States crack down on giving flu shots to low-risk groups

Saturday, October 16, 2004

From staff and wire reports

Thinking of trying to wheedle a flu shot from your doctor even though you're not at high risk for flu complications?

Forget about it in Michigan. Or Washington, D.C. Or Massachusetts.

As the vaccine shortage hits home and long lines queue around the supermarket, a handful of states and the nation's capital are threatening doctors and nurses with fines or even jail if they give flu shots to healthy, low-risk people.

Violators in Michigan face a misdemeanor punishable by up to six months in jail and a $200 fine if convicted, the health director said.

At least three other states -- Massachusetts, New Mexico and Oregon -- and Washington, D.C., have issued similar orders with varying penalties.

"It's a strong step," agreed Dr. Gregg Pane, acting director of the District of Columbia Department of Health, whose order took effect Friday.

In Washington, violators could be fined up to $1,000, and Pane said the health department would investigate complaints.

In Massachusetts, the penalty is a $200 fine per infraction and six months in jail.

"It's not rationing," said Massachusetts Public Health Commissioner Christine Ferguson. "It's being rational about how to reduce the number of deaths that could result from a serious flu season."

Health officials downplay the punishment and say that most health-care workers are following the guidelines.

Seeking to clarify rules

Missouri has not considered punishment for giving low-risk people flu shots, say officials with the state attorney general's office and the department of health.

"We've received a lot of calls from people wanting clarification," said Mary Menges, administrator for the health department's section for communicable disease prevention. "People want to do the right thing."

No complaints of price-gouging for flu shots have been made so far in the state, said Jim Gardener, spokesman for the attorney general's office.

Punitive measures in Missouri might be considered if the governor declared a medical state of emergency in regard to flu vaccine, Menges said.

Other states' officials already believe the situation is dire.

"I think it is a public health crisis," said Dr. John Foster, medical director for the North End Rehabilitation and Nursing Center. "They can't wait and give vaccines out to people who shouldn't get it."

He noted it would be difficult to hold public flu shot clinics, since those operators can't verify a patient is high-risk.

The nation is only getting about half the 100 million flu shots it had expected for the current flu season. One of two primary vaccine suppliers, Chiron Corp., is barred from shipping its vaccine from a British factory because of contamination problems.

The United States has no stockpile of vaccine and no authority to ration shots, a job that is left to the states, which have their own laws on public health emergencies.

Some states like Oregon and New Mexico have only civil penalties to enforce their orders that flu shots be given only to high-risk patients. In those states, fines and sanctions from medical licensing boards are possible.

Even so, "we are taking it very seriously," Lorraine Duncan, Oregon's immunization program manager, said Friday. "We are asking people to report an incident and we will investigate each one."

Since Oregon's order took effect a week ago, two complaints of healthy people getting shots have been checked out. But Duncan said there was no wrongdoing and offered an example: A 42-year-old getting a flu shot might look perfectly healthy to an outsider, but could have a chronic illness or might be a health care provider.

California's health chief has also ordered flu shots be reserved only for those at high-risk, but that state has even less authority.

"The real value of the order is this: When a provider has a relationship with a patient who is demanding a flu shot, the provider can point to the order...said health services spokesman Ken August. "It emphasizes the seriousness of the situation, not just in California, but nationwide."

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