By S. Humphries, MD
January 22, 2010
original link with references www.medicalvoices.org
H1N1 and seasonal influenza vaccines are now being given to sick hospital patients with or without their doctor’s consent. This is being done despite there being no data on the safety of doing so.
I am a licensed, board-certified nephrologist, otherwise known as a kidney specialist, working in a large, city-based hospital. Because I rarely admit patients to the hospital other than for specific procedures, such as a kidney biopsy, I only recently became aware of my hospital’s policy regarding flu shots for sick people. Waking up to this new rule made me realize that Big Pharma is getting closer and closer to bypassing doctors completely to deliver direct patient “care”.
We have an elaborate electronic charting system at our hospital. All of the medications and procedure orders are placed into the patient’s record by doctors and nurses so that every person has access to all that is happening with the patient. A few weeks ago, I arrived to see my first patient of the day, a patient with a kidney ailment that leaks protein and usually progresses to complete kidney shutdown. When I opened her electronic chart, I expected my section to be empty. Instead, I saw an order for an influenza vaccine with my name on it. Even more shocking was that the order was highlighted bright blue, meaning, the shot had already been given. I thought perhaps I had opened the wrong chart or some sort of mistake had been made. But it was the right file; her name in the upper left hand corner. And my electronic signature was on the page after the order. My patient, with kidney failure and an autoimmune disorder had been given a flu shot without my consent.
I was informed that according to a hospital policy that had been in effect since 2007, a pharmacist is permitted to visit a patient and offer them a flu vaccine. If the patient agrees, the RN is instructed to administer the shot and document the event in the chart. The attending physician’s signature stamp is used to complete the order. No one called to ask, “By the way, your patient wants a flu shot; can we give her one?” I’m not sure what was said to her, but she obviously agreed, and I didn’t need to be involved. The pharmacist had written an order for an injectable substance that I considered toxic and inappropriate for my patient, and it was administered by the RN before I even got to the floor.
My dissatisfaction eventually made it to the Chief of Internal Medicine who challenged me to produce peer-reviewed journal articles in support of my objection. There were dozens of case reports of kidney disease or small blood vessel inflammation following influenza vaccination. In fact, one paper cited 16 patients in its written report(1). Under-reporting of adverse vaccine reactions is a known phenomenon. The National Vaccine Information Center estimates that only about two percent of adverse vaccine reactions ever get reported. It would follow that written and published case reports found in medical journals represent a miniscule sampling of the totality of vaccine injury cases. These implications should evoke at least some curiosity on the part of doctors and health care advocates.
The peer-reviewed literature was delivered to the department head. His initial response was to suggest that future vaccination orders be signed off by another physician so I didn’t have to be involved with the process of a nurse giving a “routine” flu shot. But the point had been missed; flu shots should not be given to sick patients.
I was challenging “routine orders” that had been in place since 2007. The defense for supporting the policy was that no side effects had been reported since the standing order had been instituted. I wondered to myself and then later inquired: How do you know that is true? Is it because nobody filed a formal report? If a patient became more ill after the shot, did you consider his condition to be a side effect of the vaccine, or was it simply called an unfortunate complication to the patient’s current illness? What if the patient was discharged from the hospital but readmitted several weeks later. Was the reason logged simply as a progression of his existing disease…or was the cause an overlooked, delayed side effect of the vaccination? If vaccine reactions are not considered as part of a patient’s differential diagnosis, how do you know? Without taking a vaccine history when considering a timeline of events, how could anybody possibly make the connection between a vaccine and a subsequent illness? How does anyone else know for that matter – that there were no side effects from the “routine” administration of flu shots, ordered by a pharmacist and given by a nurse, without doctor consent? The truth is, there is no real tracking and reporting system in place. And nobody is enthused about trying to start one. What has essentially happened is that the guards have all been told to go home and nobody is thinking to even look for the wolf.
I am sure there are thousands of unreported cases of kidney failure – and a wide range of other serious health conditions – because doctors fail to ask a very simple question as part of the admission evaluation: “When was your last vaccine?” And few doctors suspect any connection because the party line screams, “Vaccines are safe, effective and harmless. They keep people healthy and prevent infection.” If nobody looks, vaccine-related side effects and complications won’t be found.
There was a law passed in 1986, the National Vaccine Injury Compensation Act, that made vaccine manufacturers and administering physicians immune from legal recourse in the event of a vaccine injury. This has given manufacturers a dangerously long leash and has enabled them to push vaccines through FDA approval with little need to create a safe product. Now drug companies have extended their reach into the hospital right past doctors, and put the power to vaccinate in the hands of pharmacists and executive committees, allowing them to make decisions about what is best for a patient.