Frontline workers were left off the vaccine list at Stanford Medical Center in Palo Alto. They fought back.

This week, some 5,000 doses of Pfizer’s newly authorized coronavirus vaccine arrived on the grounds of Stanford Medical Center in Palo Alto, Calif. — a windfall for frontline health workers eager to receive their first dose of the lifesaving injection.

But a flawed prioritization plan failed to include the vast majority of the hospital’s medical residents and fellows, instead opting to give many of the first jabs to employees who don’t interact heavily with sick patients.

On Friday morning, scores of masked clinicians gathered on the hospital campus to protest being passed over. By the afternoon, the hospital had buckled to their demands and begun vaccinating some of those left off the list — but the system rapidly devolved into a first-come, first-serve situation.

Of the 5,000 people tapped by the hospital to receive the first injections, only seven were medical residents — a paltry fraction of the more than 1,300 in the institution’s cohort. Also left out were many fellows and nurses who have spent countless shifts attending to people hospitalized with Covid-19. (Pfizer’s vaccine requires two doses, three weeks apart, to take full effect. The hospital had banked on receiving a second batch to complete the process.)

“I have done Covid-positive intubations, I have done Covid-positive procedures,” said Dr. Anna Frackman, a medical resident specializing in anesthesia. “We have put ourselves and our loved ones at risk. We think we should have been included.”

The prioritization plan, designed by researchers and ethicists, meant to list hospital personnel by highest risk of getting the virus and becoming seriously sick. It used an algorithm that assigned each person a crude risk score, taking into account factors such as age, job description and the number of coronavirus cases that had been detected in their hospital department. That resulted in personnel like environmental services workers, food service workers and older employees being shuttled to the front of the line.

Residents, who are early in their careers and tend to be young, rotate throughout the hospital to train with various teams of physicians, making them difficult to place in a designated unit. “So in that, it sounds like we all got zero points,” said Dr. Frackman, who had not seen the algorithm. (ProPublica also reported on the problems with the list.)

In an internal memo sent to a small group of Stanford Hospital administrative staff, hospital employees described the algorithm-based process as being carried out under pressure and time constraints. The Times obtained a copy of the memo.

The system also differs drastically from those used at other hospitals around the country to determine who gets injected first. Many other institutions have been able to prioritize environmental and food services workers as well — but not at the expense of health care providers treating Covid patients on a daily basis.

Hospital administrators were supposed to review the algorithmically generated list before distribution began, but “leadership review and revisions did not occur,” according to the memo, because of the fast-paced turnaround of the list and the amount of email and text messaging being sent back and forth between harried, overwhelmed hospital administrators.

“People are worn-out and frustrated by everything that is 2020,” the internal memo said. “The vaccination rollout, all well-intentioned, hit the perfect storm.”

Many attending physicians, who outrank residents and fellows, made it onto the hospital’s original list. In many cases, Dr. Frackman noted, their exposure is higher than those of their trainees. “Our attendings have made an effort to try to shield us from some of the risk,” she said. “But in all honesty, there is just too much Covid to shield us from the risk.”

In a statement released to hospital personnel on Friday, the Stanford Health Care executives David Entwistle, Paul King, Dr. Lloyd Minor, Dr. Niraj Sehgal and Dr. Dennis Lund acknowledged the “significant concerns” raised by the protests.

“We fully recognize we should have acted more swiftly to address the errors that resulted in an outcome we did not anticipate,” the statement said. “We recognize that the plan had significant gaps.”

The hospital executives also said they were “working quickly to address the flaws” in the plan and promised transparency during the modification process.

In a statement, Lisa Kim, a spokeswoman for Stanford Health Care, echoed these sentiments. “We apologize to our entire community, including our residents, fellows, and other frontline care providers, who have performed heroically during our pandemic response,” the statement said. “We are immediately revising our plan to better sequence the distribution of the vaccine.”

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