Thirty-three percent of Great River Health System staff still to be vaccinated could face termination in 46 days


FORT MADISON – A Jan. 4 mandate facing about 33% of workers in the Great River Health System is creating an unstable workforce in the health care industry.

A meeting was held Monday night, attended by about 60 health care workers in West Burlington, and another meeting is scheduled for next Monday.

Health care workers are pushing back against a mandate that requires them to be fully vaccinated by Jan. 4, 2022 or face termination.

The mandate comes from the Center for Medicare/Medicaid Services, the federal agency that oversees reimbursements to area hospitals.

The mandate puts hospital administrators around the country in unenviable positions with regard to maintaining safe working environments, respecting workers’ rights, and holding onto what makes up more than half of annual revenues in the form of Medicare and Medicaid reimbursements.


“This is the rock and the hard place,” said State Rep Joe Mitchell (R-Wayland).

“I’m usually not a black and white argument kind of guy, but this is pretty black and white. This administration does not respect individual freedoms,” Mitchell said Thursday.

Mitchell said he’s absolutely concerned there will be a critical local health care shortage because of the CMS mandate.

The Occupational Safety and Hazard Administration had a similar mandate in place for all employers with more than 100 employees, but they have since backed down from that mandate due to pending litigation and current court rulings.

The OSHA mandate will currently be in front of the 6th Circuit Court of Appeals in the very near future after being ruled unconstitutional in the 5th circuit.

The Fifth Circuit Court of Appeals on Friday affirmed a stay of the Biden administration’s vaccine rule covering employers with 100 or more workers, requiring them to be vaccinated for COVID-19 or to test negative once per week.

Great River Health Systems CEO Matt Wenzel said he doesn’t believe the CMS will step back from its mandate however.


“No, I don’t see them backing off it,” Wenzel said. “We are getting information about OSHA and that’s being challenged. But this is not, and we don’t think it will be overturned.”

Wenzel said Great River released their mandate this week to give employees time to get their affairs in order.

“That’s what we’re hearing and planning for, and that’s why we announced it this week,” Wenzel said. “I don’t think it will get overturned. Now, I’ve thought other things in the past and they’ve changed quickly, but if I was betting – this is going to stick.”

Pen City Current reached out to members of a Facebook group that has organized in opposition to the mandate, but no members of that group were willing to comment for the story.

Wenzel said he wants to be very clear that this is not a hospital mandate, but a federal mandate. And for the hospital to not suffer crippling revenue loss without Medicare reimbursements, they have to follow the mandate.

“I feel we have some employees that don’t understand this isn’t the hospital. I don’t know if it makes a difference with them or not, but this isn’t.

“We have tried to work through this as best as we can with the guidance we’ve been given. Some are choosing to terminate based on the Dec. 6 timeline. We are doing a leave of absence and (paid time off) to get them through ’til Jan. 4. That’s another sign we are trying our best. They can take PTO and they would be an employee until Jan. 4.”

However, under the mandate obtained by Pen City Current, employees would be responsible for paying for company benefits during any unpaid leave, but not during PTO.

The COVID-19 vaccine plan was sent in an email to employees Tuesday from Wenzel’s account. The plan read in part:

“To comply with a mandate from the Centers for Medicare & Medicaid Services (CMS), Great River Health employees, medical staff, and volunteers must be fully vaccinated against COVID-19 by Tuesday, Jan. 4. If we don’t enforce the vaccination mandate, we will be unable to participate in Medicare and Medicaid programs. If we can’t participate in these programs, the residents of southeast Iowa would not have any health care providers in their community.”

“If you have not been vaccinated, you must receive the first dose of the Pfizer or Moderna vaccine, or the single Johnson & Johnson vaccine, by Monday, Dec. 6, to continue working. This will allow time for employees to become fully vaccinated by the Jan. 4 deadline. 
•If you don’t receive a vaccine by Dec. 6, you must take an unpaid leave of absence or use your PTO. If you take a leave of absence, you must make payments for benefits in which you are enrolled to continue receiving them. 
•If you are not fully vaccinated by Jan. 4, your employment at Great River Health will be terminated.”

The Iowa legislature has countered the mandate with guaranteed unemployment to all health care providers terminated under the mandate, which will be billed back to employers through the state’s unemployment trust formulas.

State Sen. Jeff Reichman (R-Montrose) said he, too, is concerned for health care following the mandate.


“Who’s going to take care of people after Dec. 6? The industry is already facing shortages and mandating overtime left and right.”

Reichman said he’s not sure the executive branch has the power to withhold payments to hospitals.

“The problem is the executive branch doesn’t hold the power of the purse. (Biden) cannot say we’re not going to pay you Medicare Payments. He might be holding it over their head, but I’m not sure they are legally able to do so.”

“But as bad as things are now, and I don’t know what shortages are at Great River, but everybody in the area needs nurses and CNAs – there aren’t enough now. If you get 10% or 20% that walk on Dec. 6th or Jan. 4th and find a different profession – we’re going to be in bad shape.”

Wenzel said he’s not concerned that hospitals would be closed down if those numbers of staffers are lost, but he said he’s very concerned about another round of service cuts to residents in the Great River Health System service area.

“It’s tough. We will get out of it. I can’t tell you when and I can’t tell you how,” Wenzel said. “There are so many things changing for us. But we will make our way through it. I have not lost hope and folks in our community shouldn’t either.”

Staffers would have the option to fill out exemptions and waivers to the mandate. The waivers would be for a medical condition or a religious reason, and employees must submit a Request for Accommodation form by Nov. 30. The exemptions get reviewed by a system committee and any denials can be appealed by Dec. 6. Anyone granted an exemption would be required to wear PPE including a mask and face shield, in addition to other equipment that may be required, and maintain social distancing.

When asked what he had been hearing from staff on why the 33% weren’t getting vaccinated, Wenzel said it was either a medical or religious reason, or the employees didn’t like the mandate.

“It’s multifactorial. It could be religious, or medical, or just the mandate itself – government telling me I’ve got to do it. Those are three big ones,” he said.

“This is not unique to southeast Iowa or even Iowa. This is across the country what hospitals are facing now. Across Iowa we’re already facing workforce shortages like we’ve never seen before. And the CMS has told us very clearly, we have to be vaccinated as employees and volunteers.

“We have two choices. We either comply with the mandate as every hospital will have to do – or we don’t, and here’s the consequences. Most hospitals’ largest payer is Medicare followed by, in many cases, Medicaid. And it’s more pronounced in southeast Iowa because of aged populations. If we don’t comply, residents in southeast Iowa will be able to come in, but we won’t be a Medicare provider.”


State Rep. Martin Graber its an unfortunate scenario for health care providers who just 18 months ago were the heroes on the front of the pandemic fight.

“These people were good enough when we needed them 18 months ago, and now because they won’t take a shot which is an individual choice, we’re setting them up for financial trouble.”

Graber said the issue will certainly be a high priority for the 2022 legislative session set to being Jan. 11, but he said termination shouldn’t be the only option.

“If I have antibodies in my body because I’ve already had the virus and my employer wants me vaccinated there should be other options going forward. That shouldn’t mean termination.”

Reichman said the mandate needs to end.

“That mandate needs to be rescinded. They say you can turn in a waiver, but are they going to scrutinize them heavily or say the employee has a founded issue.”

He said he thinks some health care staff is concerned about the long-term effects of the vaccine.

“There are varying reasons, but some are worried about the long-term effect. It’s called novel corona for a reason. We haven’t seen this before and no other vaccine uses this technology,” Reichman said.

“Usually you get a non-living sample of a virus and your body builds antibodies, but here you’re blocking proteins and going about it different ways. We just don’t know the long-term difference of this mRNA technology.”

Wenzel said the situation is unprecedented and the mandate is making things very difficult for the system.

“We feel our best decisions are made employer to employee and when private businesses get mandates it makes it very difficult,” he said.

“Candidly, we care about all of our employees and we want them to make the best decision they can. We feel for them and we don’t want anybody to leave. If we lose more staff it’s going to hurt. That’s the bottom line. This is unprecedented.”

According to Great River Health Systems’ data, 59% of staff at the Fort Madison campus are vaccinated, 77% at Henry County Health Center are vaccinated, compared to 66% of staff at the West Burlington campus.


Michele Ross, administrator at Lee County Health Department, where the mandate would also be in effect for the LCHD to recover Medicare/Medicaid payments, said she wasn’t as concerned about the mandate.

“I am not concerned about our operations at LCHD due to the CMS rule at this time,” Ross said.

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