More Court Injunctions Impacting the Federal Contractor & CMS Mandatory Vaccination Rules
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Tag: Missouri
Federal Court Injunctions Impacting the Federal Contractor & CMS Mandatory Vaccination Rules
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Federal Court Enjoins the CMS Mandatory Vaccine Emergency Temporary Standard (ETS)
On Monday, November 29, 2021, the United States District Court for the Eastern District of Missouri – Eastern Division has issued a preliminary injunction staying the Centers for Medicare and Medicaid Services (CMS) Mandatory Vaccination Emergency Temporary Standards (ETS) which were set to take effect on January 4, 2022. This preliminary injunction currently only applies to healthcare providers in the plaintiff states.
On November 10, 2021, the States of Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, and New Hampshire filed a nine (9) count complaint in the United States Court for the Eastern District of Missouri seeking relief from the CMS Emergency Temporary Standard (ETS) which requires certain certified healthcare facilities to mandate COVID-19 vaccination of all employees, contractors, and those performing services “under arrangement.” The complaint alleged that the ETS violates numerous provisions of the Administrative Procedures Act (APA), the Social Security Act (SSA), that CMS failed to consult with the state agencies that would be charged with enforcing such a mandate, failure to perform an impact analysis of the new rules, and several other Constitutional violations.
In the ruling, U.S. District Judge Matthew T. Schelp, agreed with the plaintiffs that a preliminary injunction was warranted because it posed an irreparable harm and that the plaintiffs demonstrated a likelihood of success on the merits of their complaint. The thirty-two (32) page ruling cites that Congress did not give CMS the authority to enact the mandatory vaccination regulations, nor authorized CMS to issue regulations that pre-empt validly enacted state legislation that contradict these new rules. The court believed that the plaintiffs would likely be able to show that CMS violated numerous administrative and rulemaking procedures.
Throughout the ruling the court cited the likelihood of significant harm to state sovereignty and how the implementation of the rule’s requirements would cause substantial economic harm to both the states and the healthcare facilities. Not only through the cost of implementation but also through the impact to a healthcare facility’s ability to provide care due to employees who refuse to get vaccinated.
This ruling is only applicable to covered healthcare facilities in the states of Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, and New Hampshire. It is unknown if the stay will be expanded to other jurisdictions. Additionally, the OSHA Vaccination & Testing ETS is currently enjoined and OHSA has announced that they will halt implementation and enforcement associated with those rules. Despite these rulings, many EMS employers are subject to the mandatory vaccination requirements under the Safer Federal Workforce Task Force COVID-19 Workplace Safety: Guidance for Federal Contractors and Subcontractors.
I advise employers to take the initial steps toward compliance while these cases proceed through the legal system. EMS employers are already required to have policies and procedures to determine and maintain a log of their employee’s vaccination status. Additionally, many EMS employers have already been contacted by their contracted healthcare facilities who have enacted a vaccine mandate, either prior to, or in response to the CMS ETS. These facilities may still independently require your staff to be vaccinated.
I recognize that these are incredibly challenging times. If your organization has questions or need assistance deciphering or preparing for these requirements, please contact the AAA by emailing hello@ambulance.org.
St. Charles County Ambulance District | EMS Week 2021 Featured Service
St. Charles County Ambulance District
St. Peters, Missouri
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St. Charles County Ambulance District (SCCAD) began operations in 1975 with three ambulances covering a largely rural 592 square mile service area. Over the past 45 years, the community has grown considerably; today, the population eclipses 400,000 residents. SCCAD, which currently employs 195 full-time staff and 70 part-time employees, has kept pace with the growth, adding stations and ambulances in strategic locations to ensure that response times to 911 emergencies remain short. The District currently staffs 19 advanced life support units from 16 stations serving all municipalities and unincorporated areas of the county. In addition to 911 response, SCCAD offers non-emergency inter-facility transport, which is staffed separately from the 911 division. In 2019, the District implemented a successful critical care ground transport program to help high-acuity patients get from our county’s community hospitals to the larger healthcare centers in St. Louis city and county.
Over the past decade, SCCAD has developed and implemented a number of innovative initiatives to better meet the evolving healthcare needs of our community. These include a multi-faceted Mobile Integrated Health (community paramedic) program, which focuses on readmission avoidance in partnership with several hospitals in our area, and SCCAD high-utilization patients identified by our paramedics. In addition, the MIH team collaborates with commercial insurers to offer services to their patients in the county. Also developed in recent years was the American Ambulance Association AMBY award-winning Substance Use Recovery Response Team, which sees specially-trained paramedics helping facilitate overdose patients’ entry into treatment programs if they’re willing to seek help. In 2018, the District launched a successful behavioral health telemedicine program in partnership with Behavioral Health Response. Most recently, SCCAD was one of only three EMS organizations in the state of Missouri selected to pilot the Centers for Medicare & Medicaid Services Emergency Triage, Treat & Transport (ET3) program.
While COVID-19 most certainly presented operational challenges, it also offered EMS providers an opportunity to showcase our industry’s collective ability to adapt in the face of adverse conditions, and develop innovative, mission-driven solutions to meet the mobile health needs of the communities we serve.
From the onset, SCCAD embraced the challenge, working to develop strategies that would meet the needs of our employees, fellow first responders, and the community at large. To this end, our leadership team has worked in tandem with the St. Charles County Department of Public Health. Our Deputy Chiefs of Operations and Special Operations were added to the County’s incident command structure, and worked out of the County’s EOC to ensure a coordinated response. Meanwhile, our Deputy Chief Medical Officer worked tirelessly to develop aggressive contract tracing and quarantine procedures to ensure the safety of our team members, and worked to regularly push updated information out to crews. Under his direction, our training team spent time carefully reviewing donning/doffing and other safety protocols with team members.
In spring of last year, St. Charles County, like most other communities, struggled to scale up COVID-19 testing processes to meet demand. Residents experiencing symptoms were at times unable to get appointments for several days. Given the number of potential exposures that could result from a single infected paramedic, firefighter, or police officer, SCCAD’s MIH Team launched their first effort: a first responder testing program. The testing site enabled local police and fire agencies, along with SCCAD employees, to obtain a testing appointment in an expedited fashion. When local partners added more testing capacity toward autumn, we were able to scale down the testing effort.
Around the same time, Pfizer and Moderna began announcing initial success in clinical trials with their vaccines. With signs pointing toward emergency use authorization being granted by the FDA before year-end, the SCCAD team once again began strategizing on ways to make an impact. In conference with Public Health, it was determined that we would initially take point on first responder vaccinations, then move into other segments of the population while concurrently assisting with large-scale vaccination events being hosted by Public Health. Some of the vulnerable populations we’ve vaccinated have included elderly citizens residing at independent living senior apartments, homebound individuals, and those residing in rural areas of our county.
Though the past 14 months have been a stressful, challenging time, they’ve also shed a spotlight on the strength, determination, and character of many within our industry. In communities large and small across our state and nation, EMS is playing a critical role in getting things back to normal.
“Each and every day, our team of skilled professionals embody our values of dedication, compassion, accountability, integrity and respect. Through interactions on 911 calls, non-emergency transfers, and community safety programs, they are promoting best practices to integrated, community healthcare and enhancing the reputation not only of our organization, but also of the EMS industry.”
Kelly Cope, Chief“Today’s healthcare landscape is constantly evolving, and paramedics are increasingly being relied upon to deliver the right treatment at the right place, time, and cost. Our team has risen to the occasion, developing and implementing several unique programs to address the unique needs of our community in recent years.”
Dave Lewis, Assistant Chief of Administration“As is the case in many communities, our paramedics frequently find themselves serving not only a clinical role, but also one of counseling/social services. Our team has helped members of our community navigate everything from bed bug infestations to food instability. No matter the circumstances, patient advocacy is a critical role fulfilled by EMS.”
Kimberlyn Tihen, Mobile Integrated Health Division Captain“EMS plays an important role in communities every day, but that role is heightened during significant and/or unique events. We’re relied upon to be part of the overall solution, projecting a sense of calm and reassurance. I’m grateful to work for an organization that invests heavily in training and equipment for these unique scenarios, giving me the tools I need to serve residents when the need arises.”
Rees Remington, Battalion Chief
To celebrate EMS Week, we’re patronizing a local small business in our community to show our appreciation to the paramedics and support staff of SCCAD. Prados, an upscale locally-owned Mexican cantina located within our community, will be preparing meal kits on May 17, 19 and 21 so each of our crews can enjoy a handcrafted lunch. Our leadership team will report to Prados at 11 a.m. on each of the aforementioned days, and will deliver the kits to our 16 stations across the county. Of course, our training, service center, maintenance, administration and other non-clinical team members are included.
In addition, we’ll be utilizing our social media feeds to highlight EMS Week and the work of our team.
40 Under 40: Craig Boschert (St. Charles County Ambulance District – St. Peters, MO)
40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession.
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Craig Boschert
Deputy Chief of Operations
St. Charles County Ambulance District
St. Peters, MO
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Nominated by: Kyle Gaines (St. Charles County Ambulance District – St. Peters, MO)
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Biography:
A lifelong resident of St. Charles County, Craig Boschert has spent more than two decades providing assistance to those in need. Craig’s history of public service started in 1998 when he began volunteering with Orchard Farm Fire Protection District. Three years later, Craig earned his Paramedic certification at St. Louis Community College, and began a career with St. Charles County Ambulance District (SCCAD) shortly thereafter. In 2008, Craig was promoted to Battalion Chief – a role that enabled him to mentor dozens of new Paramedics entering the SCCAD system. Four years ago, a retirement among the District’s leadership team led to Craig’s promotion to Deputy Chief of Operations. In this role, Craig works closely with Platoon and Battalion Chiefs to ensure that each of the Ambulance District’s Paramedics are developing and promoting best practices so that the mobile healthcare provided exceeds expectations.
Craig has been married to his wife, Renee, for more than a decade. The couple resides in Orchard Farm with their sons, Caleb and Curtis.
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Reason for Nomination:
Craig Boschert began his career with St. Charles County Ambulance District (SCCAD) nearly two decades ago as a volunteer EMT, providing care and comfort to friends and neighbors in the rural communities of the District’s service area. While volunteering, Craig opted to turn his desire of helping others into a career, earning his Paramedic license and joining the SCCAD team full-time in 2002. Through the years, Craig has proved himself as a strong clinician, staunch patient advocate, and capable leader. In 2008, Craig was promoted to Battalion Chief – a role that has enabled him to mentor dozens of Paramedics throughout the years.
Though past achievements as a Paramedic and Battalion Chief are noteworthy, those undertaken since his promotion to Deputy Chief of Operations are what truly showcase Craig as a forward-thinking leader within our industry.
Craig’s ascent to Deputy Chief occurred in 2016 and came at a pivotal time in the District’s history. Call volume was rising steadily with no signs of slowing. In order to keep response times short amid significant projected growth over the next decade, the District would need to add numerous stations and vehicles at planned intervals. Craig was charged with developing a 10-year operation plan for the organization, and with assistance from his team developed a robust capital improvement framework. Craig spared no detail, gathering information from a variety of sources to chart planned neighborhoods, commercial developments, roadways, and population centers that would eventually contribute to call volume. Thanks to his foresight, District leadership was provided with a comprehensive snapshot of the next decade that enabled leadership to clearly communicate the forthcoming needs to our community when asking for their approval to issue bonds for the project.
In addition to capital needs, Craig is also responsible for ensuring that work force needs are addressed. SCCAD’s 48-hour shift staffing model requires that six full-time paramedics be promoted from our part-time non-emergency transfer division when a new 911 truck is added to our fleet. Craig is thoughtful in his timing, working closely with transfer leadership to ensure that an addition will not create trickle-down staffing challenges. Though new emergency division employees have typically been with SCCAD as transfer division paramedics for approximately two years at the time of their promotion to full-time, Craig provides a thorough orientation, clearly conveying the expectations of their new role within our organization.
As a senior leader, Craig never loses sight of the fact that SCCAD must take great care of its team in order to be successful. In recent years, the effects of post-traumatic stress, compassion fatigue, and secondary trauma have been well-documented among first responders. For too long, individuals in our line of work pushed aside troubling experiences, simply moving on to the next call. Craig has been an instrumental part of bringing about a culture change here in St. Charles County. When crews respond to challenging calls, Craig is often at their station within short order to check on them. Craig immediately arranges Critical Incident Stress Debriefing not only for our staff, but for any others involved in the call. Craig has worked together with our human resources team to ensure employees are aware of counseling and other programs available to them, and most recently, championed the development of an employee-led Peer Support Committee.
Since assuming the role of Deputy Chief, SCCAD has faced several significant operational events. Most have been weather-related, and each time, Craig works diligently with others on our team to ensure that our community is protected, no matter how long the hours. Most significantly, our region faced historic flooding in 2019, with access to one rural town completely cut off. Working closely with our Deputy Chief of Special Operations, Craig developed a plan to staff the “island” 24/7 to ensure residents had access to emergency care if the need arose. For over 60 days, SCCAD’s Urban Search and Rescue Task Force staffed the community of Portage Des Sioux, transporting patients out by boat if the necessary. The conditions were less than ideal but strong leadership and teamwork made the operation a success.
Though his workload SCCAD is substantial, Craig makes time to give back to the community he serves. Most notably, Craig has been heavily engaged in the St. Charles County CAPS (Center for Advanced Processional Studies) program, hosting groups of high school students for half-day sessions at our stations. Craig covers a wide array of topics with the students who are leaning towards careers in the health field, providing an exhaustive overview of our industry and organization. Students leave Craig’s sessions with a new outlook on EMS, and several have even enrolled in the District’s EMT training course.
Including his time spent as a volunteer firefighter, Craig Boschert has dedicated more than 20 years to serving St. Charles County. The programs and practices Craig has worked tirelessly to put in place will serve our organization and community well for decades to come, and SCCAD is proud to nominate him for the American Ambulance Association’s 40 Under 40.
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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees
Spotlight: SSM Health Cardinal Glennon Children’s Hospital STARS Program
The Special Needs Tracking & Awareness Response System (STARS), was founded just over two years ago at SSM Health Cardinal Glennon’s Children’s Hospital in St. Louis, Missouri. The team at Cardinal Glennon realized that they needed to do something to address the growing number of children in the U.S. with special health care needs, many of whom are at a higher risk for repeated ambulance transports.
As an EMT for over 18 years, Patricia Casey, the Missouri Coordinator of the STARS Program, knows how intimidating it can be for a first responder to walk into a home that in many ways may look like a hospital room. Children with special health care needs can require many different types of in home medical equipment that first responders are often not familiar with. The STARS Program aims to make the job of the first responders easier while making children with medical needs and their parents more comfortable with ambulances in case they need to be transported in one.
Cardinal Glennon works with local ambulance districts to enroll children with special medical needs in that district’s STAR Program. Once a child is registered in STARS, they are given a unique patient identification number and a home visit is scheduled with the patient and their family to compile pertinent medical history. Participating ambulance companies then create a book with all of the stars in their area so that their first responders have access to the medical information on the go. If a STAR needs to be transported, their caregiver can relay their STAR number to the dispatcher who will then let the first responders know. First responders can then look up crucial medical information about the STARS patient, so they can be better prepared when they arrive on scene.
Knowing that many medical devices in the homes of the STARS may be foreign to first responders, Cardinal Glennon’s staff provides free necessary trainings all around Missouri and now Illinois. Shelby Cox works as the Team Lead for EMS outreach, and Josh Dugal, RN, is the EMT-P STARS Coordinator for Illinois. Together with Casey, they help keep the program running smoothly. Each participating ambulance company appoints a STARS coordinator on their staff who will make biannual home visits and make sure the STARS medical information is up to date. Cardinal Glennon also sets up regular opportunities for STARS to visit their local first responders. Giving STARS the chance to get familiar with an ambulance and their local first responders prior to a medical emergency has been proven to help out both parties when an emergency occurs.
A paramedic who has responded to STARS calls explains that “the STARS system permitted me to have advanced medical knowledge before I walked through the door. There was no time lost backtracking to learn the patient’s history or baseline in the midst of a chaotic scene”. In addition to helping the first responders, the STARS program has been a huge reassurance to the parents of STARS whose children may often need medical assistance.
To learn more about Cardinal Glennon’s STARS program, visit their website or check them out on Facebook. Also check out Patricia Casey’s Article on the STARS Program which includes testimonials from both parents and first responders who have participated in the program.
Thanks to the entire team at Cardinal Glennon for your great work!
Do you know of other innovative programs being run by ambulance services? Share with the AAA so that we might feature those programs on the AAA Blog as well.
Spotlight: David Tetrault
David Tetrault
Farmington, MO, USA
Administrator/CEO, St. Francois County Ambulance District
Director, AAA Board, Region 4
Tell us a little about yourself, please.
I grew up in Jennings, Missouri, a small town in St. Louis County. I’m the baby of six kids—four brothers and a sister. I am very proud of my twin girls who just graduated from high school while simultaneously completing their associates degrees. They are now off to college to Rolla, Missouri, to finish their bachelors degrees. In addition to sharing time with my family and friends, I enjoy softball, camping, swimming, tennis, and walking.
How did you come to work in the industry? How long have you been involved?
Years ago I was involved in part of the law enforcement arena called “Police Explorers”, primarily because my brother was a police officer. From there, I progressed through many different facets of law enforcement. The one thing that sticks out in my mind is that every time I was involved in an incident including a sick person or trauma, I really felt as if I would filling my calling. I could calm people and make them feel better, even when at that point I had only first responder training.
I have been involved with EMS for more than 30 years now, from my early days as a dispatcher, then up the ranks to Training Officer, then Manager, and now CEO/Administrator here in St. Francois County.
What do you enjoy most about your job?
I enjoy working with the public, people in our community, and my staff. They are my second family.
What is your biggest professional challenge?
Dealing with the younger spirited individuals coming into the world of EMS. Understanding the different challenges in funding, retention of our employee’s, the right mix of people and balancing the good/bad at the same time.
Making sure the Emergency Medical Services is not the forgotten one in the mix of Fire and Police. We all have a very important roles and the same amount of responsibility.
What is your typical day like?
My day typically starts with putting out fires and finishing my to do list from the previous day. Having 24/7 responsibility for a large program has its ups and downs—including sometimes getting called into work in the middle of the night. By sunrise, I have usually been up and on the highway for several hours. During typical office hours, I attend meetings and handle projects, budgeting, scheduling, and other tasks that need to be completed to keep our service operating. I also address any concerns or needs of the board of directors.
How has participation in AAA membership and advocacy helped your organization?
The American Ambulance Association has bridged the gap for me in my role as a service Administrator/CEO. AAA has many valuable resources, and provides me access to a vast network of ambulance services across the United States. My fellow AAA members as well as staff are always available to answer questions.
AAA has been the leader in ambulance services resources for many years, and they continue to strive to be the best in everything they offer. I enjoy the daily updates, and feel that the work AAA does with benchmarking and standands forms the backbone of the industry. The American Ambulance Association is truly a leader for EMS.