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Essentia adds flu to mandatory vaccines - Longtime Pine River doctor refuses flu shot, is let go

Dr. David Laposky

After 30 years of providing medical care in Pine River, Dr. David Laposky was let go from the Essentia Health-St. Joseph's Medical Center Clinic in Pine River over his decision not to comply with a new mandatory flu shot policy.

Laposky came to the clinic in Pine River in 1987 straight out of residency, before the clinic was a branch of St. Joseph's or Essentia Health.

"I had several partners here and then ended up on my own for a couple years after they all left," Laposky said. "Then I needed some help and asked the hospital to come in. They bought me out, and that's how we became more of the Essentia clinic. (In) 1995 I think they bought the clinic from us."

He wasn't planning to leave.

"I always said I could work to 70," Laposky said. "I just turned 60, but I was thinking probably another 10 years in some form of work. I fully expected to finish my career in Pine River. I love the town and the staff. We had a wonderful work setting there."

In September, Essentia Health enacted a policy mandating flu shots for its staff and volunteers. Miranda Anderson, communications expert with Essentia Health-St. Joseph's Medical Center in Brainerd, said the policy was in consideration for five years. Before this policy, employees only needed to complete a declaration if they wanted to forgo the flu shot.

This is not the first vaccination required of employees and volunteers with Essentia Health. Also required are the measles, mumps and rubella vaccine, as well as the tetanus, diphtheria and pertussis (whooping cough) vaccine, said Dr. Rajesh Prabhu, Essentia's infectious disease physician and chief of patient quality and safety.

"You have hepatitis B; you have chickenpox vaccines. All those are required," he added.

Laposky said he hasn't gotten a flu shot for the last six or seven years, after experiencing the low-grade fever and flu-like symptoms commonly cited as side effects of the shot. He decided to continue not getting the shot for several reasons, though the crux of the decision lies on the effectiveness of the vaccine and the effectiveness of mandatory flu vaccination policies.

"I had my own political reasons why I have not taken the flu vaccine the last six or seven years now, as I do the research on it and I see the efficacy rate being so low," Laposky said. "I think the average efficacy rate for the last 13 years is about 36 percent." (That rate is 41 percent, according to the Centers for Disease Control.)

Laposky said he would be more likely to consider the shot if it had a higher effectiveness rating.

Prabhu said that while the flu vaccine is not perfect, it can still be over 50 percent effective some years, and some prevention is better than none.

"There's a phrase, 'Perfect is the enemy of the good,'" Prabhu said. "We shouldn't wait for the 'better flu vaccine' because there is still benefit to what we have now even though it's not perfect. If we don't take it, people will suffer influenza when they do not need to suffer."

Anderson said Essentia Health chose to implement the mandate for seasonal flu shots because voluntary vaccination had plateaued under the former policy at approximately 80 percent.

"There's over 600 other health systems with a required immunization policy," Anderson said. "To really push beyond 80 percent of our work force, looking at what others have done, by updating our policy requiring the immunization, that was what could facilitate going beyond 80 percent of the work force being immunized and providing that greater protection for patients."

Anderson said Essentia Health has approximately 13,900 employees. Of those, approximately 99.5 percent stayed with the company either by getting waivers or by complying with the flu shot mandate. Those who chose not to vaccinate, approximately 50 employees, were let go.

Though Laposky was unaware of any co-workers at the clinic in Pine River to refuse the flu shot, some only chose to comply with the mandate because they needed their jobs, he said.

"Most of them just needed the work," Laposky said. "They had to do it. For me, I've got options outside of where I work right now. It's not probably as big a deal for me as it is for them. They had families to support. I can understand that."

Laposky also doubts the effectiveness of mandatory vaccination against the spread of the flu.

"Vaccinating healthcare workers against flu has never been shown to reduce transmission to patients," Laposky said, citing the Cochrane Review and a specialist from Minnesota. "Mike Osterholm, he's the director of the Center for Infectious Disease Research and Policy in Minnesota. He said the same thing. Major studies on the issue could not find any demonstrable benefit from mandatory healthcare worker vaccination programs."

Prabhu disagreed.

"The science is not a slam dunk," Prabhu said. "Every year it comes out, even this last year, that they found a correlation. The higher percentage of the work force that is vaccinated, there is a trend of fewer cases of hospital acquired influenza."

Prabhu said in Minnesota the majority of patients with the flu arrived with the illness. In Europe, Canada and in places where vaccination rates among hospital staff aren't as high, hospital-acquired influenza is far more common.

"Our institution itself had hospital-acquired influenza," Prabhu said. "I think it was nine confirmed throughout the whole Essentia market. If we can do anything to reduce that number, that would be great."

Prabhu cited a study by the University of Texas MD Anderson Cancer Center, which concluded that mandatory vaccination showed correlation with reduced influenza cases among compromised cancer patients. Prabhu said this is not the only study to find these results.

Prabhu said even preventing influenza for one Essentia patient is worth it, especially when patients at Essentia Health facilities area already sick or susceptible to more severe infections, like cancer patients.

"The other point on that is that the risk of having a bad case of influenza is much higher if you are a patient in a hospital than if you are in the community," Prabhu said. "If we are taking care of sick people to begin with for other reasons - the really old, really young or those with certain health problems - there are certain studies out there that show a higher mortality rate or death rate from influenza. Fortunately those numbers are small, but every patient counts."

"Both the CDC and Minnesota Department of Health, though they don't require it, recommend all healthcare workers be vaccinated against flu," Anderson said.

Of course, Laposky does not disagree with protecting patients. He always advocated for other precautions in working with patients, including hand washing, staying home when sick and at times wearing a mask. Laposky said he just cannot support a policy that "coerces" employees to get flu shots that he considers ineffective.

"I guess you'd have to say their voluntary informed consent was taken away from them," Laposky said. "A lot of them, most of them that didn't want to get a shot, it was kind of coerced. I personally really couldn't buy into that idea that we would be more or less coerced into getting a vaccination against their will. That would take away their voluntary, informed consent that should be a right for everybody. That was a stickler in my mind."

Laposky won't be in the clinic anymore, but that doesn't mean he's moving away. He's weighing his options right now.

"I am kind of doing interviews," Laposky said. "I've thought about the potential of maybe opening a practice of my own, which is something I'm not sure about yet at 60 years old. I've had ideas on that. I looked into telemedicine, a kind of up-and-coming technology doctors toward the ends of their careers look into. I could very well be working for another clinic."

Laposky said he felt bad about some of his patients having to see new doctors, but he's confident they are in good hands.

"I feel a little bad about leaving people I've cared for for years and years and years," Laposky said. "They will be in good care. We have a new doctor and good people. I'm not worried they won't get good care there."

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