Religious exemptions to COVID vaccine more common among state agency workers
Health care workers in state agencies are claiming medical or religious exemptions to vaccine mandates at a higher rate than health care workers outside government, data show — an imbalance that some say raises questions about whether the state is handing out exemptions too easily.
In general, 10% to 12% of health care workers in most executive branch agencies are getting tested for COVID after claiming an exemption, instead of getting vaccinated. By comparison, about 2% to 6% of health care workers at the state’s top hospitals are testing for COVID after claiming exemptions instead of being vaccinated, a CT Mirror survey of nine hospital systems found.
Of the cases that have been adjudicated, approximately 95% of 200 health care workers in state agencies who claimed a religious exemption were granted one, and 100% of the roughly 20 who claimed a medical exemption were granted one, according to data provided to the CT Mirror by the Office of the Chief Operating Officer. By contrast, Hartford HealthCare and Yale New Haven Health reported approving about half of religious exemption requests filed, The Mirror previously reported. Among smaller hospitals, Connecticut Children’s approved about 70% of religious exemptions while Middlesex Health approved about 90% as of Nov. 10.
Though the data collected represent a limited sample, the numbers raise concerns about the state’s policies on approving religious exemptions to its vaccine mandate, said Arthur Caplan, professor of bioethics at New York University’s Langone School of Medicine.
“We do not want to speculate about our employee’s personal reasons for filing exemptions,” Lora Rae Anderson, director of communications for the Office of the Chief Operating Officer, wrote.
An employee’s motivation in claiming an exemption is only one factor influencing the numbers. What’s equally important is whether the state grants the request.
Anderson would not comment on whether the data indicated cause for concern regarding the state’s exemption approval process. The Department of Mental Health and Addiction Services and the Department of Children and Families referred questions about exemptions to her.
“There may be worrying that they (the executive branch agencies) will lose some staff in a tight job market. So making it more flexible with test options may be one way to avoid that,” Caplan said.
The Mirror has previously reported that Whiting Forensic had “grave staffing shortages.”
“We did not lower health standards based on potential shortages,” Anderson wrote. “Our agencies worked through contingency plans, and we continue to keep public health in our workplaces as a high priority.”
Testing rates higher in state health care
The most recent health care worker vaccination rates by state agency are from last month. The Office of the Chief Operating Officer plans to share state worker vaccination numbers monthly, and the next data release is expected before Thanksgiving.
Most state employees have to get vaccinated or agree to weekly testing to stay compliant with Gov. Ned Lamont’s COVID vaccine mandate, which went into effect Sept. 27. But health care workers employed in state agencies – including those at the children’s psychiatric facility Solnit, Connecticut Valley Hospital and Whiting Forensic — are subject to a more restrictive mandate that does not allow them to choose weekly COVID tests instead of being vaccinated. Instead, health care workers must claim religious or medical exemptions to the vaccine mandate in order to go the testing route.
Health care workers typically cannot do their jobs remotely, and a stricter mandate for them helps ensure patient and workplace safety, said Ted Doolittle, the state’s health care advocate.
Though non-health care workers in state agencies can choose to test in lieu of vaccination and health care workers within those same agencies have to be approved to do so, both groups were testing weekly at similar rates, as per data released last month. In other words: Health care workers have to navigate more obstacles to test weekly, but they were only slightly less likely than their counterparts within the same state agency to be doing so.
It is unclear how many exemption applications from health care workers are still pending, Anderson said. Some non-health care workers in state agencies submitted exemptions though they do not need approval to test weekly. Fewer than 100 total exemption requests are pending, but Anderson could not break out how many of those were submitted by health care workers.
"We plan to continue to process them as soon as possible," she wrote. Employees who are awaiting a decision are testing weekly in the meantime, which implies that vaccination and non-compliance rates may rise in the next few weeks if the state rejects some pending exemption requests among health care workers.
"Exemptions are reviewed by human resources and the office of labor relations, and outreach to agencies and individuals will be conducted if necessary," Anderson wrote.
The religious exemption application form asks for a personal statement and a self-reported immunization history. Applicants are encouraged to provide documentation of their beliefs and are required explain why they have received vaccinations in the past if that is the case. Agencies may then follow up to discuss the request and ask for "additional supporting documentation," the form states.
The medical exemption has more stringent requirements — it requires a medical provider to verify that an applicant's health issues would count as contraindications for the COVID-19 vaccine. Doctors, physician assistants and advance practice registered nurses are authorized to fill out the form.
High approval rates for religious exemptions are "indicative of being too lax, especially around vulnerable people," Caplan said. Even in the case of children, who tend to be less severely affected by COVID-19, kids with disabilities can have much worse outcomes than those without, he added. In general, people have "high vulnerability if they're institutionalized," he said.
While exemptions processes differ by hospital, some hospitals have asked for attestations from religious leaders as part of the application process, The Mirror previously reported.
Over the past few weeks, the CT Mirror asked 13 hospital systems for their data, ranging from the state’s largest, such as Hartford HealthCare and Yale New Haven, to smaller hospitals such as Bristol Health and Middlesex Health. Nine provided the Mirror with exemption data, and 10 provided the Mirror with non-compliance numbers. In general, state health care workers are getting tested at higher rates than those outside government.
Some hospital systems still had applications pending, while others did not; Hartford HealthCare has hired new employees in the last month and therefore some have gone on to file new requests, but the number is small, said Dr. Ajay Kumar, Chief Clinical Officer for Hartford HealthCare.
All hospitals that reported non-compliance numbers gave out numbers under 2%, while state agencies have reported higher percentages of non-compliance. The combination of higher testing rates and higher non-compliance rates results in generally lower vaccination rates among state agencies' health care workers when compared to hospitals.
State will not release facility-level data
The state plans to include aggregate exemption numbers as part of its data release later this month. It will not be breaking out the numbers by facility.
Unlike the state’s acute care hospitals, state facilities like Solnit, Connecticut Valley Hospital and Whiting Forensic are not subject to federal measures that would require care providers to disclose vaccination rates on the facility level, according to Connecticut Hospital Association spokesperson Jill McDonald Halsey. UConn’s John Dempsey Hospital is an acute care hospital and therefore would be covered by those requirements, she added.
In advocating for the rule, policymakers argued that patients had a right to know vaccination rates to empower them to make informed choices about their medical care and level of risk. Generally speaking, the Connecticut Department of Public Health expects hospital vaccination data to eventually be made public by the federal government, wrote Chris Boyle, agency spokesperson, though DPH could not comment on whether state health care facilities would be covered. The Centers for Medicaid and Medicare did not respond to questions.
“We are releasing agency-level data at this time in order to ensure our staff's information remains safe and protected, including pulling together our agencies with under 100 staff members," Anderson wrote at the end of October.
"I'm always going to come down on the side of the patient's right to know any risk that they're exposing themselves to so that they can make a considered decision as to whether they want accept that risk," Doolittle said.
In a July interview with the CT Mirror prior to the announcement of the state’s vaccine mandate, DCF Deputy Commissioner Michael Williams estimated that 80% of Solnit staff were vaccinated, based on voluntary employee self-reporting. "Our health care workers in our facilities get it, I think they understand it. I know the union that they're a part of as well has been helpful in pushing this ... So we really have had the success of folks taking advantage of the vaccine," he said.
“We take care of patients and the safety of our staff incredibly seriously, which is why progressive discipline is applied when employees do not intend to comply with either a testing or vaccination mandate, and those who test positive for COVID-19 follow isolation and quarantine protocols,” Anderson wrote.