Fla. doctor to patients: No shots, no service
MIAMI — Throughout the pandemic, Dr. Linda Marraccini has kept her office door open for inperson visits with patients — just as she has done nearly every day during more than 30 years as a practicing family doctor here.
Marraccini kept in touch with all her patients via regular emails, guiding them through the latest developments and recommendations on prevention, treatment and ultimately a vaccine for COVID-19.
For the August email blast, Marraccini informed the nearly 3,000 patients in the practice she shares with her brother, John Marraccini, that the Food and Drug Administration had approved the PfizerBioNTech COVID-19 vaccine for regular use, lifting the emergency authorization the agency had granted the vaccine in December.
Then Marraccini announced a vaccine mandate — for her patients.
She posted a note outside the office door and gave patients until Sept. 15 to get vaccinated against COVID-19, or else she will end the doctor-patient relationship.
Those patients who can’t find a new doctor before the deadline will receive teleconference consultations, Marraccini said. She’s not granting many exemptions, and she won’t entertain appeals.
“I feel if I can’t have a good doctor-patient relationship, I’m not going to be comfortable taking care of those patients and they should find someone who’s a better fit for them,” Marraccini told the Miami Herald recently.
Marraccini said she expects her patients to at least take the minimum steps needed to stop the pandemic. Those who refuse, she said, aren’t willing to do their part for the greater good.
“We feel that they’re on the backs of the people who took the vaccine,” she said. “There’s no team playing. There’s no team participation.”
Far from abandoning patients or violating any medical credo, Marraccini’s vaccine mandate is good medicine, said Kenneth Goodman, founder and director of the University of Miami Miller School of Medicine’s Institute for Bioethics and Health Policy.
Goodman said rampant misinformation about the COVID-19 vaccines and the hyperpolitical environment around the science behind the drugs has created a “sociological phenomenon” where some citizens believe they have the liberty to make others sick.
“Doctors have duties to their patients, all of them, not just to the one that’s gaming the system,” Goodman said. “You don’t expose your patients to a potentially deadly disease.”
Marraccini’s mandate comes at a time when, after 17 months of battling the pandemic, many in the health care community are debating the question of how to allocate scarce hospital resources and whether to ration care for those who are not vaccinated.
In Florida, a majority of the Legislature and Gov. Ron DeSantis have opposed mask mandates for students in public schools and prohibited businesses, schools and government entities from asking anyone to provide proof of vaccination.
Marraccini’s order, however, does not appear to run afoul of Florida’s ban on so-called vaccine passports.
The Florida Department of Health, which is authorized to issue fines of up to $5,000 per violation of the statutory ban on vaccine passports, declined to comment.
Like all Florida doctors, Marraccini can choose to end a patient relationship, according to the state Board of Medicine, which oversees physician licensing. The board advises doctors to follow the Florida Medical Association’s guidelines when severing ties with their patients, including adequate notice in writing and assistance in finding a new provider.
Marraccini said she’s not requiring proof of vaccination to provide a service. She’s choosing to end a relationship with noncompliant patients, just like she does with those who repeatedly miss appointments. And she emphasized that she’s not denying lifesaving treatment to anyone or abandoning patients with lifethreatening conditions that only she can manage.
“It is not to punish people,” she said. “Honestly, I’ve spent a lot of time talking to people. I’ve had people who are teachers that are going to be teaching kids who are not vaccinated and they (the teachers) are not vaccinated. That’s not great for our community. I have a big problem with it. … Some of these people are very high risk themselves. They can’t afford to get sick. I’ve had patients die because they were afraid to go to the hospital.”
Hospitalizations for COVID-19 in Florida appear to have peaked recently and have been declining for more than a week. But COVIDrelated hospitalizations in Florida remain high.
A board-certified family physician, Marraccini said she hopes the new policy makes a statement to the broader community about a shared responsibility to protect those who are vulnerable, including young children who are not eligible for vaccination, and to help relieve the burden of COVID-19 patients overwhelming hospitals.
For some patients, the message is resonating.
Holly G., a 69-year-old resident of Kendall, Fla., is also a retired school teacher who asked that her last name not be used for fear of backlash from people who are hostile to the COVID-19 vaccine. She said she had read a Newsweek article about Marraccini’s vaccine mandate and was alarmed by the negative comments that some readers left online.
Holly said she took the vaccine in January. She has been Marraccini’s patient for 39 years and said the doctor is fastidious about keeping patients on schedule for all their vaccines and medications.
“She’s not just this doctor that tells you go get this particular inoculation, you have to get them all. She keeps you up to date. When you go in for a physical, she checks all of you. So you gotta get the pneumonia, the shingles,” the patient said. “I trust her.”
Holly said Marraccini takes precautions to prevent spread of the coronavirus in her office. She schedules appointments far apart so patients do not have to interact in the waiting room. She requires them to wear masks indoors. And she has remained accessible to patients via teleconference, phone calls and emails.
When Marraccini sent the email to patients announcing the vaccine mandate Aug. 24, Holly said she was supportive.
“I was proud of her,” she said. “I mean, it’s like, come on. Just think if all the doctors would do it, maybe more people would get vaccinated.”
But Marraccini has also taken criticism, mostly on social media, from those who accuse her of violating the Hippocratic oath historically taken by new doctors and pledging to uphold certain ethical standards.
Goodman of the bioethics institute, said physicians are ethically bound to provide care for their patients, but there is no firm adherence to the Hippocratic oath or any particular credo.
“People who cite the Hippocratic oath as a doctor’s duties have not read the Hippocratic oath,” Goodman said.