No vaccine, no service. Miami physician orders patients to get a shot or find another doctor

By Daniel Chang

MIAMI — Throughout the pandemic, Dr. Linda Marraccini has kept her office door open for in-person visits with patients — just as she has done nearly every day during more than 30 years as a practicing family doctor in South Miami.

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 Pfizer-BioNTech 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 last week.

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 staunchly 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 for this story.

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 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 life-saving treatment to anyone or abandoning patients with life-threatening 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 last week and have been declining for more than a week. But COVID-related hospitalizations in Florida remain high, with 13,452 inpatients reported Tuesday — the second highest number in the nation after Texas.

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 Kendall resident and retired school teacher, asked that the Herald not use her complete last name 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 she said that 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 on 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, the UM bioethics professor, 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.

Medical students no longer take the Hippocratic Oath because it is outdated and counsels physicians not to perform abortions or surgery for kidney stones, he said. Instead, medical students now create their own credo or use a hybrid of other pledges, such as the Oath of Maimonides.

“People who cite the Hippocratic Oath as a doctor’s duties have not read the Hippocratic Oath,” Goodman said.

He added that the doctor-patient relationship is built on trust, but many “ideologues” seem intent on eroding that foundation with misinformation and flawed reasoning about personal choice or freedom.

“We’re facing a sociological phenomenon that is absolutely extraordinary, where ordinary citizens think they have a liberty interest in sickening other people,” Goodman said. “Where did that come from? ... Why is it you trust your doctor to save you when you didn’t get vaccinated, but not to counsel you to get vaccinated in the first place? The answer is you’ve been beguiled by ideologues, and in Florida that includes people in government leadership.”

Though the pandemic has been the subject of political disagreement from the beginning, Marraccini said she has no patience for those patients who minimize the seriousness of COVID-19 or fail to follow her evidence-based medical guidance.

Marraccini said “99.9%” of patient responses to the mandate have been “extremely favorable.” But some have resisted and she doesn’t expect they’re going to comply by Sept. 15. She blames much of their reluctance on rampant misinformation, a driver of vaccine resistance also cited by the U.S. surgeon general and the White House.

“I resent the people coming in that I spent a lot of time talking with. They obviously don’t relate to me. A lot of them have the disinformation going,” she said. “There’s no way, shape or form they are going to listen to this. I feel they are making our community sick.”

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