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By Joshua D. Sussman, Esq., Beth E. Roxland, Esq., Jessica Woodrow, Esq. & Carla Hogan, Esq.

On August 16, Governor Cuomo announced a new vaccine mandate for New York State healthcare workers. This announcement aligns with the Department of Labor’s OSHA June emergency temporary standard, the Center for Disease Control’s July guidelines urging employers to encourage its workers to get vaccinated, and the requirements of several other U.S. states, including California and Maine, that have introduced similar vaccine mandates.

I. Scope of Newly-Announced NYS Vaccine Mandate Policy

Not surprisingly, the announcement’s fine-print is narrower and more nuanced than the attention-grabbing headline. The announcement states that the New York State Department of Health will implement this new mandate by issuing regulations and guidance pursuant to New York State Public Health Law (PHL) Section 16, specifically requiring hospitals, long-term care facilities (LTCF), and nursing homes to develop policies requiring their employees be vaccinated by September 27, 2021.

Despite the breadth of the Governor’s pronouncement, the new policy appears to exclude private practices, health care groups, and in-home health care workers. However, the Governor alluded to – but did not define – “other congregate care settings,” which could open the door to a broad reading of the Executive Branch’s intent.  In addition, it is important to note that the Commissioner of Health is separately imbued with the authority to issue orders, regulations, or guidance that exceeds the scope of the Governor’s announcement, as PHL Section 16 empowers the Commissioner to order a person to act or discontinue activities that are a danger to public health, so long as the Commissioner provides that person with an opportunity to be heard at a hearing and to present proof that such condition or activity does not constitute a danger to public health. In short, although the stated focus of the new vaccine mandate is on hospitals, LTCFs, and nursing homes, it is foreseeable and within the powers provided to the Commissioner of Health that the vaccine mandate could extend to private practices, health care groups, in-home health care workers, private facilities or any type of employer entity that provides care to patients.

Per the announcement and consistent with the legal requirements of Equal Employment Opportunity Commission guidelines, all healthcare institutional policies must contain limited exemptions to a vaccine mandate for employees with religious objections or medical reasons.

II. Mandates Aimed at Employers and Entities Rather than Healthcare Workers and Other Individuals

Importantly, and similar to other recently-enunciated policies by the State, this new pronouncement mandates that healthcare employer institutions require their employees to be vaccinated, rather than directly requiring healthcare workers themselves be vaccinated. There are several potential reasons why the State’s new vaccine policy is aimed at employers rather than health care workers.

One possible reason New York State is putting the onus on employers rather than instituting a government-level mandate directed at healthcare workers is because the currently available vaccines have not been fully approved by the federal Food & Drug Administration (“FDA”), but instead are being made available under a mechanism known as an “Emergency Use Authorization,” which is a type of conditional approval rarely relied upon except in special circumstances, such as a public health emergency. See 21 U.S.C. 360bbb-3, 360bbb-3a, and 360bbb-3b, as amended by Pub. L. 113-5. There is much debate about whether the government or other entities can or should mandate an intervention that has not yet been fully approved by the FDA, and many individuals have expressed hesitation in taking an intervention for that reason. This objection has been the basis of several of the lawsuits challenging healthcare and academic institutions’ vaccine mandates for their workers and students. To date, however, courts have found this claim without merit and insufficient to invalidate any such vaccine mandates. Moreover, the FDA has recently posited that it may grant full approval to at least one of the mRNA vaccines for adult populations in the near future, which may moot this line of reasoning.

Another potential reason why the State’s new policy may be aimed at entities rather than individuals may rest with the limitations of PHL Section 16, which requires orders to be served and opportunities to be heard for each individual personally affected by decisions made by DOH under this Section. As such, the State may need to personally serve each affected healthcare entity if the State enforces compliance with any vaccine mandates issued pursuant to PHL Section 16. While that will be a difficult task, it is far easier than serving the approximately 450,000 hospital workers, 30,000 adult care facility workers, and 145,500 nursing home workers cited in the Governor’s announcement. Additionally, as proposed, only employer health care institutions would be entitled the opportunity to be heard to contest the validity of the Orders—not their employees.

III. Legality of Vaccine Mandate Policies

In addition to the long-standing Supreme Court precedent Jacobson v. Commonwealth of Massachusetts, 197 U.S. 11 (1905), which upheld the legality of vaccine mandates, the legality of vaccine mandates set by private institutions for healthcare workers, university students, and others, has been the subject of several recent litigations – all of which have upheld such mandates. Notably, on June 16, 2021, a federal district court dismissed a challenge by 117 workers at Houston Methodist Hospital who refused to abide by the institution’s vaccine mandate. See Bridges, et al. v. Houston Methodist Hospital, et al., 21 CV 1774 (S.D. Tex. June 12, 2021).

More recently, on August 12, 2021, the United States Supreme Court denied students’ challenge of the University of Indiana’s vaccine mandate, following the 7th Circuit’s refusal to issue an injunction pending appeal of the University’s vaccine mandate to students returning to campus. See Klaassen v. Trustees of Indiana University, No. 21-cv-2326 (7th Cir. Aug. 2, 2021). These decisions may be persuasive authority in denying other challenges to similar vaccine mandates.

IV. Application of Government Mandates to Unionized Workers

Although courts have upheld vaccination mandates, it is unclear whether management in collectively bargained environments can unilaterally force union members to be vaccinated. That issue is currently being litigated in Illinois. Each collective bargaining agreement challenge is different, but employers should not unilaterally implement policies without first bargaining in good faith on certain issues related to such policies, such as: (i) implementation, including who is subject to vaccination unless specified, (ii) pay for time spent being vaccinated, (iii) timing of the vaccination, and (iv) consequences for an employee’s refusal to submit to vaccination.

V. Penalties for Non-Compliance 

Thus far is it unclear how the State intends to enforce any Section 16 orders that issue, but the Department of Health already reviews vaccine policies related to grade schools and universities and delegates enforcement of those vaccine policies to local health departments. A transition to reviewing and enforcing these new policies may be seamless. Additionally, the Public Health Law contains powerful statutory enforcement tools, including imposition of a $2,000 penalty for each violation pursuant to PHL Section 12, and also authorizes the Attorney General to seek an injunction against any person who violates, disobeys or disregards such orders.

As neither the Commissioner nor the Department of Health has issued regulations or guidance on the new vaccine mandate, however, it is unclear how or to what extent any noncompliance will be penalized.