No Vax, No Visit: Florida Doctor Won't Treat Unvaccinated Patients in Person

A Florida doctor says she will stop treating patients in person if they are not vaccinated against COVID-19, citing the risk of exposing immunocompromised patients and staffer to the virus that has killed over 46,000 people in the state and more than 648,000 nationwide.

“I understand that people are free to choose, but to me, it’s a problem when it affects other people,” Dr. Linda Marraccini said.

With the Delta variant fueling the latest COVID-19 surge, the Marraccini said she had to make a tough decision for her practice. 

“When it comes to the safety of others, when it comes to the fact that it’s a global health problem and community health problem, at this point, I really say that this is where it draws the line in the sand for me,” Marraccini said.

The family practice physician based out of South Miami sent a letter to her patients saying they will no longer continue serving patients who are not vaccinated from COVID-19 by Sept. 15.

Marraccini said the decision was based on science, not politics, and aims to avoid subjecting other patients and staff to unnecessary risk. 

“There’s been millions of deaths globally so that’s not something to ignore. People are getting to the point where everybody knows somebody that died from COVID," said Marraccini. "This is a problem that really everyone needs to help out with and it’s affecting our collective communal health."

The doctor insisted the policy doesn't violate her Hippocratic Oath, a set of ethical standards doctors pledge regarding the obligations to their patients, noting she’s still offering the option of telemedicine or helping with referrals to other doctors. She also said she would make exceptions for people who could not get vaccinated for health reasons.

Marraccini said only about 10% to 15% of her patients were vaccine hesitant. She gave them a month to help them work out a plan moving forward. 

Florida is in the grip of its deadliest wave of COVID-19 since the pandemic began, a disaster driven by the highly contagious delta variant. While Florida’s vaccination rate is slightly higher than the national average, the Sunshine State has an outsize population of elderly people, who are especially vulnerable to the virus; a vibrant party scene; and a Republican governor who has taken a hard line against mask requirements, vaccine passports and business shutdowns.

Earlier this year, Gov. Ron DeSantis signed a bill banning vaccine passports. Starting on Sept. 16, Florida could start issuing up to $5,000 fines to businesses, schools and government agencies that ask for proof that you’re vaccinated. 

Attorney Juan Carlos Planas believes the state will have a hard time finding legal standing to fine Marraccini's practice, if they were to try.

“I don’t believe you can treat a medical clinic the same way you can a business. But I also think that she lays something very clear that will probably impede the state's ability to fine any business," Planas said. "She lays out in a medical way how exactly she wants to protect her staff and she specifically states that no medical professional has found many people who cannot be vaccinated for medical reasons. She even says that the antibody treatment is not a substitute for vaccination."

Below is the full letter Dr. Marraccini emailed to her patients:

1) MOVING FORWARD

The Pfizer Covid 19 vaccine has been approved by the FDA for general use, no longer emergency use status. As we have stated, we feel our patients should have the Covid 19 vaccine.

Our reasoning, based on science:

• There has been overwhelming amount of research on this vaccine in multiple countries by thousands of researchers on millions of people.
• Not all the vaccines investigated made it “to market”.
• These vaccines have been tremendously funded, something rarely seen in medical research in general due to the emergency nature of the situation.
• Hundreds of millions of patients have received the 3 vaccines in this country.
• Smallpox and Polio were not eradicated by herd immunity - they were essentially eliminated by universal vaccination. Smallpox was eradicated by mandatory immunization. It is possible we may never reach herd immunity if vaccine resistance (continued mutations) continues.
• The hospitals and healthcare system are so stressed that many patients are hesitant to go to the ER or hospital for life-threatening conditions.
• We have had people die due to this fear. Patients with other medical conditions are laying in hallways, while Covid patients with preventable admissions are in rooms.
• Ventilators had to be retrieved from the National stockpile again and the local hospital system is short of things such as oximeters, not to mention personnel and ICU space.
• The Delta mutation and subsequently our prolonged issue dealing with masks, distancing and vaccine hesitancy, not to mention disinformation, are all causes of the current surge, especially in our community.
• This is not about a patient not wanting to be pro-active about their weight, blood pressure or cholesterol. This affects all of us.

In our practice we find almost no one that cannot take one of the vaccines for medical reasons.

Therefore, it is our decision to no longer continue services for those patients who will not have a vaccine by September 15. We will no longer subject our patients and staff to unnecessary risk.

This is a public health emergency -- the health of the public takes priority over the rights of any given individual in this situation. It appears that there is a lack of selflessness and concern for the burden on the health and well-being of our society from our encounters. If any of our patients have a valid medical reason for not having the vaccine or have their first shot by September 15, please let us know.

Patients no longer in our practice will be given one month to find another health care provider.
During that timeframe we will provide encounters by televist only.

2) A REVIEW OF FACTS REGARDING COVID 19

• While true it may not kill you, it can cause long term damage to people in 1/3-1/2 of cases, even with mild initial symptoms.
• It causes damage to multiple organ systems including your lungs, cardiovascular and nervous system, even if you receive monoclonal antibodies, or other treatments.
• You can be responsible for other less strong people to be infected before you know you are sick.

Monoclonal antibodies, while very helpful are not as good as prevention.

• That means barriers (masks) and the vaccine.
• People also get inflammatory reactions to the antibody infusion and do not get “cured”, just have their disease lessened.
• That means long term effects can still occur -- you have already had inflammatory damage to your body before you receive the infusion.
• Remdesivir
• This is an anti-viral treatment given in the hospital to people who are admitted to the hospital due to certain criteria, such as low oxygen.
• Again, this is after a person has already been infected, damaged by the virus.

Ivermectin

• This is a treatment used for years for worms and other parasites and has been studied since 2020. Multiple studies have shown it not to have any prevention or curative effects for Covid-19. It does however have significant effects on the liver. It needs to be monitored when used for the appropriate reasons, as it has many drug interactions. Again, not for Covid-19.

Hydroxychloroquine

• This is a treatment proposed and studied for use in Covid-19, but not found to have any benefit, compared to the “control group”. It has been used for years for arthritic conditions
• Antibiotics are not indicated for Covid-19, unless we are treating a secondary infection. That is determined on a case by case basis.
• Yes, many X-rays can show “Covid pneumonia”- it is a viral pneumonia, not necessarily treated by antibiotics
• Steroids, medications which reduce inflammation, are used in many cases, but since they can suppress immunity, their use must be weighed carefully

Treatment is not a “one size fits all”.

• It is important even for vaccinated patients to be careful of exposure to the unvaccinated, as we are seeing “break-though” infections. Contributing factors are exposure time (viral load), and how long it has been since the last vaccine. We do recommend a booster vaccine between 6-8 months from your last shot.
• Immune-compromised people, patients with certain conditions, or those on certain medications are recommended to have their booster sooner, as they may not have good antibodies.
• Unfortunately being in close proximity with unvaccinated grandkids for example, can be a concern when one is not masked, if everyone is not vaccinated.
• A vaccine is still necessary after infection with Covid-19. If the person has recovered, they can have the vaccine fairly soon. If they have received monoclonal antibodies, we recommend they wait 3 months.
• Re-infection with another Covid infection is absolutely possible and very risky.
• What is known is over 95% of the Covid hospitalized and 99% of the deaths are unvaccinated patients.

3) We have been here all during this Covid pandemic, in office, available for in person visits, televisits, by phone 24/7 and by email.

We have done our best to educate our patients and we plan to continue to provide the safest possible environment to provide continuity care.

Thank you