After court-ordered injunctions, Cleveland Clinic, HCA and other providers hit pause on workforce vaccine mandates

Early decisions from a pair of federal judges have several hospitals and health systems pumping the brakes on workforce COVID-19 vaccination requirements as they wait to see how the Biden administration’s nationwide mandate will play out in the courts.

Thursday, Cleveland Clinic published a statement saying it would be pausing a systemwide vaccine policy while the Centers for Medicare & Medicaid Services’ (CMS’) rule was placed on hold.

Cleveland Clinic had announced its rule Nov. 12, roughly a week after CMS issued the emergency temporary standard. The system said it plans to roll out out additional requirements “including periodic testing for those providing direct clinical care” for unvaccinated employees in the meantime.

HCA Healthcare was another late holdout, announcing its COVID-19 vaccine mandate just days after CMS had rolled out its controversial rule. In an email statement, a representative of the 183-hospital chain said it has now paused its requirement except in states that have their own vaccination mandates (California and Colorado).

“We continue to strongly encourage our colleagues to be vaccinated as a critical step to protect individuals from the virus and the majority of HCA Healthcare colleagues have been fully vaccinated,” the representative wrote.

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CMS’ rule would have required healthcare facilities participating in Medicare to have a policy in place ensuring that eligible staff receive their first dose of a COVID-19 vaccine series by Dec. 5 and complete their series by Jan. 4, 2022.

Within weeks, the rule saw legal challenges from 24 states arguing that CMS had exceeded its authority and would cause irreparable harm to those states, among other claims. A pair of judges agreed, issuing at the top of the week a pair of preliminary injunctions blocking the rule from going into effect across the nation.

Many hospitals had found themselves in compliance limbo even prior to the judges' orders, as Republican-led states such as Texas and Florida swiftly passed laws and executive orders intended to counteract the federal mandate.

Although the Department of Health and Human Services has since filed an appeal in the U.S. Court of Appeals for the Fifth Circuit, several provider organizations are reportedly rolling back their internal vaccination requirements as they await a clear answer on compliance.

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In an email statement, Intermountain Healthcare said that it, along with other major Utah healthcare providers, was "temporarily pausing enforcement" of the requirement "until there is clearer direction from the courts." The system noted that 95% of its caregivers had already complied with the federal government's requirement and that it would continue to encourage the remaining employees to receive their vaccinations.

In a Dec. 1 statement, the Montana Hospital Association said that the state’s hospitals have halted implementation of the federal mandate and will instead be focusing on remaining compliant with Montana state law. Montana’s attorney general was among those who had signed onto a challenge lawsuit, which highlighted healthcare staffing issues being felt across rural regions.

The association stressed that the state’s hospitals were not directly involved in the case but “were simply following the federal mandate” to remain compliant in CMS programs.

“Montana healthcare providers have been in the very difficult position of complying with conflicting state and federal laws. We value every one of our team members and it is unfortunate that they have been drawn into this conflict,” Montana Hospital Association President and CEO Rich Rasmussen wrote. “The COVID-19 vaccine is a safe and effective tool for reducing disease and hospitalizations. Hospitals will continue to urge all eligible Montanans, including our healthcare staff, to get vaccinated against COVID-19.”

University Hospitals released a statement announcing that “unless there is further legal action,” its “caregivers may continue to provide patient care services regardless of their vaccination status.”

Ballad Health, which has locations in Tennessee, Virginia, North Carolina and Kentucky, reportedly issued a memo announcing it would be suspending its requirement for employees but still recommends its employees receive a vaccine or booster.

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In Delaware, Bayhealth and Beebe Healthcare are also reportedly putting their mandates on pause but will follow the state’s directive to regularly test those who do not receive a shot.

However, some organizations are moving ahead with their requirements despite this week’s orders. In Oklahoma, another of the states that signed onto a challenge lawsuit, SSM Health, Mercy Health and OU Health each told a local NBC affiliate that they will continue to require vaccination as a condition of employment.

“Mercy announced its vaccination requirement in July prior to any federal requirements,” the system told the affiliate. “We join the CDC, many other health care organizations and companies in our communities and across the country, who mutually recognize COVID vaccination serves the common good, protects patients and is crucial to safeguarding public health.”

Tuesday, a Kentucky District Court granted a preliminary injunction in Kentucky, Ohio and Tennessee against the Biden administration’s requirement for vaccination among government contractors and those that do business with them.

CMS’ rule isn’t the only federal vaccine push to hit a snag in the courts.

In November, a U.S. appellate court ordered the Occupational Safety and Health Administration (OSHA) to temporarily halt its emergency temporary standard that would require businesses with 100 or more employees to require COVID-19 vaccination or testing—a decision cited by U.S. District Judge Terry A. Doughty in Tuesday’s ruling as “almost identical” to his own.

OSHA published a statement shortly afterward saying it “remains confident in its authority to protect workers in emergencies” but has suspended implementation and enforcement of the requirement “pending future developments in the litigation.”

More recently, a Kentucky District Court granted a preliminary injunction in Kentucky, Ohio and Tennessee against the Biden administration’s requirement for vaccination among government contractors and those that do business with them.

Despite the pushback, healthcare associations, individual experts and the Biden administration have all stood firm on the importance of organizations’ vaccination mandates, with the novel omicron variant only adding to the president’s urgency to get shots in arms.