By Diana M. Alba
Las Cruces Sun-News
LAS CRUCES, N.M — A yet-unknown percentage of Dona Ana County’s volunteer firefighting and EMS staff aren’t up-to-date on a vaccination meant protect the employee and public from Hepatitis B.
At issue is that a number of the county’s 300 volunteer firefighters and EMS staff haven’t received a one-time Hepatitis B virus vaccination, despite a 2006 county manager’s directive requiring it.
County Commissioner Karen Perez, who publicly highlighted the problem in late November, said she learned about the situation after attending another meeting in which volunteers complained they’d not received the vaccination or tests.
“It’s a concern for the workers themselves and the people they come into contact with,” she said. “The county manager assured me he was looking into it.”
Hepatitis B virus, spread through bodily fluids, can cause serious liver disease.
A 2006 directive by County Manager Brian Haines required that all paid and volunteer employees in 13 job types, including firefighters and emergency medical technicians, begin the Hepatitis B vaccination process within 10 days of a job assignment that puts them at risk for exposure to the disease, according to the document. County officials assured that paid employees are in compliance with the directive.
In addition, some volunteers also have complained they aren’t receiving an annual tuberculosis test, a practice among some medical providers to monitor whether employees might have contracted the disease as a result work.
How did the situation arise?
County Fire Marshal Robert Monsivaiz said he began about 10 months ago, within a year of his hiring, to assess the status of the county’s 16 volunteer fire districts for planning purposes. He said he requested information from each district about the number of EMS volunteers it has and their vaccination status. But he said that the districts have been slow to respond.
“From where I’m sitting currently ... I do not have information or total information as far as the numbers of volunteers and what they have or don’t have,” he said. “The districts at this time are in a better position at this time to know who they have and who has what.”
Monsivaiz said he wasn’t aware about the problem until he began the assessment, and he doesn’t know what happened prior to his hiring in May 2009.
The fire districts operate from 19 fire stations that reach from Garfield to Chaparral.
A volunteer, whose identity is being withheld because of his concerns about retaliation from county officials, said he’s aware of some districts that have replied to the fire marshal’s request for volunteer information several times, but the situation remains unchanged. He criticized the fire marshal, saying the measures are basic precautions in the medical community.
“I don’t understand why this is an issue,” he said of the lack of vaccinations and testing. “It’s something that should be done because it makes sense.”
Hepatitis B
Hepatitis B virus can cause a mild to severe form of liver disease, sometimes resulting in death, and is typically spread when blood, semen or other body fluids enters the body of an uninfected person, according to the Centers for Disease Control and Prevention. The best way to prevent the disease is through vaccination, according to the CDC. Tuberculosis, meanwhile, is a bacteria-caused illness that can be spread through the air, according to agency. It can affect key organs and sometimes cause death.
There are no immunization requirements for EMS personnel to be licensed in New Mexico, a spokesman for the state department of health said.
Walter Simmons is an Arizona physician under whom Do-a Ana County’s EMS volunteers are licensed. Asked whether he’s concerned about the lack of Hepatitis B vaccinations, he replied:
“It would be in everybody’s best interests if we would provide that immunizations for the volunteer EMS personnel. But I wouldn’t say I’m concerned. It would be nice if they could.”
Simmons acknowledged it’s possible for a provider to infect a patient, but said it’s “probably about as close to zero as you can get.”
“With Hepatitis B, what you’re concerned about is that the patient might have bodily fluids that could come into contact with the provider,” he said.
In addition, Simmons noted that tuberculosis isn’t prevalent in this part of the country, and the risk of transmitting it between patient and provider is low.
Monsivaiz said he feels confident that volunteers are taking precautions, outside of the vaccination and testing, to minimize their risk of exposure to disease.
Dennis Pacheco, chief of the Do-a Ana Volunteer Fire Department and president of the county’s Fire Officers Association, said he wasn’t aware of the county manager’s directive until someone brought it to his attention recently. But the districts are attempting to correct the situation, he said.
“We’re really trying to move forward with this one,” he said.
Dollars lacking
Monsivaiz said part of the delay has stemmed from the fact there hasn’t been a budget in place to pay for what may turn out to be a large number of vaccinations. Annual tuberculosis testing is about $23 per person, while a three-part Hepatitis B vaccination costs about $225 per person. In a request for funding, he assumed that as many as 250 people may require the testing and shots, he said.
“I’m guessing that’s a little bit high, but it’s better for me to be high than low,” he said.
All county employees, not only volunteers, can formally opt out of the vaccination.
Monsivaiz said their is some money in place for a few individuals within a district to seek out the vaccination and testing. But a funding body recently OK’d additional revenue, he said, an allocation that’s expected to soon be voted upon by the county commission.
Monsivaiz said he doesn’t have a time line for how quickly volunteers might begin being immunized and tested. After all current volunteers are brought up to date, he said, individual districts would be responsible for the costs.
Simmons noted that, even if the Hepatitis B vaccinations are offered by the county for free to existing volunteers, there’s no guarantee EMS personnel will get them. Based on past experience with free immunizations given to hospital staff, he said, he estimates that a little more than half of volunteers would get the vaccination.
Volunteer districts
In 2007, the county commission moved to exert more authority over the fire districts by creating a countywide fire department. Part of the reason behind the move, officials said at the time, was to ensure employees were properly following human resources policies to reduce legal liability to the county.
Assistant County Manager Sue Padilla said the county manager’s office could force the districts to submit the information about volunteer personnel, but said county officials would prefer to collaborate with the chiefs of the individual departments.
Asked whether it was the county manager’s office or the fire districts’ job to ensure the policies are followed, Padilla replied: “I think there’s responsibilities on both sides, and we’re working on correcting that.”
Regardless of the reason for the problem, Perez said what matters is that it gets resolved.
“I don’t really care why; I just care that it’s fixed,” she said.
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