Dr. Leo Li, an infectious disease doctor receives the Pfizer-BioNTech COVID-19 vaccine from nurse Hyang Esther Han, at Whittier Hospital Medical Center in Whittier, Calif., Wednesday, Dec. 16, 2020. Credit: Keith Birmingham / The Orange County Register via AP

HALLOWELL, Maine — Like most doctors, Scott Schiff-Slater has learned to balance routine check-ups with coronavirus screenings at his small downtown practice.

His job sometimes takes him to MaineGeneral Health in Augusta, such as when a patient gets admitted for a more serious condition and their caretakers could benefit from someone who knows them. He is considered medical staff at the hospital, but he is not an employee.

As the first shipments of Pfizer vaccines arrived, Schiff-Slater and other MaineGeneral employees received an all-hands email informing staff to look for an email containing a coronavirus vaccination sign-up link. The vaccines would come in a “tiered approach,” with physicians and other medical staff, nursing staff and respiratory therapists in the emergency department and critical care until first, and then to those who are in the “highest-risk roles.”

But for Schiff-Slater and other non-employee staff, the second email never arrived, as they are not yet included in the hospital’s plan. The vaccination plan from the Maine Center for Disease Control and Prevention directs hospital systems to prioritize workers who have the most frequent contact with COVID-positive patients, based on federal guidelines.

It splits high-risk employees into three groups — intensive care unit workers, emergency department employees and others, but hospitals have been left to decide how to prioritize them while getting a large share of vaccines since the first one was approved earlier this month.

The lack of specificity has led to uneven approaches to vaccinating staff who frequent hospitals but are not on payrolls across the country. One of Maine’s biggest health care systems says those workers are included in their vaccination efforts, but others are waiting for clarity. It’s an example of how the state’s vaccine plan is largely developing on the fly.

Dr. Scott Schiff-Slater sits in his office at his Hallowell family practice on Tuesday, Dec. 22, 2020. Schiff-Slater’s work occasionally brings him to an Augusta hospital, but it is unclear where he and other staff  like him fall on the state’s vaccine priority list. Credit: Caitlin Andrews / BDN

Schiff-Slater and other doctors like him say they never expected to be at the front of the line, but was frustrated by the lack of clarification, as he frequently interacts with sick patients.

“I think they are doing the best they can right now,” he said of the state. “But I just hope we do not get forgotten.”

Maine CDC Director Nirav Shah said Monday that hospitals do not have to limit vaccines to their direct staff and that his agency has asked hospitals to “make what they think is the right call” on who to vaccinate based on their risk of getting sick, admitting to communication shortfalls.

“I think what we need to do is make sure that our recommendations are more uniform,” he said. “I don’t think we’ve really done that as explicitly as we need to.”

Of the two major hospital systems that were the first to receive the vaccines last week, only Northern Light Health, which has locations across northern, eastern and central Maine as well as one in Portland, is including non-employee medical staff in their first phase of vaccinations, said spokesperson Suzanne Spruce.

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Shah’s comments on Monday prompted Portland-based MaineHealth, which has felt the brunt of the pandemic and operates Maine Medical Center among other hospitals, to issue a news release on Tuesday calling for clearer guidelines from the Maine CDC for medical providers outside of hospital settings.

“MaineHealth’s goal is to vaccinate as many of its care team members as it can, as quickly as it can, so as to better secure the health system’s ability to care for those most impacted by COVID-19 as well as provide needed care for other conditions,” it said.

The initial limited supplies of vaccines require hospitals to be thoughtful in how they approach vaccination; in addition to working around schedules, workers also need to be observed to make sure they do not have poor reactions. Fatigue and headaches can sometimes occur after the vaccine is received, so vaccinations need to be staggered to keep the workforce at strength.

Nicole McSweeney, vice president of development and communications at MaineGeneral, cited some of those factors in a statement, saying the hospital had yet to “get enough vaccine to cover our acute care staff.” Once it covers acute care staff, she said the hospital would work through a list based on what services staff provide and their risk of exposure.

Michael Kipp, a private practice podiatrist in Augusta who performs surgeries at MaineGeneral, said while he did not expect to be vaccinated along with those who interact more frequently with sick patients, the confusion was making him question working at the hospital.

“It seems unfair to ask me to continue to provide care when I haven’t been offered the same protections,” he said.

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