Becker's Hospital Review

72 CMO / CARE DELIVERY One physician's case for refusing to treat unvaccinated patients in person By Molly Gamble A family medicine physician gave nearly 3,000 patients of her independent practice in South Miami a deadline of Sept. 15 to get vaccinated against COVID-19 or terminate their patient-physician relationship, the Miami Herald reported. Patients who were unable to find a new physician before the deadline instead received teleconference consultations. "I feel if I can't have a good doctor-patient relationship, I'm not go- ing to be comfortable taking care of those patients, and they should find someone who's a better fit for them," Linda Marraccini, MD, told the Miami Herald. She shares the practice with her brother, John Marraccini, MD. e physicians' website states: "At this time, we are no longer seeing medically eligible unvaccinated patients unless they have an exemption." e question of whether healthcare providers can ethically decline or treat unvaccinated COVID-19 patients differently than their vac- cinated counterparts was raised this summer, and several physicians and ethics experts have shared their opinions. Daniel Wikler, PhD, professor of ethics and population health at the Harvard T.H. Chan School of Public Health in Boston, wrote in an Aug. 23 op-ed for e Washington Post that culpability, blame, sin, cluelessness, ignorance or other personal failings should not be factors in the evaluation of patients for healthcare. "Doctors and hospitals are not in the blame and punishment busi- ness. Nor should they be," he argued. "at doctors treat sinners and responsible citizens alike is a noble tradition, an ethical feature and not a bug. And we shouldn't abandon it now." When it comes to nonemergency situations, physicians are legal- ly able to refuse patients for a variety of reasons, provided they are not doing so because of some aspect of the patient's race, gender, sexuality or religion, according to Timothy Hoff, PhD, professor of management, healthcare systems and health policy at Northeastern University in Boston. Northeastern experts convened their thoughts on the ethical impli- cations of refusing to care for unvaccinated patients in an Aug. 25 article written by Tanner Stening. While physicians can legally dismiss patients who do not need urgent care because of their unvaccinated status, the decision to do so still raises ethical questions. If a physician who wants to reduce the spread of COVID-19 sees the care of unvaccinated patients as a risk to his safety or the safe- ty of staff, the physician needs to explain the reasons for refusal of treatment and offer to connect patients with an alternative provider. Otherwise, it could be a breach of the duty of care doctrine, according to the article. But if a physician refused to care for an unvaccinated patient as a tactic to incentivize receiving the COVID-19 vaccine, that would fall into the category of ethically problematic because it can "erode trust in the profession," according to Patricia Illingworth, PhD, a philoso- phy professor and ethics expert at Northeastern. Robert Baginski, MD, associate clinical professor and director of interdisciplinary affairs for the department of medical sciences at Northeastern, said it is vital for health authorities to continue urging the public to get vaccinated, but not at the expense of care. "Healthcare professionals are frustrated and tired," Dr. Baginski said. "It's not that we want to deny patients care. We're tired, we're at risk, we're doing absolutely everything that we can." n Off-shift nurse delivers baby in Sparrow Hospital's parking ramp elevator By Mackenzie Bean A n off-duty nurse at Lansing, Mich.-based Sparrow Hospital helped deliver a baby in the elevator of the hospital's parking lot Sept. 13, reported the Lansing State Journal. Christine Kadu, RN, had already gotten off her 12-hour shift and left the hospital Sept. 13, but turned back around after realizing she forgot some materials for a class. Upon entering the parking garage to leave the hospital for a second time, Ms. Kadu said she saw a pregnant woman squatting in the traffic lane. The woman, Miranda Moncado-Sullivan, and her hus- band Ryan Sullivan were at the hospital to deliver their third child, who was coming much faster than expected. Ms. Kadu usually cares for adult post-operative pa- tients, but nonetheless sprung into action. She called the hospital's obstetrics triage line for help before walking the couple into the elevator, where Ms. Kadu quickly gave birth. "She easily could've just made a few phone calls and turned right back around," Mr. Sullivan told NBC affiliate WILX of Ms. Kadu's actions. "I mean, finishing a 12-hour shift, she's probably tired, but she came right in there to the elevator with us." "There are a lot of things that definitely could've gone very, very wrong," Ms. Moncado-Sullivan added. "In that moment, we were just so blessed that, in the grand scheme of things, everyone is safe and everyone is healthy." n

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