Health Board pushes back on COVID-19 test requirements

The Washington County Board of Health sent a departmentwide vaccine mandate back to the drawing board after a 2-2 split over clauses about additional COVID-19 mitigation efforts.

As a recipient of funds from the federal Centers for Medicare and Medicaid Services (CMS), the Washington County Department of Public Health has been directed to adopt internal vaccine requirements and other mitigation efforts.

Board Member Chris Grier said he couldn’t support a clause of the proposed policy that involved weekly COVID-19 tests for staff with medical and religious exemptions to the vaccine mandate.

“I see no requirement from the federal government for testing,” Grier said. “I think it would be an expense for the department and I think it would be a bother for our employees.”

While federal guidelines don’t explicitly mention testing requirements, other health officials said they would be key to open-ended standards from the same CMS mandate.

“There is no requirement for testing, but what there is, is a requirement for mitigation measures,” said Nursing Director Karri Fisher, who worked with County Attorney John Gish to draft the policy. “The survey guidance looks at mitigation efforts you’ve put in place specific to COVID.”

Public Health Director Emily Tokheim said routine testing was the norm at other departments nearby, and was the clearest way to meet those federal standards.

“The other thing the surveyor guidance looks for is measurable … documentation of these mitigation strategies,” she said. “Hand washing, other PPE, those are all good hygiene practices (but) we did not feel that was adequate to meet the requirements of this policy and to meet the requirements of that surveyor guidance that will look at this policy down the road.”

Fisher urged board members to err on the side of caution, given the magnitude of CMS funding.

“If we don’t institute measurable (mitigation), then we stand at very high risk to be cited by CMS,” she said. “What that means, especially in this instance, is we hold ourselves open to civil monetary penalties as well as decertification. And that is going to impact the residents of this county, because we will no longer be able to provide care. That’s going to impact Medicare, Medicaid, VA, all of them, even some of our private insurances.”

Grier said he did not expect things to go that far.

“I do not believe that the federal government will stand on the fact that we are not testing and say that we’re not compliant,” he said. “Why would CMS not have put that in their requirements?”

Board Member Dr. Trevor Martin joined Grier in voting against the motion, saying the requirement would be unfair.

“Currently, vaccinated individuals are still getting infected and still getting the guidance, and I think it would be discriminatory to only swap people that are unvaccinated,” Martin said. “I think that could be some legal grounds for somebody actually suing on that ground … I would say if we implement this policy, we would have to test everybody to be fair.”

County Attorney John Gish declined to comment, citing requirements of his advisory position for the board.

Martin proposed an alternative mitigation effort of vitamin D tests, citing studies that it lowered risks from the virus.

“If somebody gets a medical exemption, that’s going to be from a provider and I’d request that if somebody’s doing that, they get a vitamin D level drawn,” he said. “If they have a level over 50, that would be a mitigation strategy that’s measurable, they could provide that with their exemption, and I believe that protects them more than having a swab every week.”

Grier agreed with the pitch.

“I love the idea,” he said. “A quarterly vitamin D test would not only help everybody in the department, but it would be a documented, objective test with research to back the mitigation of getting COVID and spreading COVID.”

Tokheim said the measure was not specific enough to COVID-19 to pass muster.

“The tests are testing to see if our staff have COVID, that’s an answer, yes or no,” she said. “Testing for vitamin D doesn’t tell us whether somebody has COVID.”

Martin said it was on par with vaccination as a preventive tool.

“They are less likely to die from COVID-19 if they have a vitamin D level over 50, they are less likely to end up in the ICU if they have a vitamin D level over 50, that is what the vaccine does as well,” he said. “It’s doing the same thing. The vaccine does not prevent spread … I don’t think COVID testing is going to help, even if the reviewers want to see that.”

Martin proposed vitamin D supplements for staff whose levels came in too low, an option other health officials criticized as amounting to another medical mandate. Grier said he still thought it was reasonable.

“If we’re forcing people to take pharmaceutical products versus forcing people to take vitamin D, I think the team would be on board with that,” he said.

Board Member and Vice Chair Jack Seward Jr. voted in favor of the originally proposed policy, despite his opposition to federal efforts.

“You and I think along the same lines in some respects,” he said to Grier and Martin. “But your issue is with CMS, and not with how public health administration is going to implement the requirements from CMS … they require mitigation and documentation, and our administration has decided that this is the best and most efficient way to do that.”

The motion failed after a 2-2 vote, with Board Members Connie Larsen and Seward voting in favor and Grier and Martin voting against. Board Chair Cathy Buffington was not present.

After the vote, Seward appointed Grier and Martin to a committee to propose an alternative policy, which the department will discuss at a special meeting Feb. 24 at the fifth floor conference room of Federation Bank.

Comments: Kalen.McCain@southeastiowaunion.com