Central Vermont Medical Center wasted 99 Covid-19 doses in February because the Berlin hospital didn’t create a waitlist or find a way to use extra doses, according to chief operating officer Anna Noonan.
“We lacked a process to quickly fill appointments for no-shows and cancellations,” Noonan acknowledged in an email to VTDigger.
The squandered doses accounted for more than one-fifth of the state total of 488 unused doses, according to data provided by Secretary of Human Services Mike Smith — a proportion he called “concerning.”
The data, given to the state by facilities administering the vaccine, appears to be incomplete. In addition to the 99 wasted doses recorded by the state, CVMC threw away 16 doses in December and January, Noonan said. Six of those were lost due to a faulty vial and 10 expired before they could be used, she said.
According to Smith, every other hospital in the state has figured out a system to contact others seeking the vaccine in the event that extra doses are available and set to expire.
He expressed displeasure with CVMC’s failure to make better use of such a valuable commodity. “You find somebody. You don’t waste doses,” he said. “If inconvenience is the excuse for wasting doses, that’s not an excuse.”
Smith noted that providers in the state had discarded a tiny fraction — 0.3% — of the 167,000 total doses that Vermont had been allocated.
After CVMC, the next greatest number of spoiled doses came from the Department of Health’s White River Junction district office, at 44, and its Burlington district office, at 39, according to the data provided by Smith. Northeastern Vermont Regional Hospital in St. Johnsbury threw out 38, while Rutland Regional Medical Center wasted 27.
Noonan said in an interview Thursday that when the hospital switched from vaccinating healthcare workers to those in the 75-and-over age band, staff members stopped managing a waitlist. When a person with an appointment didn’t show up, health care workers just threw out the extra dose.
Noonan said she didn’t learn until this week that the staff had “inadvertently dropped that waitlist process” and said she didn’t know who was responsible.
The hospital executive said she took responsibility for the misstep and was “deeply sorry.”
“We are accountable for that, we own that, we did not have a process to do that,” she said.
On Wednesday, CVMC moved its vaccine clinic from the hospital to a new site at the Berlin Mall. As part of that transition, Noonan said that staff members would ensure that they had procedures and backup plans in place to make sure no doses were lost.
“I’ve reiterated that we have to have a process to address cancellation and no-shows — that’s just part of the operations of a vaccine clinic,” Noonan said. “My commitment and CVMC’s commitment going forward is absolutely to ensure we’re getting every dose into a member of our community.”
The Vermont Department of Health has instructed vaccine providers to “minimize vaccine waste.” A clinic site’s staff can organize the system as they see fit, but they must keep track of no-shows and prioritize people who are currently eligible for vaccination under the state’s guidelines for the open slots.
If that fails and the vaccines are at risk of going to waste, the site is permitted to contact anyone “it can reasonably reach,” including staff, if necessary. “The goal is to reach as many eligible people as possible, while eliminating vaccine waste,” the health department explains in its guidance.
The state’s scheduling system doesn’t have a means of creating such a waitlist, said spokesperson Ben Truman. Most hospitals have nevertheless abided by the guidance.
Gifford Medical Center has created its own waitlist by surveying doctors for the names of patients they’re worried about but who are not yet eligible under the state’s guidelines, said Rebecca O’Berry, vice president of operations for the Randolph hospital.
Three doses have gone unused at Gifford since mid-December, she said — one because a syringe leaked. (The state data does not list Gifford as having lost any doses.)
Gifford staff members try to end their vaccine clinics, which are ramping up to 400 people a day on Wednesday and Friday, before 4 p.m., to make time to find replacements for the one to two people who don’t show up.
When staff members open a new vaccine vial, they have to use all the doses before the end of the day, O’Berry explained. A Moderna vial contains 10 doses; Pfizer has five.
“Our goal is to not waste doses. We try to find somebody,” O’Berry said.
Staff at University of Vermont Medical Center reschedule recipients for the next day rather than open a new vial, according to spokesperson Neal Goswami. The state lists UVMMC as having wasted just 13 doses, though Goswami said the actual figure is 25.
Smith said he planned to address CVMC’s wasted doses with its administrators. “It’s out of the ordinary what’s going on at CVMC and I can’t explain it,” he said.
For her part, Noonan said she had already learned her lesson. The hospital’s new system — with staff huddles multiple times a day, a team tasked with making a waitlist and staff tracking patients’ distance from the hospital — would address the issue, she vowed.
“I’m very, very confident that this system will have us getting every dose into every member of the community that wants a dose of the vaccine,” she said.
Correction: An earlier version of this story inaccurately described the state’s plans relating to vaccine waiting lists.
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