Gov. Mills’ mandate threatens the standard of healthcare in Maine


In the last two months since Governor Janet Mills’ announcement of an emergency rule to require all healthcare workers, as well as emergency medical services (EMS) and dental office staff, to be “fully vaccinated” for COVID-19, Mainers have heard from numerous concerned citizens. Fire chiefs, ambulance drivers, nurses, and other affected professionals are worried about how their departments will cope with resignations over the fast approaching enforcement deadline for the mandate.

Today, those worries seem well-founded. Some healthcare and emergency services providers have reported steep staffing losses in the last two weeks leading to emergency department closures and talk of rationed care across the state.

The mandate was announced as an emergency rule on August 12, slated to come into effect on October 1. On September 2, the governor pushed enforcement of the rule to October 29th. With only about two weeks until the hard deadline, pressure is mounting on Gov. Mills and Dr. Nirav Shah, director of the Maine CDC, to recognize the unintended consequences of this policy and bring the state’s standard of care back from the brink.

Though Mills’ mandate has not yet been enforced, significant damage to the state’s healthcare capacity has already been wrought. The Maine Wire reported this week that, as of October 1, approximately 70 staffers resigned across the Central Maine Healthcare (CMH) system. Northern Light Health has lost 99 staffers: 46 in direct patient care and 53 in indirect patient care. MaineHealth has seen at least 69 staffers resign since the beginning of August.

For some Maine healthcare systems, these resignations are a very small portion of their overall workforce. But others, like CMH, have recently announced that they have closed off their neonatal care unit and are diverting pediatric emergency admissions to other area facilities. Dr. Steven G. Littleson, Chief Executive Officer of CMH, in a declaration filed in support of a lawsuit challenging the vaccination rule this week described the immense financial and logistical strain the mandate has placed on the health system. 

He urged the administration to consider broader alternatives to the mandate such as those offered by the states of New Jersey, Maryland, and Illinois, Dr. Shah’s former employer. Dr. Littleson noted that CMH is planning to dramatically reduce bed capacity in the hospital because of the mandate: cutting surgical beds by 40% and ICU beds by half.

While overall losses may be small in comparison, losing even fewer than 5% of workers can be devastating to the quality of care provided by a hospital or care home, especially since the effects are not equally distributed across the state, or across disciplines. Some small offices in rural parts of Maine are not able to withstand a sharp drop in their staff and maintain current level of care. 

Based on Maine CDC data on healthcare workforce vaccinations, staff of some ambulatory service centers (ASC) and Intermediate Care Facilities (ICF) in central and eastern Maine, for instance, are 20% or more unvaccinated.

Mills quickly rejected calls from lawmakers and others in the medical community to alter the mandate even slightly, or allow for surveillance and testing alternatives for healthcare workers who remain unvaccinated. In a combative statement, the governor argues that “regular testing is not nearly as effective at protecting peoples’ health as vaccination” but given notable recent CDC data showing near-equal viral loads among the vaccinated and unvaccinated, it seems as though testing would be the only way to know whether the virus which causes COVID-19 is circulating among a particular workforce.

Mills’ argument is flat-out wrong on the science, especially so considering that she has been unwilling to factor immunity from previous infection—shown to be broader and at least as durable as the immune response gained from vaccination—into exemptions to the workplace mandate.

Because of Mills’ intransigence, healthcare workers who bravely exposed themselves to the virus, gained immunity through a previous infection and returned to work for the duration of the pandemic, will be forced to lose their livelihoods. Is this a fair way to treat essential healthcare workers?

The administration must rescind this emergency rule as soon as possible. At the very least, it must substantially alter it to allow for broader exemptions and alternative protocols for those who have yet not taken a vaccine. As more and more data comes to light on the waning effectiveness of the various COVID vaccines, especially against infection, scientists have noted that unfortunately, mass vaccination will not get us to herd immunity. Given this reality, proponents of broad COVID vaccination mandates have very little moral ground on which to stand. Whether one takes a vaccine or not should, and ought to be, solely a matter of personal choice.

Governor Mills must recognize that she was wrong when she said that a statewide healthcare worker mandate would contribute to ensuring a level of care. It has most assuredly reduced the standard of care for some providers, even if others are relatively unaffected. For this reason, it is vital to not only provide more alternatives for healthcare service employees, but to remove EMS and dental office staff from this unprecedented mandate because of significant blowback from those ranks.

Clearly, the administration’s assertion of broad power over new swaths of Maine’s workforce is backfiring. It is a shame that the governor has already refused to admit this fact, instead opting to double down on her statement on August 12. That day, she said that it would guarantee patients a level of care they expect and that the universality of the mandate would ensure that “there won’t be many places [for workers who refuse] to go.”

It seems as if those workers do have other options. Instead of being coerced into compliance with the governor’s mandate, they are exercising those options. As the winter cold and flu season approaches, this will be to the detriment of Mainers seeking urgent medical care.