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Stanford's resident doctors protest exclusion from first round of COVID-19 vaccinations

Algorithm error blamed for ruling out over 1,300 residents and fellows, many whom are on the frontlines

On Dec. 18, Stanford Health Care apologized for the allocation of COVID-19 vaccine doses to its hospital residents, fellows and other care providers. Embarcadero Media file photo by Veronica Weber.

When Stanford Health Care and Stanford Children's Health administered the first doses of the COVID-19 vaccine on Friday, Dec. 18, most of its resident physicians, many of whom are on the frontlines of caring for patients with the deadly virus, weren't among those being inoculated, according to a letter to hospital leadership.

In response, a large group of resident physicians staged a protest in front of Stanford Hospital on Friday morning to raise concerns over the allocations.

Of the 5,000 doses of the vaccine in the hospital's planned rollout to hospital employees, only seven residents and fellows were included, the Chief Resident Council said in the Dec. 17 letter sent to the medical center's leadership.

"There is still no articulated plan to vaccinate the remaining 1,300+ residents and fellows, including those on the front line directly treating COVID-19 patients," the letter said. The residents felt "a deep sense of distrust towards the hospital administration given the sacrifices we have been making and the promises made to us," the letter said.

"Stanford's decision to de-prioritize residents and fellows is defenseless on the basis of science, reason, ethics, and equality. Many of us know senior faculty who have worked from home since the pandemic began in March 2020, with no in-person patient responsibilities, who were selected for vaccination. Meanwhile, we fellows strap on N95 masks for the tenth month of this pandemic without a transparent and clear plan for our protection in place."

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In a Dec. 17 email obtained by this news organization, a member for the Graduate Medical Education community, of which the residents are a part of, said: "This is of course hurtful and frustrating as many of us have been on the frontline for weeks and we are actively being recruited onto the COVID ICU Surge unit."

The hospital's vaccine task force allegedly did not alter the list when they were contacted by the residents. The residents said they were not included due to an algorithm the hospital followed because they don't have a "location," such as being assigned to a specific nursing unit or nursing emergency department unit, and thus received zero points in the algorithm. Age was also a factor, and the residents received fewer points because they are younger, according to the email.

"Even many of our ICU fellows are not included in the vaccine pool for tomorrow (Dec. 19)," a resident who requested anonymity told this news organization.

Dr. Niraj L. Sehgal, chief medical officer for Stanford Health Care, apologized for the way the vaccine allocations rolled out in a letter on Thursday to the graduate medical education community.

"I wish we had been able to focus on the excitement of tomorrow and the start of our vaccination efforts. Despite our best intentions to thoughtfully map out a principled vaccine plan to include our residents, fellows, and faculty, it's clear there were several unintended missteps. Please know the perceived lack of priority for residents and fellows was not the intent at all. We've spent the day understanding the issues so we can quickly move forward together. It won't make up for how you felt today. I personally couldn't feel worse about it."

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The hospital anticipates receiving additional doses of vaccine from Moderna Inc., which received authorization by the Food and Drug Administration on Friday to distribute its inoculant. Sehgal said the hospital is "increasingly confident" it would have enough vaccine doses "for everyone," including the residents and fellows, he said.

The Chief Resident Council found that explanation inadequate, however. When the error was discovered on Tuesday, the hospital still did not make any changes to equitably distribute the vaccine to the residents and fellows, it noted.

"Negligence to act on the error once it was found is astounding, and to us is reflective of the lack of resident representation in decision-making and oversight at Stanford Medicine," the council wrote.

Stanford Medicine, which oversees Stanford Health Care and Stanford Children's Health, also acknowledged the error in a statement on Friday.

"We take complete responsibility for the errors in the execution of our vaccine distribution plan. Our intent was to develop an ethical and equitable process for distribution of the vaccine. We apologize to our entire community, including our residents, fellows, and other frontline care providers, who have performed heroically during our pandemic response. We are immediately revising our plan to better sequence the distribution of the vaccine," the statement said.

Stanford Health Care spokesperson Lisa Kim said the revised allocations would be coming out of the first 3,900 doses the hospital received from Pfizer-BioNTech.

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.

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Sue Dremann is a veteran journalist who joined the Palo Alto Weekly in 2001. She is a breaking news and general assignment reporter who also covers the regional environmental, health and crime beats. Read more >>

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Stanford's resident doctors protest exclusion from first round of COVID-19 vaccinations

Algorithm error blamed for ruling out over 1,300 residents and fellows, many whom are on the frontlines

by / Palo Alto Weekly

Uploaded: Fri, Dec 18, 2020, 6:05 pm

When Stanford Health Care and Stanford Children's Health administered the first doses of the COVID-19 vaccine on Friday, Dec. 18, most of its resident physicians, many of whom are on the frontlines of caring for patients with the deadly virus, weren't among those being inoculated, according to a letter to hospital leadership.

In response, a large group of resident physicians staged a protest in front of Stanford Hospital on Friday morning to raise concerns over the allocations.

Of the 5,000 doses of the vaccine in the hospital's planned rollout to hospital employees, only seven residents and fellows were included, the Chief Resident Council said in the Dec. 17 letter sent to the medical center's leadership.

"There is still no articulated plan to vaccinate the remaining 1,300+ residents and fellows, including those on the front line directly treating COVID-19 patients," the letter said. The residents felt "a deep sense of distrust towards the hospital administration given the sacrifices we have been making and the promises made to us," the letter said.

"Stanford's decision to de-prioritize residents and fellows is defenseless on the basis of science, reason, ethics, and equality. Many of us know senior faculty who have worked from home since the pandemic began in March 2020, with no in-person patient responsibilities, who were selected for vaccination. Meanwhile, we fellows strap on N95 masks for the tenth month of this pandemic without a transparent and clear plan for our protection in place."

In a Dec. 17 email obtained by this news organization, a member for the Graduate Medical Education community, of which the residents are a part of, said: "This is of course hurtful and frustrating as many of us have been on the frontline for weeks and we are actively being recruited onto the COVID ICU Surge unit."

The hospital's vaccine task force allegedly did not alter the list when they were contacted by the residents. The residents said they were not included due to an algorithm the hospital followed because they don't have a "location," such as being assigned to a specific nursing unit or nursing emergency department unit, and thus received zero points in the algorithm. Age was also a factor, and the residents received fewer points because they are younger, according to the email.

"Even many of our ICU fellows are not included in the vaccine pool for tomorrow (Dec. 19)," a resident who requested anonymity told this news organization.

Dr. Niraj L. Sehgal, chief medical officer for Stanford Health Care, apologized for the way the vaccine allocations rolled out in a letter on Thursday to the graduate medical education community.

"I wish we had been able to focus on the excitement of tomorrow and the start of our vaccination efforts. Despite our best intentions to thoughtfully map out a principled vaccine plan to include our residents, fellows, and faculty, it's clear there were several unintended missteps. Please know the perceived lack of priority for residents and fellows was not the intent at all. We've spent the day understanding the issues so we can quickly move forward together. It won't make up for how you felt today. I personally couldn't feel worse about it."

The hospital anticipates receiving additional doses of vaccine from Moderna Inc., which received authorization by the Food and Drug Administration on Friday to distribute its inoculant. Sehgal said the hospital is "increasingly confident" it would have enough vaccine doses "for everyone," including the residents and fellows, he said.

The Chief Resident Council found that explanation inadequate, however. When the error was discovered on Tuesday, the hospital still did not make any changes to equitably distribute the vaccine to the residents and fellows, it noted.

"Negligence to act on the error once it was found is astounding, and to us is reflective of the lack of resident representation in decision-making and oversight at Stanford Medicine," the council wrote.

Stanford Medicine, which oversees Stanford Health Care and Stanford Children's Health, also acknowledged the error in a statement on Friday.

"We take complete responsibility for the errors in the execution of our vaccine distribution plan. Our intent was to develop an ethical and equitable process for distribution of the vaccine. We apologize to our entire community, including our residents, fellows, and other frontline care providers, who have performed heroically during our pandemic response. We are immediately revising our plan to better sequence the distribution of the vaccine," the statement said.

Stanford Health Care spokesperson Lisa Kim said the revised allocations would be coming out of the first 3,900 doses the hospital received from Pfizer-BioNTech.

Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.

Comments

John
Registered user
Midtown
on Dec 18, 2020 at 6:17 pm
John, Midtown
Registered user
on Dec 18, 2020 at 6:17 pm

The article omits: WHO DID get the first allocation of the vaccine? If the residents didn't get it, WHO did get it? The cynic in me, wonders...did the "old timers", well established Palo Alto'ians get it who work at Stanford?


BL
Registered user
College Terrace
on Dec 18, 2020 at 7:02 pm
BL, College Terrace
Registered user
on Dec 18, 2020 at 7:02 pm

Dr. Niraj L. Sehgal, If you truly feel terrible about this then resign. How awful that Stanford didn’t prioritize its frontline residents and fellows.


parent
Registered user
Barron Park
on Dec 18, 2020 at 7:47 pm
parent, Barron Park
Registered user
on Dec 18, 2020 at 7:47 pm

Typical Stanford. Unless you are a well known, tenured professor or doctor, Stanford considers you disposable. They abuse alot of their graduate students and teachers who are not tenured. They want only the "best" so unless you have established your self elsewhere, or on track to win a Nobel as a Stanford researcher, they are treated as cogs in the wheel. Easily to be replaced by others willing to come to Stanford for the name, to then be replaced themselves by others.


parent
Registered user
Barron Park
on Dec 18, 2020 at 7:52 pm
parent, Barron Park
Registered user
on Dec 18, 2020 at 7:52 pm

The priority for the Stanford Hospital medical staff is getting publications. More publications, greater "prestige", easier to raise more money and keep expanding. Treating patients is just a way to get enough clinical data to submit in their publications, and show how Stanford is on the cutting edge. If you are looking for individual, compassionate care, look elsewhere.


JR McDugan
Registered user
Palo Verde
on Dec 18, 2020 at 8:20 pm
JR McDugan, Palo Verde
Registered user
on Dec 18, 2020 at 8:20 pm

This is effectively a protest over nothing. With a few weeks, all health care workers who want a vaccine (including residents) will get one. Residents are typically under 30 years old and usually don't suffer severe symptoms from C19 anyway. Why not protest something meaningful instead, like Stanford furloughing health care workers despite sitting on a $26 billion dollar endowment?


Online Name
Registered user
Embarcadero Oaks/Leland
on Dec 18, 2020 at 9:07 pm
Online Name, Embarcadero Oaks/Leland
Registered user
on Dec 18, 2020 at 9:07 pm

Stanford's getting lots of national press over this, with an entire story package on Google News.

And with the 60 Minutes expose of Sutter/PAMF's practices and the problematic Palo Alto city testing program as described by Diana Diamond, we're not looking too good.


Stephen Voss
Registered user
another community
on Dec 19, 2020 at 1:04 am
Stephen Voss, another community
Registered user
on Dec 19, 2020 at 1:04 am

Stanford must immediately provide vaccination for every nurse, resident, and other person now putting their life on the line for covid 19 patients. Its conscious ongoing disregard for these people covers Stanford with shame. As a Stanford PhD I feel the shame myself.
Dear Stanford: Fix the disaster. Now.


Annette
Registered user
College Terrace
on Dec 19, 2020 at 8:59 am
Annette, College Terrace
Registered user
on Dec 19, 2020 at 8:59 am

I agree with the resident who defined this as indefensible. And, to borrow a word from our mayor, it is "rich" that Stanford would blame an algorithm. Stanford! I don't buy it; an algorithm for something this important and this new had to have been written recently by people who are expert at doing such things and then tested. This is Stanford. Tech Central. The explanation is kind of pathetic. It also raises questions. Those administrators and doctors who got it know they are not on the front line; where are their voices in this? Why is it that those who should have gotten the vaccine but didn't needed to raise their voices in protest while those who shouldn't have gotten it but did apparently kept their silence and rec'd something so badly needed by those on the front line? Who cares about an apology - get the vaccine to those working so hard to give comfort and save lives.


Nayeli
Registered user
Midtown
on Dec 19, 2020 at 9:09 am
Nayeli, Midtown
Registered user
on Dec 19, 2020 at 9:09 am

Why would Stanford use an algorithm when frontline essential workers are readily identifiable? After all, they are medical employees.


Anonymous
Registered user
Duveneck/St. Francis
on Dec 19, 2020 at 1:12 pm
Anonymous, Duveneck/St. Francis
Registered user
on Dec 19, 2020 at 1:12 pm

I predicted this (see other threads), though not specifically predicting Stanford would prioritize known, well-connected people.
CA is in a disease crisis and CA medical professionals directly treating (contagious) disease = Covid MUST be prioritized.
Blaming an algorithm is childish.
Hadn’t Administration planned for the vaccination rollout!? (and with clear prioritization) as time is of the essence. Seems this is basic common sense. Yes, I respect they’re busy but vaccinating crucial medical staff seems obvious to me. They have job titles, departments, specialties, locations, Covid or non Covid work.


Nancy RN
Registered user
Midtown
on Dec 19, 2020 at 3:08 pm
Nancy RN, Midtown
Registered user
on Dec 19, 2020 at 3:08 pm

There needs to be an outside investigation into what really happened. All the C level suits let their people down & David Entwistle - you are not our colleague. Patient facing licensed clinicians are our colleagues. People are not calling the switchboard asking for us to be fired, people are asking for you to be fired. Pushing out to the public that an 'algorithm' went out unchecked and was the result of 'crossed wires' is the most pathetic story and does not justify the over-pumped salaries of the worst leadership team we have ever had.

Nursing administration is also culpable. There needs to be an audit of travel & magnet expenses because their focus has not been on ethical and responsible care of their employees. Ironically, this is the biggest fail in transformational leadership ever. AND Trish Britt gets an award for working on the COVID team and pastes self congratulation all over linkedin? More time spent on making certain your nurses are taken care of?? or maybe check the 'algorithm' to prevent 'crossed wires'.

Clinicians care for patients under a scope of licensure and ethics. We have been pressured to step up and we have. This is not whining that we didn't get on the list it is ethical outrage that your 'algorithms' put so many non-patient facing leaders at the top of the list and worse - they took it without concern for even considering their employees. CEO - fail, CNO - fail, University - fail. External independent inquiry.


Annette
Registered user
College Terrace
on Dec 19, 2020 at 4:05 pm
Annette, College Terrace
Registered user
on Dec 19, 2020 at 4:05 pm

@NancyRN from Midtown: go ahead and whine if you are a patient-facing clinician who was passed over while others who are not caring for patients were vaccinated. Whine, complain, do what you must to keep the issue front and center until those responsible for this fiasco remedy the situation and put in place safeguards to make sure the "error" is not repeated.

And if you are a patient-facing clinician: thank you. Society owes all who are on the medical front lines an enormous debt of gratitude.


Online Name
Registered user
Embarcadero Oaks/Leland
on Dec 19, 2020 at 5:38 pm
Online Name, Embarcadero Oaks/Leland
Registered user
on Dec 19, 2020 at 5:38 pm

Echoing Annette here! Thank you for all you do and let's keep this front and center, esp. since Stanford had the nerve to cut the salaries of the hard-working healthcare professionals earlier this year, when you're risking your own health and safety to serve others.

How shameful that Stanford could insult your service and everyone's intelligence with an excuse like "the computer made me do it" couched in slightly more sophisticated language.


blah
Registered user
another community
on Dec 19, 2020 at 5:41 pm
blah, another community
Registered user
on Dec 19, 2020 at 5:41 pm

I am not sure why anyone is surprised by this. It wasn't THAT long ago that Stanford forced its staff to take a 20% pay cut to preserve its financial health.

Web Link


Online Name
Registered user
Embarcadero Oaks/Leland
on Dec 19, 2020 at 6:15 pm
Online Name, Embarcadero Oaks/Leland
Registered user
on Dec 19, 2020 at 6:15 pm

@blah, mot surprised, just disgusted. But you bring up and interesting point: maybe Stanford should rescind the pay cut they made "due to Covid" AND give them a bonus "due to Covid."


Puuuuuulease
Registered user
Midtown
on Dec 21, 2020 at 11:09 am
Puuuuuulease, Midtown
Registered user
on Dec 21, 2020 at 11:09 am

It's easy to apologize AFTER you've already received the vaccine. That's hysterical. We all know the phrase: it's easier to ask for forgiveness than permission.

This was no accident or algorithm mistake. And what's even more absurd is that Stanford thinks anyone is going to buy that excuse given, as Annette has already nicely articulated, we are surrounded by tech experts.


EmmaP
Registered user
Old Palo Alto
on Dec 21, 2020 at 11:55 am
EmmaP, Old Palo Alto
Registered user
on Dec 21, 2020 at 11:55 am

I hope a fairly hefty proportion of the first batch of the vaccine went to the nurses. Note that there wasn't enough vaccine in the first batch to jab everyone in the hospital so some sort of algorithm is needed (weighing risk of catching, risk of suffering severe or fatal effects from Covid-19, essentialness, and probably some other factors). The algorithm doesn't seem to have been sanity checked ahead of time.
<blockquote>
The residents said they were not included due to an algorithm the hospital followed because they don't have a "location," such as being assigned to a specific nursing unit or nursing emergency department unit, and thus received zero points in the algorithm. Age was also a factor, and the residents received fewer points because they are younger, according to the email.</blockquote>
Age makes sense so the failure on how to properly handle no "location" seems to be the major design error. I do wonder whether this means other employees or contract workers not assigned to a specific "location" but still working in locations where exposure is likely are also being overlooked.


Anonymous
Registered user
Duveneck/St. Francis
on Dec 21, 2020 at 11:36 pm
Anonymous, Duveneck/St. Francis
Registered user
on Dec 21, 2020 at 11:36 pm

It gets worse...early anti mask, Covid denier Senator Marco Rubio (not elderly) receives vaccine as well as Rep. Alexandria Ocasio-Cortez, who is a young woman.
Not to mention they get the high quality Pfizer vaccine (which I would also like, since that is a very reputable large established company - as opposed to later questionable vaccines like Astra Zeneca/Oxford, which have reported scary problems and I swear I read may be combined with a - get this - Russian vaccine!? -
These will may provided to many of us — Q3? - at the end of the line in California.
Expectations of the general public are increasingly getting managed by Dr. Fauci and others, have you noticed? - hazy timelines for us regular folks w/o power or identity groups.
Hilarious jockeying of special interest groups lobbying for their workers to get priority. Uber?!
I don’t pretend to know much about vaccines (but I am educated and read) - so it IS clear, of course, frontline medical/healthcare workers are at risk and must be first in line.
But politicians, their pals, families (various ages), paper-shuffling administrators, bureaucrats (of various ages) ....(even the governor has a lieutenant governor to take over if he goes out of state, falls ill, etc.), random unions...appear to be already getting vaccinated - why should they be prioritized over those of us who are under 75, but as middle-aged...by AGE we are more at serious risk compared to: twenty-somethings, forty-somethings, fifty-somethings?
Who is “essential.”
Who are priority groups...
Why are younger prioritized!? (UNLESS truly front line workers, of course).
Why are late middle-aged listed behind felons, undocumented and twenty-somethings (unless State of California vaccination plan has changed since I uncovered it several weeks ago)!? At the time I was stunned to read New York Times search function find your place in line to discover California places me last.
Yes, I have emailed my government representatives. They don’t have any interest in me (turning 60 shortly). I have paid a lot of taxes to this state and hope to leave. The idea that felons and undocumented are more valued over me is sickening. To be clear, I suppirt prison WORKERS getting vaccinated well before me.
Sorry for the rant.
I wish I lived in Vermont along with Bernie Sanders - bet I’d be vaccinated in a reasonable number of months.
California government sucks.


Lee Forrest
Registered user
Crescent Park
on Dec 22, 2020 at 10:17 am
Lee Forrest, Crescent Park
Registered user
on Dec 22, 2020 at 10:17 am

From the land that brought us Covid-19, another new virus to be wary of...

Web Link


The Voice of Palo Alto
Registered user
Crescent Park
on Dec 24, 2020 at 1:06 pm
The Voice of Palo Alto, Crescent Park
Registered user
on Dec 24, 2020 at 1:06 pm

Statement by the useless Stanford Administrators: “Oops! Sorry about that! I hope you all understand it was all just because of this pesky algorithm error that led to absolutely no frontline workers but all useless administrators to be vaccinated. I mean those kind of errors are just bound to happen with some of the greatest minds working here at STANFORD. But still we are all nice and safely vaccinated and you are all not. Please accept this even more useless apology and thank you for all of your understanding. Now get back to work and hang in there for a few more weeks until we get the next batch of vaccine.”

“This is effectively a protest over nothing. With a few weeks, all health care workers who want a vaccine (including residents) will get one.”

No it’s not. Stop downplaying it. It’s the principle of what took place here, and what took place here was an absolute disgrace.


Online Name
Registered user
Embarcadero Oaks/Leland
on Dec 24, 2020 at 1:48 pm
Online Name, Embarcadero Oaks/Leland
Registered user
on Dec 24, 2020 at 1:48 pm

Yup. Their letter concludes,"We remain grateful for your steadfast support of our Stanford Medicine community."

Stop downplaying it AND making unfounded assumptions about your community. Time to tweak those algorithms again.


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