Confusion, delays hamper COVID vaccine shipments to Clay County hospitals

Liberty Hospital was told last week by Missouri’s health department that its initial shipment wasn’t arriving.

Doses of Pfizer's COVID-19 vaccine are prepped to be administered to healthcare workers on the frontlines at Truman Medical Center in Kansas City on Monday, December 14, 2020. (Photo courtesy of Truman Medical Centers/University Health)

Last week, as celebratory photos of healthcare workers receiving the first doses of a coronavirus vaccine flooded social media, frontline staff at Liberty Hospital waited in anticipation — knowing their shipments would be coming this week.

The ultra-cold freezers sat waiting. Staff who had prepared to administer doses were standing by.

Instead, the hospital was told by the Missouri Department of Health and Senior Services Friday that it would not be receiving any vaccine this week as expected. Clay County’s other major medical center, North Kansas City Hospital, hadn’t received any doses yet either.

Hospital staff expressed frustration that frontline workers would now have to wait even longer for a vaccine that they hoped would usher in the beginning of the end to a 10-month pandemic that has been unlike anything they have ever experienced. 

By Monday, after a flurry of emails and calls over the weekend, the department reversed course. It notified the local state senator’s office that Truman Medical Center in Kansas City would redirect 975 doses to North Kansas City Hospital. Of those, 250 would then be sent to Liberty Hospital.

North Kansas City received a shipment and began vaccinating staff Tuesday morning. Liberty received its doses from North Kansas City later that morning, a hospital spokeswoman said.

It’s unclear how many hospitals across the state faced similar delays, and the process has left some calling for greater transparency as to where and how vaccines are being allocated. The confusion underscores the challenges of equitably distributing a limited supply of a highly sought-after vaccine at a scale that hasn’t been seen since polio.

Dr. Keith Neuenswander, an anesthesiologist and director of Liberty Hospital’s anesthesiology department, said Sunday that it’s “completely unforgivable” that the hospital’s emergency room staff haven’t yet been given an opportunity to receive a first dose.

Meanwhile, he said, other hospital systems around the state received enough in their initial shipments that they were able to begin vaccinating healthcare workers who don’t interact with COVID patients.

“We’re in absolute shock,” Neuenswander said Sunday afternoon. 

Over the weekend, the hospital struggled to get answers. Dr. Robin Morris, a family practice physician at the Liberty Clinic and executive team lead for family practice, said that DHSS said it was trying to prioritize larger hospital systems and certain geographic areas.

Morris said the department told Liberty Hospital it didn’t meet certain deadlines, which the hospital disputes, and that the allocation system was “first come, first serve” — a point she said was never relayed throughout the application process.

Emails between Liberty Hospital and DHSS show that subsequent requests before the deadline to order doses went unanswered and that the hospital was later told it would be among the first 50 slated to receive vaccine shipments.

“Excuses do not help,” Neuenswander said. “And that’s all we’re getting.”

In a statement Monday afternoon, Lisa Cox, a spokeswoman for DHSS, said changes in allocation estimates at a federal level “resulted in reduced supplies and not all orders being fulfilled as originally requested.”

Supply is extremely limited, Cox said, and although a hospital may submit an order request, that “doesn’t equate to an order.”

“Only the state can order vaccine,” she said, “and we have more requests than supply available.”

Last week, DHSS Director Randall Williams said Missouri may receive up to 30 percent less of the second dose of Pfizer’s COVID vaccine than it had anticipated. Other states reported similar reductions, and Gen. Gustave Perna, the chief operating officer for Operation Warp Speed, apologized Saturday and cited a miscalculation in how many doses could be shipped.

“However, through collaborative efforts between DHSS, area hospitals and our federal partners, vaccine shipments will be available for both Liberty Hospital and North Kansas City Hospital this week,” Cox said.

Cox said the department would not provide specific details about doses being sent to each site, but that the shipment would come from redistributions from doses other hospitals had received.

File photo of the North Kansas City Hospital campus. (Photo courtesy of North Kansas City Hospital)

“North Kansas City Hospital has learned it will be receiving its first shipment of the vaccine this week and will begin initiating its vaccination program once it arrives,” Libby Hastert, a spokeswoman for the hospital, said Monday afternoon.

Mindy Warner, a spokeswoman for Liberty Hospital, said Monday night that supply scenarios changed throughout the day and that the hospital is still working with DHSS to secure doses.

State Sen. Lauren Arthur, a Democrat from Kansas City whose district encompasses both hospitals, said Monday afternoon that receiving doses will help in starting to protect frontline workers.

“Even just having a couple hundred doses, that makes a difference and has the potential to save lives,” Arthur said. “And I think it represents that as a state, we’re not going to let people feel neglected or ignored.”

‘Left out in the cold’

Located north of the Missouri River, Liberty Hospital and North Kansas City Hospital are both public hospitals and the two largest in Clay County. Their coverage area is broad, accepting patients over 100 miles away up to the Iowa border.

They have about 650 beds between the two of them, and just this weekend were treating over 140 COVID patients, Morris said.

“To lock an entire county out when it serves a huge area and is, by population, the fifth largest in the state, doesn’t seem very logical,” Morris said Sunday afternoon.

It’s unclear how many hospitals the delays may have affected.

Steve Edwards, the president and CEO of CoxHealth, tweeted Monday afternoon that the full shipment of 7,000 doses would not be arriving at Cox Medical Center South in Springfield Monday night, and that shifting the vaccines its Branson and Monett locations received would ensure the 300 employees already scheduled to receive vaccinations Monday would still get them.

A tray of the Pfizer-BioNTech COVID-19 Vaccine placed in a freezer at the University Hospital pharmacy on Tuesday, Dec. 15, 2020 in Columbia, Mo. The vaccine must be stored in specialized freezers at -94 degrees Fahrenheit. (Photo courtesy of Justin Kelley/MU Health Care)

“We have been told the full allotment will arrive tomorrow,” Cox wrote. “We are from the show me state, so when we have it in hand I will be confident. It is a huge operation to ship this much vaccine, so we (will) try not to be too (impatient).”

Kaitlyn McConnell, a spokeswoman for CoxHealth, said Tuesday morning they are unclear what caused the delay and know of 300 doses that were reallocated for another hospital in the state. They expect to receive the 7,000 doses of Moderna’s vaccine by mid-morning.

Last week, Mosaic Life Care in St. Joseph told News-Press NOW that the expected date for a vaccine shipment changed three times.

Other states, like Texas, have published lists on which providers will be receiving vaccines and how many. DHSS did not respond to a request last week on whether the locations of sites receiving initial vaccine shipments in Missouri would be made public.

“I think all of that information should be public facing. And at the very least, other providers should have a glimpse into who’s receiving what and how those decisions are being made,” Arthur said. “I would hope that there is some sort of standardized rubric that’s informing that decision making.”

Arthur said she understands complications with the vaccine’s rollout were likely as the state embarks on a brand-new vaccination effort on a massive scale. But transparency needs to be paramount, she said, for residents to have a sense of fairness in the distribution.

‘We are living on the edge’

The news of delays left hospital staff disappointed and feeling crushed. Without a vaccine in hand and an expected post-holiday surge of cases, Neuenswander is concerned that already strained staffing levels could be decimated.

“One of my biggest concerns is, it could go through a department like wildfire,” Neuenswander said. “And we could get to a point to where if two or three anesthesiologists get it at the same time, half of our operating room has to shut down.”

They’ve been lucky. So far, only three anesthetists have contracted COVID — and never at the same time. Without a vaccine, it becomes not just a staffing issue, but potentially a safety issue if surgeries are delayed. 

“It’s inexcusable that there’s any hospital that is not able to have access to the vaccines as early as possible,” Neuenswander said, later adding, “I just feel that the state has totally dropped the ball. And they’re putting patients and providers at risk at Liberty and North Kansas City.”

As elective procedures were paused early in the pandemic, Neuenswander’s team shifted to helping intubate COVID patients within the ICU. With a team of seven anesthesiologists and 15 anesthetists, if one is out due to COVID, then 24-hour shifts stretch into 36-hour workdays to ensure there’s enough staff on hand.

Morris has been working with COVID patients directly, swabbing multiple patients a day. Each time she suits up in her personal protective equipment, the same set of questions runs through her mind: Are her goggles tight enough? Are her gloves on right? Is there anything she’s missing?

“And you go and do it. And when you come out, you undo all of that and hope that you did everything right,” Morris said. “It’s a tough way to live on a day-to-day basis. It’s created a lot of tension overall. It has taken a lot of the enjoyment out of medical practice when you’re that worried about it.”

Most staff eat lunch alone in their cars to minimize any potential exposure. When Morris returns home each night, a small part of her always agonizes, could she be sick and not know it yet, potentially bringing the virus home to her family?

“We are living on the edge right now, and it’s frustrating,” Morris said. 

“I know that to them a delay of a day or two doesn’t seem like much,” Morris said of the state, “but to us those hours stretch on.”

This story has been updated since it was first published.