As deadlines for several health care worker Covid-19 vaccine mandates have passed, health systems in various states are handling employees who remain unvaccinated differently—ranging from large-scale terminations to unpaid "grace periods."

Resource library: How health care organizations can navigate vaccination mandates and other issues in the post-pandemic world

New York health system fires 1,400 noncompliant employees

Northwell Health, the largest hospital system in New York, on Monday announced it fired 1,400 employees for not complying with the state's Covid-19 vaccine mandate, which went into effect on Sept. 27.

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According to the New York Times, the terminated workers made up less than 2% of the organization's more than 76,000 employees. In a statement, the organization said it took a "rapid, aggressive approach" to reach 100% vaccination in its workforce.

"[H]aving a fully vaccinated workforce is an important measure in our duty to protect the health and safety of our staff, our patients and the communities we serve," Barbara Osborn, Northwell's VP of public relations, said, "[A]s health care professionals and members of the largest health care provider in the state, we understand our unique responsibility to protect the health of our patients and each other."

Separately, Joe Kemp, a spokesperson for Northwell, said the company regretted losing any employees because of vaccination. He added that terminated workers have the opportunity to interview for reinstatement if they get vaccinated, although the company is "openly recruiting" for newly vacant positions.

"The goal was to get people vaccinated, not to get people terminated," he said.

California health systems pursue different mandate enforcement routes

In California, several health systems were able to vaccinate 90% or more of their workforces by the state's Sept. 30 deadline for health care workers, including:

• Sharp HealthCare, where 92% of workers have received at least one dose of a Covid-19 vaccine and 4% received medical or religious exemptions
• Cedars-Sinai, where 98% of its 16,000 employees are vaccinated
• Sutter Health, where 91% of its 54,000 workers are vaccinated
• University of California, Los Angeles Health, where more than 90% of its 29,000 employees are vaccinated and 3% have requested exemptions
• Scripps Health, where 140 out of 17,000 employees are currently unvaccinated
• University of California, Davis Health, where at least 94% of its employees are vaccinated

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According to Modern Healthcare, none of the health systems have terminated any unvaccinated employees for being noncompliant with the statewide vaccine mandate yet. Instead, many health systems have placed unvaccinated employees on unpaid leave and given them a grace period to get vaccinated before they are terminated.

For example, Sharp HealthCare has placed 305 employees on administrative leave and given them 30 days to get vaccinated before they will be terminated. Kaiser Permanente has also placed the 2% of its 216,000 employees who are unvaccinated on unpaid leave and given them until Dec. 1 to get vaccinated and return to work.

Other organizations, such as UCLA Health, are currently notifying unvaccinated employees about their noncompliance and considering disciplinary action for these employees, including prohibiting access to work areas.

However, since the state's mandate did not tell providers how to evaluate exemption requests, some rural hospitals in California have significantly lower vaccination rates, the Los Angeles Times reports.

For example, in Tulare County, which has a 43.3% vaccination rate, Kaweah Health Medical Center granted exemption requests for more than 30% of its employees. According to CEO Gary Herbst, this lenient approach to exemptions was to prevent a "mass exodus" of employees as the hospital struggles with a surge of Covid-19 patients and high staff turnover.

However, Felipe Osorno, executive administrator of continuum of care and value improve at Keck Medicine of University of Southern California, said vaccine mandates, both at the state level and at individual institutions, were important in turning the tide for vaccination rates among health care workers. At the USC health system, only two out of 7,500 employees were ultimately terminated for not being vaccinated, the Los Angeles Times reports.

"It definitely shows that the mandates have an effect in helping convince some folks across the finish line," Osorno said. "I know these mandates will become pretty commonplace among large employers and all healthcare institutions, and I think it'll help us keep people protected." (Devereaux, Modern Healthcare, 10/4; Saric, Axios, 10/4; Slotnik, New York Times, 10/4; Nelson/Sheets, Los Angeles Times, 10/1)