators who choose not to get vaccinated will be allowed an unpaid one-year leave with their health insurance intact. But they will not be allowed to enter school buildings starting Tuesday. Unions that represent educators and other school staff members are warning of disruptions for students and have urged Mayor Bill de Blasio to delay enforcement of the mandate.

New York State’s vaccination requirement for health care workers is among the largest mandates of its kind that is set to take effect in the United States, with weekly virus testing not permitted as a substitute measure. How it goes — and whether it leaves hospitals understaffed — will be closely watched. California is requiring health care workers there to be fully vaccinated by Sept. 30, and a similar mandate in Maine will not be enforced until Oct. 29. New York’s willingness to risk large-scale layoffs of health care workers comes amid a national nursing shortage, and the requirement is facing numerous legal challenges.

“We give patients a Bill of Rights, and they are able to choose what procedures or tests or medications they want to put in their system,” said Gregory Serafin, a registered nurse at the Erie County Medical Center, and the lead plaintiff in a New York lawsuit that seeks to stop the mandate. “Health care workers deserve the same medical autonomy to make those decisions.”

Depending on how many health care workers are fired, the policy could also test the resiliency of New York’s health care system. Hospitals across the state are activating emergency staffing plans that they typically reserve for natural disasters or, more recently, surges in Covid-19 cases. Volunteers, students and retirees will fill vacancies, along with traveling nurses.

Northwell, which has 77,000 employees, believes it can weather any loss of employees without the care of patients being affected. The Erie County Medical Center is not as sure.

On Monday, the hospital had 553 inpatients, its busiest day on record. A big reason the hospital is so crowded is that it cannot discharge as many patients as usual to nursing or group homes, because they are also limiting admissions in anticipation of their own staff shortages because of the vaccine mandate.

“This is creating an unprecedented crisis for us,” said Tom Quatroche, the Erie County Medical Center Corporation’s president. “I think we need more time to comply, and I’ve asked for that. For all the right reasons, the vaccine mandate was put in place. But the reality is it is creating a public health crisis in hospitals, with nobody to care for patients.”

In New York City, more than 5,000 of the 42,000 employees of the public hospital system were unvaccinated as of Friday. They will be barred from hospitals starting Monday and from other care facilities beginning Oct. 7, and they will be placed on unpaid leave.

The hospital system anticipates the vaccine mandate could reduce the ranks of radiology technologists and phlebotomists, in particular, and some doctors have been urged to limit the amount of imaging and blood work they order next week, according to an internal message.

Firings under the new directive could prove particularly problematic for nursing homes, which are already facing staffing problems. The New York State Health Facilities Association, a trade group that represents about 250 nursing homes, has asked state officials to temporarily let unvaccinated nursing home workers keep working as long as they get tested regularly.

“While we are striving for 100 percent, we do not feel we will achieve that by Monday,” said Stephen Hanse, the association’s president.

The wider range of workers who must be vaccinated starting Oct. 7 includes those at diagnostic and treatment centers, adult care facilities, certified home health agencies and hospices.

Despite the potential staffing challenges, the Greater New York Hospital Association, which represents about 140 health systems and 55 nursing homes, supports the deadline.

“The mandate is the best way to ensure the safest possible patient care environment and protect the public’s health,” Kenneth E. Raske, the association’s president, said in a statement. “We will work with the state to address any staffing challenges that arise.”

The vaccination mandate for health care workers was issued on Aug. 26 as an emergency order by the Health Department. It permits limited medical exemptions, which employers can determine, but does not currently allow religious exemptions.

The lack of religious exemptions has created some confusion, because an earlier order, issued Aug. 18 under former Gov. Andrew M. Cuomo, allowed such exemptions, and some hospitals had granted them. NewYork-Presbyterian, for example, granted 129 religious exemptions, but withdrew them after the state’s policy changed, court documents show.

The conflict over religious exemptions has prompted several lawsuits accusing New York of violating either the First Amendment or federal law prohibiting employers from discriminating on the basis of religion. Many of the suits’ plaintiffs argue that they do not want to get a Covid-19 vaccine because cell lines derived from fetuses aborted decades ago were used in the development or production or testing of the vaccines.

In legal papers, most of the plaintiffs, most of whom are identified as John or Jane Doe, insist that as opponents of abortion they must abstain from getting vaccinated against Covid-19.

What to Know About Covid-19 Booster Shots

The F.D.A. authorized booster shots for a select group of people who received their second doses of the Pfizer-BioNTech vaccine at least six months ago. That group includes: Pfizer recipients who are 65 or older or who live in long-term care facilities; adults who are at high risk of severe Covid-19 because of an underlying medical condition; health care workers and others whose jobs put them at risk. People with weakened immune systems are eligible for a third dose of either Pfizer or Moderna four weeks after the second shot.

Regulators have not authorized booster shots for recipients of the Moderna and Johnson & Johnson vaccines yet, but an F.D.A. panel is scheduled to meet to weigh booster shots for adult recipients of the Moderna and Johnson & Johnson vaccines.

The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.

The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.

It is not recommended. For now, Pfizer vaccine recipients are advised to get a Pfizer booster shot, and Moderna and Johnson & Johnson recipients should wait until booster doses from those manufacturers are approved.

Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.

One plaintiff in a suit filed in Brooklyn, a NewYork-Presbyterian employee, is described in court papers as a Christian Scientist who opposes all vaccines and believes in the healing power of prayer.

For now, the fate of unvaccinated health care workers who have sought religious exemptions remains uncertain, and will not be decided for at least a few weeks. A federal judge in Utica has issued a temporary restraining order preventing the state from enforcing the mandate on those seeking such exemptions until Oct. 12, when he will decide what to do.

In the meantime, the mandate can take effect for all other workers.

At Northwell, the vaccination rate reached 91 percent on Friday, rising steadily as the deadline approached. Of the employees who still were not vaccinated, about 2,000 had applied for religious or medical exemptions.

Only a small group of people are being approved for medical exemptions, including those who are allergic to vaccine components, Maxine Carrington, the company’s human resources chief, said. Being pregnant or breastfeeding does not qualify. Unvaccinated employees without exemptions that have been approved or are pending have until 11:59 p.m. Monday to get a shot or they will be let go on Tuesday, she said.

NewYork-Presbyterian set an earlier deadline for its workers to get vaccinated — Sept. 22 — and officials there said on Thursday that fewer than 250 employees would lose their jobs. Still hundreds of employees remain unvaccinated: Around 200 got medical exemptions; more than 500 had pending requests for religious exemptions, according to a court filing.

The state’s emergency order does not dictate exactly how hospitals or other health care employers should enforce the mandate, stating only compliance is expected by Sept. 27.

Vaccination rates vary among hospital staffs.

John R. Oishei Children’s Hospital in Erie County says that 100 percent of its employees have been fully vaccinated. At Maimonides Medical Center in Brooklyn, 75 percent of the staff is fully vaccinated, according to state data; nearly 90 percent have received at least one dose, a spokeswoman said.

Some hospital executives said they did not anticipate that any terminations would have much effect on medical care at their institutions.

At St. Barnabas Hospital in the Bronx, about 12 percent of the nearly 3,000 employees had not been vaccinated as of midday on Friday, the chief medical officer, Eric Appelbaum, said in an interview.

The group included three doctors, and a larger number of nurses, Dr. Appelbaum said. Most of the rest worked in nonmedical roles, including housekeeping and food services.

Dr. Appelbaum, noting that there had been a sharp uptick in vaccinations in the past 48 hours, said he was optimistic that a good number of unvaccinated staff members would soon get the shot. (There was a similar rush at the city’s public hospital system, officials said, with more than 2,000 employees getting vaccinated just this week.)

“Obviously,” Dr. Appelbaum said, “Monday’s getting close.”

Eliza Shapiro contributed reporting.