Charlie O’Neill received a portion of her husband’s liver in a living donor transplant in 2013 and has been taking immunosuppressive medicines to keep her body from destroying the organ since then.

“I get infections all the time,” she said. “As an immune-compromised individual, you are susceptible to any and all colds and flu.”

O’Neill resides in Pony, a tiny hamlet in the Madison Valley in southern Montana. Despite living in a rural area, O’Neill said the coronavirus pandemic’s first year was horrifying. She stayed at home as much as possible while waiting for covid-19 vaccinations to become available.

O’Neill said the virus is always on her mind even after getting vaccinated when she journeys into neighboring Bozeman for shopping and other necessities. She hides behind a mask and tries to avoid people as much as possible. Vaccinations give strong protection against hospitalization and mortality in healthy people, but they are significantly less effective in immunocompromised people.

O’Neill developed liver abscesses, necessitating daily trips to the hospital in Bozeman for antibiotic infusions. She fretted about who of the many individuals engaged in her treatment were putting her at risk: the folks checking her in at the front desk, the traveling nurses, the imaging techs, in a state where the governor has encouraged health professionals to seek vaccine exemptions.

According to a recent news release from Gov. Greg Gianforte’s office, “thousands of health care professionals” have acquired religious exemptions and “stay in the workforce.”

“I ask folks whether they’re vaccinated all the time,” O’Neill said, “particularly if I have to take my mask off for MRIs or something like that.” She claimed she’d ask for someone else if a worker refused to respond or indicated he or she wasn’t vaccinated, but that hasn’t occurred.

Under a federal Centers for Medicare & Medicaid Services mandate, most medical employees in the United States are now obliged to be completely vaccinated against covid. While petitions for religious or medical exemptions are required by law at all institutions, they are carefully evaluated and accepted cautiously across much of the country. For example, in New York City’s 12-hospital public system, 100% of employees are vaccinated on the inside; those who were granted exemptions are assigned outside responsibilities.

In Montana, though, the pendulum has swung in the opposite way.

Gianforte, a Republican who opposes the federal requirement, urged health-care employees to seek religious exemptions before the Feb. 14 deadline for receiving one vaccination shot. His government issued instructions to hospitals stating that the religious views of health-care personnel should not be questioned when requesting exemptions. Gianforte also directed the state health department to prepare a religious exemptions application, which is available for download at the top of its website.

When asked if Gianforte would be available for an interview, publicist Brooke Stroyke pointed to the governor’s open letter to health care employees dated Feb. 10.

“The State of Montana will continue to assert in district and appellate courts that the requirement is unconstitutional or otherwise illegal,” the letter stated. “In the interim, those of you who are unvaccinated should think about using the religious and medical exemptions that your employers are supposed to allow, as well as talking to your coworkers or personal health practitioner about being vaccinated.”

Employers should presume that a request for a religious exemption is founded on deeply held convictions, but if there is an objective reason for doubting the request, the employer is justified in conducting a limited factual examination, according to the Equal Employment Opportunity Commission.

There’s no way of knowing how many unvaccinated health-care personnel there are at any one hospital. Many hospitals in the state refuse to disclose the information.

With Montana Public Radio, Yellowstone Public Radio, and KHN, 11 of the state’s almost 65 hospital institutions disclosed their exemption percentages. The percentages range from less than 1% at two critical access facilities run by the United States Indian Health Service to 37% at Prairie Community Hospital in Terry. Four facilities said a quarter or more of their employees were exempt.

Burt Keltner, CEO of Prairie Community Facility, claimed he didn’t check exemption requests since losing nearly 40% of his workforce would force the hospital to fail.

“Some of the folks who had taken the decision not to get the vaccination were some of our greatest employees,” he explained.

One reason most hospitals are hesitant to share how many personnel are still unvaccinated, according to Montana Hospital Association CEO Rich Rasmussen, is a rule passed last year barring discrimination based on immunization status. Hospitals are concerned that even offering a fraction of unvaccinated personnel may put them in legal hot water, he added.

Martha Sharan, a spokeswoman for the Centers for Disease Control and Prevention, said the agency will soon provide national immunization statistics for medical employees in CMS-certified acute care hospitals. She went on to say that the dashboard might ultimately incorporate data from additional medical facilities that participate in CMS initiatives.

CMS will publish facility-level immunization rates on its Care Compare website in October, according to CMS spokesman Beth Lynk.

According to a CDC review of voluntarily submitted data, 70 percent of medical facility staff members were vaccinated as of mid-September, although lower vaccination rates were likely in rural locations. That was before to the Biden administration’s announcement of the CMS vaccination requirement, and rates are likely to have risen since then.

The lack of openness about covid vaccination rates for medical professionals, according to Paul Conway, head of policy and global affairs at the American Association of Kidney Patients, puts immunocompromised patients in a bind.

“If you’re at a dialysis facility for hours, having blood exchanged, you’re near a lot of different employees, you’re around a lot of different patients, your vulnerability is really high during covid,” he added.

According to a University of Michigan research, a fifth of dialysis patients who caught covid died. The data utilized in that research was from 2020, when vaccinations were not available until December.

The renal patients’ organization, according to Conway, wants CMS to publish immunization rates for hospitals and dialysis institutions so that patients may make educated decisions. However, he stated that they are on their own for the time being. This puts them in the awkward position of questioning caretakers about their vaccination status at a time when vaccination is a contentious subject across the country.

“Patients always have the right and freedom to ask the question,” said Joel Wu of the University of Minnesota’s Center for Bioethics. “Similarly, doctors and nurses always have the right and flexibility to answer the question or not.” “I believe that answering the question honestly is vital since it fosters confidence.”

Unvaccinated employees, according to Roger Gravgaard, a 62-year-old kidney transplant recipient from Billings who works as a patient advocate for renal disease groups, must recognize that unvaccinated employees have actual implications for patients like him. He is pleased that all of his caregivers have been willing to vaccinate him without him having to ask, he added.

“I feel better knowing they’re vaccinated, and I hope they feel the same way knowing I’m vaccinated, because it’s a two-way street,” he explained.