September 19, 2005

Medics reminded: Shots for anthrax are voluntary

Errors prompt new instructions

By Deborah Funk
Times staff writer


A federal judge has ordered the Pentagon to redouble its efforts to prevent
involuntary anthrax vaccinations after a military medic injected someone
who did not volunteer for the shot.

U.S. District Judge Emmet Sullivan, whose ruling last year shut down the
Pentagon�?Ts mandatory anthrax vaccination program, ordered military
medical officials to issue recent clarifying instructions by Sept. 15 �?oto
all medical staff administering vaccines.�?�

Those instructions had been written by the commander of a medical unit in
Iraq for his personnel two days after the commander learned a medic in the
unit mistakenly vaccinated a soldier against anthrax.

They read: �?oIf administering anthrax vaccination, ensure the patient has
signed in, received training and trifold [brochure], understands the right
to refuse, and states they want to receive the anthrax vaccine. Immediately
prior to administration of the anthrax vaccination (once site and vaccine
are prepared) ask the patient, �?~Do you want to receive the anthrax
vaccination?�?T If the patient confirms, administer.�?�

Army Col. John Grabenstein, director of the Military Vaccine Agency, said
defense officials sent those instructions Aug. 11 to staffs that administer
vaccines and are sending them out again specifically to comply with the new
court order.

Vaccinations are given at about 360 military clinics by roughly 1,000 to
1,400 staff.

Under an earlier order by Sullivan, defense officials are required to
report weekly to him on whether any anthrax shots were given involuntarily.

An affidavit Grabenstein provided the judge describes the incident that
prompted the Aug. 30 order from the court. On July 9, an enlisted medic in
Iraq gave the anthrax shot to a soldier who was due to be vaccinated
against both anthrax and hepatitis.

The medic thought the soldier had to get the anthrax shot; the patient
thought she was getting only a hepatitis shot. When the patient learned
otherwise, she told the medic she did not want the anthrax vaccine.

The medic reported the error to superiors and was told to follow
instructions more carefully. The medical unit commander wrote a memo to
unit members on proper procedures, and included detailed instructions about
asking patients if they want the anthrax shot before injecting them.

In the affidavit, Grabenstein acknowledged the error violated �?oapproved
procedures�?� and said it was unintentional.

The clinic issued verbal and written apologies to the patient.

An airman at Cannon Air Force Base, N.M., also was vaccinated
involuntarily. On Aug. 17 the technician administering the shot told the
airman that Central Command required the shot. The airman, who had received
the standard brochure outlining the voluntary nature of the program, later
questioned the action. Grabenstein revoked that clinic�?Ts authority to
administer the anthrax vaccine, and reported the incident to Sullivan, he
said.

�?oWe�?Tre upfront about all of our operations,�?� Grabenstein said.

Defense officials began issuing voluntary shots in May, and have now given
about 42,000 under the revamped program. Slightly more than half of the
troops offered the shots accept them.