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Austin freestanding ERs will begin receiving the COVID vaccine after hospital ERs—a rule workers say is unfair

COVID-19 vaccines have already been delivered to healthcare workers throughout the state of Texas. However, none of those allocations went to freestanding emergency rooms physicians and nurses.
Texas Gov. Greg Abbott announced yesterday that more than 220,000 doses were doled out to medical personnel this week. In accordance with the state's two tier plan, freestanding emergency room staffers are in the program's second tier and won't begin to receive the vaccines until next week or even until the end of the month, a delay some medical personnel say is dangerous.
The allocation plan laid out Dec. 4 by Texas Department of State Health Services Commissioner Dr. John Hellerstedt, listed "protecting health care workers who fill a critical role in caring for and preserving the lives of COVID-19 patients…" as the top basis for distributing the initial limited supply.
Although the process included hospital staff working directly with patients who are positive or at high risk for the disease to be included in the top tier of allocation—such as hospital emergency room personnel—the care staff of freestanding emergency medical care facilities was linked with urgent care clinic employees under Tier 2.
Freestanding ERs are emergency rooms that aren't physically attached to a hospital, said Dr. Daniel Roe, the medical director for Vik Complete Care, a company with 16 freestanding emergency rooms throughout Texas, including two in the Austin area. There are 200 freestanding ERs in the state, he said.
DSHS Director of Media Relations Chris Van Deusen said the vaccine distribution tiers are not rigid requirements but "just rough groupings" to help organize the first allocation phase. He said freestanding ERs "will begin getting vaccine(s) next week."
"There's a common misperception among both civilians and medical people that freestanding ERs see a lower acuity or lower volume of patients," said Roe, a 26-year veteran of the medical field who is board certified in emergency medicine. "And, that's just not true."
The staff of those facilities sees a range of patients, from motor vehicle accidents to heart attacks and stroke, he said. And, they are seeing a lot of the coronavirus.
Complete Care has performed 25,000 COVID-19 tests in the past few months, and is on track to perform 30,000 such tests by the end of the year, Roe said. Within the company, he said the rate of positive results for those tests is 19%, or about 4,500 positive tests, a statistic that comports with or is greater than the positivity and testing rates for hospital emergency rooms, he said.
Roe said the tier system adopted by the state for vaccine distribution priority is erroneously based on facility types instead of provider roles.
"As emergency physicians and as emergency nurses and emergency techs, we should have access to the vaccine at the same time as employees that provide care at hospital-based ERs," he said. "We've really put ourselves out there, on the front line, and we feel like we should have access to the vaccine."
Texas Emergency Care Center CEO Rhonda Sandel agrees. The registered nurse not only heads the freestanding emergency room company but is also a founding member and immediate past president of the Texas Association of Freestanding Emergency Centers, an organization that advocates for fair regulation within the field, along with serving as the current president of the group's national organization.
Along with several TAFEC affiliates, Sandel penned her name to a Dec. 16 correspondence sent to the DSHS panel that drafted the tier guidelines, urging its members to include all emergency medical personnel in Tier 1.
"I think the State absolutely got it wrong and they did a disservice to many, many healthcare providers across the state," Sandel said of excluding freestanding ERs from Tier 1. "Any emergency room personnel, whether it's in a hospital-based emergency room or a licensed, freestanding emergency room have the same exact exposure to COVID patients."
She echoed Roe's sentiments that freestanding ERs across Texas are seeing thousands of COVID-19 patients daily, with many transferred to a hospital's intensive care, or COVID-unit, without the patient ever entering the hospital's emergency room. Freestanding ER personnel are intubating many COVID patients, a procedure that helps a patient breathe but presents a high risk for passing the infection on to assisting healthcare workers, Sandel said.
"Certainly, we are not at any less risk than those physicians or those nurses working in hospital-based emergency rooms," she said.
St. David's Healthcare staff unpack the first few shipments of its initial supply of the COVID-19 vaccine on Thursday.(St. David's Healthcare)
Additionally, a freestanding ER owned by a hospital group falls under the hospital's Tier 1 designation and is among the first group to be vaccinated, Sandel said. But a freestanding ER owned by an independent source, such as Vik Complete Care, is classified as a Tier 2 facility, whose staff will be vaccinated later, she said.
St. David's HealthCare maintains freestanding emergency centers in the Austin area, including Bastrop, Bee Cave, Cedar Park, Leander and Pflugerville. According to a St. David's spokesperson, each emergency center serves as an extension of a St. David's HealthCare hospital, hospitals that are classified as Tier 1 facilities for vaccine purposes.
"Employees of our emergency centers who meet the Tier 1 guidelines will be immunized during the first wave of COVID-19 vaccinations," the spokesperson said.
St. David's Healthcare staff unpack the first few shipments of its initial supply of the COVID-19 vaccine on Thursday.(St. David's Healthcare)
On Thursday, St. David's HealthCare received the first few shipments of its initial supply of the COVID-19 vaccine and personnel were slated to administer the vaccine to its employees and medical staff on Friday.
Carol Campbell, spokesperson at local freestanding ER group Austin Emergency Center, said she's hopeful there will be enough doses of the COVID-19 vaccine to administer to her personnel in the first round of distributions.
"The health and safety of our frontline workers who go above and beyond every day remains a top priority for our company," she said in an email to Austonia.
The danger of delaying COVID-19 vaccines to freestanding emergency room workers is that those employees could contract the disease, compromising their ability to continue to treat high numbers of patients and shunting more patients to hospital emergency rooms, Roe said.
"If there's an ethical priority and a pragmatic priority to protect frontline healthcare workers, we are in that group," he said.
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(Paxton Smith/Instagram)
Paxton Smith’s 2021 valedictory speech at Lake Highlands High School in Dallas wasn’t the same speech she had previously shared with school administrators. She dropped the approved speech and made a case for women’s reproductive rights after lawmakers passed the Texas "Heartbeat Bill.”
Her advocacy made news on NPR, YouTubeTV and in The Guardian. Just over a year later, the “war on (women’s) rights” she forewarned has come to a head as the U.S. Supreme Court voted Friday morning to overturn Roe v. Wade, ending constitutional protection for abortion access.
“It is up to the people to show up and show the courts and the politicians that we won’t sit back and let this happen,” Smith told Austonia Friday morning. “We will show up, we will fight back. Before, we were scared of them, now they should be scared of us.”
Now a University of Texas sophomore and abortion rights activist, 19-year-old Smith said she wanted to give the same speech in the “the most public way possible” to reach “as many people as possible who don't agree that I deserve this right.”
However, she says the response was “actually overwhelmingly positive” and supportive of her cause. According to a recent UT poll, 78% of Texas voters support abortion access in most cases.
The speech opened up further opportunities for activism: she advocated for reproductive rights at the International Forum on Human Rights in Geneva, interviewed with Variety magazine and spoke to tens of thousands at Austin’s Bans Off Our Bodies protest at the Texas Capitol in May.
Smith also serves on the board of directors for the Women’s Reproductive Rights Assistance Project, a national nonprofit organization that helps fund abortions or medication abortion—like Plan C pills—in all 50 states. Most recently, Smith has been attending protests in Washington, D.C. leading up to the ruling.
“This is land of the free. This is where you get to choose how you live your life,” Smith said. “Overturning Roe v. Wade violates everything that we have come to believe about what it means to live in this country. I think a lot of people aren't willing to accept that this is a human right that is most likely just going to be gone for over half of the country within the next couple of weeks.”
Bracing for the next steps, Smith gave some tips for supporters:
- Find a protest to attend.
- “I would say invite somebody to go to those protests with you, invite a couple of friends, invite people into the movement,” Smith said.
- Talk about the issue on social media—use the platform you have.
- “Have these kinds of conversations where people can just talk about their fears and then find ways to go and advocate for yourself,” Smith said.
- Volunteer at a nonprofit near you.
“I feel like a lot of the reason things have gotten as bad as they have within the abortion rights world is that people are not making a scene, not protesting, not putting the effort into ensuring that the government doesn't take away this right,” Smith said. “I want to emphasize that if you're not doing anything, don't expect the best scenario, expect the worst because that's the direction that we're going in.”
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(Council Member Chito Vela/Twitter)
The U.S. Supreme Court overturned Roe v. Wade, the landmark ruling that guaranteed a constitutional right to an abortion, Friday morning. Moments later, Austin City Council set a special meeting for next month to pass a resolution aimed at decriminalizing abortion.
The GRACE Act, which stands for guarding the right to abortion care for everyone, is a twofold plan submitted by council member Jose “Chito” Vela. It recommends that city funds shouldn’t be used to surveil, catalog, report or investigate abortions. It also recommends that police make investigating abortion their lowest priority.
Council Member Vanessa Fuentes, who co-sponsored the resolution along with council members Paige Ellis, Kathie Tovo and Mayor Steve Adler, said the importance of the GRACE Act cannot be overstated.
“By introducing this resolution during a special session, City Council is doubling down on fighting back for reproductive health,” Fuentes said. “Items like the GRACE Act will promote essential healthcare while enabling individuals to exercise their bodily freedom.”
The act takes an approach similar to when former council member Greg Casar moved to decriminalize the possession of small amounts of marijuana. Ultimately, state law doesn't allow city officials to order police chiefs to adopt specific enforcement policies so the resolution would be a request to Police Chief Joe Chacon. In May, Politico reported that Vela is having "ongoing conversations" with Chacon about the proposal.
Austonia contacted Attorney General Ken Paxton for comment on the GRACE Act but did not hear back by time of publication. On Friday, Paxton celebrated the overturning of Roe and announced an annual office holiday on June 24 in recognition of the high court's decision.
In a press release, Vela said the Texas state government has a history of overturning municipal protections of human rights. Thirty days after the Supreme Court’s ruling, Texas will ban all abortions, with exceptions only to save the life of a pregnant patient or prevent “substantial impairment of major bodily function.”
Still, Vela expressed hope for the GRACE Act’s longevity. Council’s special meeting on it is set for the week of July 18.
“We know this resolution is legally sound, and Austin is not alone in this fight,” Vela said. “We are working with several other cities who are equally horrified by the prospect of an abortion ban and want to do everything they can to protect their residents.”
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