Local filmmaker Roy Dorantes (seated left) and Imperial Irrigation District Director Alex Cardenas, both volunteers and associates of Dr. Tien Vo’s urgent-care clinic and nonprofit foundation, are shown being vaccinated at El Centro Regional Medical Center on Jan. 3. Dorantes and Cardenas were among as many as 35 people who were vaccinated by ECRMC at the direction of CEO Dr. Adolphe Edward on Dec. 30 and Jan. 3 who were not part of the highest-priority Phase 1A Tier 1 group allowed to be vaccinated at the time. | SCREEN CAPTURES
(Updated at 8 p.m. Jan. 14: Responses to this story were added near the end.)
Lingering concerns remain over why as many as 35 individuals who were not part of the initial priority list of higher-risk acute healthcare workers and first responders were administered the already-scarce COVID vaccine out of turn, a partial list that includes present and past El Centro City Council members and office workers and volunteers of a lower-priority urgent-care clinic.
The nexus is staff vaccination events at El Centro Regional Medical Center that took place on separate dates — Wednesday, Dec. 30, and Sunday, Jan. 3 — and more specifically, the common denominator is personal invitations of friends and associates by hospital chief administrator Dr. Adolphe Edward, according to a series of interviews conducted over several days.
What is known is that some of the confirmed individuals inoculated out of turn were El Centro Mayor Cheryl Viegas Walker, former El Centro City Council members Jason Jackson and Efrain Silva, El Centro City Manager Marcela Piedra, between 20 to 25 members of Dr. Tien Tan Vo’s staff, both those who directly attend to the ill and those who do not, and several of Vo’s nonprofit COVID-19 Meals to Heal volunteers, including Imperial Irrigation District Director Alex Cardenas and filmmaker Roy Dorantes.
“These actions are a deviation from the state and local county priority loading order. It is unethical and should be made example, so that anyone who attempts to create a VIP line or uses their privilege to skip the line must be fined or removed of being entrusted with applying vaccines,” said Luis Olmedo, executive director of Comite Civico Del Valle, whose organization is a member of both the county and state vaccine committees.
“I don’t blame those who got the vaccine; some may not know any better. But ECRMC knows better and should have used good moral judgement,” Olmedo said Friday, Jan. 8. “No matter what happened or how it happens, this is the responsibility of the CEO.”
No one among that partial list who received vaccinations was part of the tier — the highest-priority Phase 1A Tier 1 vaccine distribution list approved by the state — supposed to be undergoing the first doses on those dates, and many of the people listed acknowledged that fact in separate interviews, including Walker, Jackson, Dr. Vo, Cardenas, Dorantes, and Dr. Edward himself.
Although the issue has taken on a life of its own with a legal threat over defamation against Edward and El Centro Regional Medical Center by Dorantes, Edward told this newspaper in one of two separate interviews as the story was still developing that he ultimately did not regret his decision, and laid some of the blame at the feet of both county elected officials and Public Health Department staff.
The greater issue caused by the stir, Edward said, proved his point that greater advocacy is needed by the county’s elected officials to acquire more vaccine in Imperial County amid what he continues to call the “rationing of healthcare” through the tier system.
On Wednesday, Jan. 13, that tier might have been thrown into a bit of disarray, as Gov. Gavin Newsom announced that 6 million Californians, age 65 and older, are now pushed to the top of the vaccine list. There are more than 26,000 Imperial County residents in that age range.
Meanwhile, in earlier published reports, Dr. Edward had been quoted as stating the county Public Health Department needed to do a better job of lobbying for increased vaccine supplies, yet on Thursday, Jan. 7, after Public Health Director Jeanette Angulo and Public Health Officer Dr. Stephen Munday explained their roles and attempts to get increased allocations from the state during a joint press conference Edward was part of, Edward said it was elected county officials that needed to step up during a follow-up interview about an hour later.
“Everybody should be calling to get more vaccine, I know I’m doing it,” Edward said. “Why can’t the elected officials get it?
“Who’s advocating on our behalf? That’s the part I’d like to see, can we continue to advocate for our community?” he continued. “That’s what an elected official does.”
On Wednesday, the county was scheduled to complete its vaccination of the Phase 1A Tier 1 group and continue with other high-risk health workers in Tier 2.
Edward’s statement regarding county elected officials didn’t sit well with County Executive Officer Tony Rouhotas Jr.
“Our board is supporting Public Health in their operation 100 percent. To say we’re not advocating enough; California is the hardest, as far as an allocation push,” Rouhotas said. “Without the help of our partners in the community, it doesn’t make it any easier to succeed.”
The whole issue became further convoluted toward the end of the week with Dorantes’ threats to sue Edward and the hospital for something Edward said during the Jan. 7 joint press conference.
The criticism over Cardenas and Dorantes getting vaccinated had already been well-documented before the press conference, as both took to social media within hours after their Jan. 3 vaccinations to post photos and video of themselves receiving doses that, according to the only prescribed tier in effect at the time — Phase 1A Tier 1 — should only have gone to acute care, psychiatric, and correctional facility hospital staff, which include front-line health workers at Pioneers Memorial Hospital in Brawley and ECRMC, and emergency first-responders such as paramedics and emergency medical technicians, among a select and directly affected few other subgroups.
During the Jan. 7 press conference, when Edward was questioned about the vaccinations of Cardenas and Dorantes by this newspaper, an exchange that was recorded via Facebook Live on the Public Health Department’s social media page, Edward claimed Dorantes was kicked out of the vaccination event but re-entered without his knowledge to receive the vaccine.
Dorantes said he was asked to leave, because he was trying to film Vo’s staff receiving the vaccine, but he said he was allowed to re-enter with Vo, and even said on Saturday, Jan. 9, that Edward invited him back in to be vaccinated and Edward joked with Dorantes about administering the injection on Dorantes himself.
“He said he was going to be the one to stab me” with the syringe, Dorantes said in an interview.
Cardenas and Dr. Vo both told this newspaper in separate phone interviews that Dorantes was vaccinated with Edward’s full knowledge.
Dorantes has since asked for a public apology from Edward and retraction of his statements made during the press conference. If that is not forthcoming, Dorantes said, he will take legal action and said Jan. 9 he had already been in consultation with an attorney.
Dorantes added on Thursday, Jan. 14, that he has yet to hear back from ECRMC after sending a letter through email making his demands and putting a Jan. 26 deadline for response.
When contacted about the legal threat or any of the issues surrounding the vaccination of up to 35 people out of the tier group, El Centro Regional Board of Trustees President Amanda Brooke on Tuesday morning, Jan. 12, had no comment due to the possibility of litigation.
On his end, Cardenas, who said his wife was also vaccinated, claims that he posted his vaccination and vaccination card online as a way to show the community that the vaccine is safe and encourage participation. He added that he and his wife, as volunteers of the Meals to Heal program, do directly come in contact with COVID patients as they deliver meals to the doorsteps of the quarantined.
“My intention never was to line jump or be categorized as a line jumper,” Cardenas said on Friday morning, Jan. 8. “It was not meant to disenfranchise anybody.”
On Tuesday morning, Jan. 12, Angulo reported that only 76 percent of those residing in Tier 1 had received their first dose of the vaccine. That figure was up to 96 percent on Thursday, Jan. 14, a Public Health spokesperson confirmed.
There were 2,580 first doses allocated to Tier 1 individuals, according to Angulo.
The Latest Developments
On Sunday morning, Jan. 10, select members of the city of El Centro and the county of Imperial met behind closed doors in what was referred to as a two-on-two meeting. Although the meeting was referred to by county Supervisor Ryan Kelley during its weekly board meeting Jan. 12, no details were shared.
El Centro Mayor Pro Tem Tomas Oliva, one of the city’s representatives on the board, reported Monday, Jan. 11, that there was some discussion over what had taken place regarding the out-of-turn vaccinations, but Oliva said the thrust of the dialogue was about how to repair tense relations between the city and county to move forward together on the continued rollout of vaccinations in the city and larger county that will continue well into mid-2021 and beyond.
Still, Oliva acknowledged on Friday, Jan. 8, that he had contacted CEO Rouhotas on Monday, Jan. 4, to discuss reports of “rumors” that El Centro city officials, past and present, had been vaccinated in improper order. Oliva also told this newspaper he was disappointed in his past and present colleagues and in Edward’s actions.
Imperial County Supervisor Jesus Escobar has said much of the same in recent days, upset over the fact that people were vaccinated when they should not have been as the county struggles to secure scarce supplies of the vaccine.
One of the reasons Oliva asked to be part of the two-on-two discussions is because Mayor Walker had been among those vaccinated.
In attendance for the county were Supervisors Escobar and Luis Plancarte, Rouhotas, and Angulo. For El Centro, there was City Council member Edgard Garcia, City Manager Marcela Piedra, and Fire Chief Ken Herbert, in addition to Oliva.
Oliva didn’t have much to say regarding how the ECRMC and Edward situation might be addressed, but he did say that the city will be planning a series of town hall-style meetings in the future to communicate about the vaccine and the upcoming distribution efforts.
During the county board meeting Tuesday, Jan. 12, Escobar asked Public Health officials whether there has been a commitment from vaccine partners and providers that they will stick to inoculating those within the allowable tiers, to which Angulo and Dr. Munday both responded yes.
“There are agreements that providers have to sign,” Munday said. To become a provider through the state Department of Public Health’s Calvax program, member agencies have to sign an agreement “that they will follow the allocation guidelines.”
But like all rules, Munday said, there are those who will still color outside the lines.
At no time during this discussion was Edward or ECRMC mentioned by name.
State Public Health spokespersons did not immediately return a request asking whether ECRMC has signed on as part of Calvax or whether there were any sanctions against agencies who vaccinate outside the guidelines, or tier groups.
As an aside, local Public Health officials were asked whether those who moved ahead of the tier would still receive the second dose of vaccine in a timely manner, that is, after 21 days in the case of the Pfizer-BioNTech second dose and 28 days for the Moderna second dose.
If not, would it be as if a dose was wasted?
“There is no limit to how long someone can wait to get their second dose. So, if someone were to wait and get it late, it would still be effective,” stated Dr. Munday in a Jan. 8 email.
How Did This Occur?
Before several interviews had been conducted with El Centro officials and Dr. Vo by this newspaper, Edward in the Jan. 7 follow-up interview made it seem as if only four or five vaccinations occurred, something that was necessary as not to waste doses of the volatile Pfizer vaccines that once drawn into syringes, must be used within hours or they go bad.
Unclear at the time that two vaccination dates were being discussed, Edward told this newspaper that during an event an inexperienced lab tech had pre-loaded too many syringes full of vaccine and that there were not enough Tier 1 staff members available to receive the doses.
Rather than let them go to waste, he said he first contacted on-duty front-line staff, and there were no takers. He next had department heads contact other ECRMC staff to come in, but again, no one was available.
That is when he confirmed, after the names were told to him, that he personally called Walker, Jackson, Piedra, and Silva. Initially this was thought to have occurred on Jan. 3, the same night Vo’s staff was vaccinated, but the city people were called in Dec. 30, Jackson and Walker said.
Jackson said on Jan. 7 that he had just had three close family members all diagnosed with COVID within 48 hours, and that Edward encouraged him to come down and get the vaccine to protect himself.
Jackson said in hindsight he should not have done it and wouldn’t have done it had he thought it through.
“It didn’t occur to me,” he said.
Walker said much of the same, although how Edward invited her seems a bit different, and more intentional.
An email sent out to City Council and hospital board members on the afternoon of Dec. 30 reads:
“Good Afternoon, The COVID-19 vaccine is now available for all ECRMC employees, this includes our ECRMC Board Members. I am emailing you to extend an invitation to come to our hospital to get the COVID-19 vaccine.”
The email was signed by Edward’s executive assistant.
“This was the email I received about 20 minutes after a phone call from Dr. Edward regarding the vaccine,” Walker wrote in a follow-up message to a phone interview with this newspaper on Friday, Jan. 8.
“As I said to you on Friday, I did not question the message/invite. Hindsight is a wonderful thing — and I realize now that at the time I probably should have asked a question or two — but the combination of the phone call and email led me to believe I was eligible for the vaccine as a member of the ECRMC Board,” Walker wrote.
She said in the phone interview a day earlier that she does not believe Dr. Edward meant to put anyone out; rather, he wanted to get as many people vaccinated as soon as he could, which is what Walker and others want in the end, too.
Piedra did not return a call seeking comment, and when contacted by phone on Jan. 7, former mayor and council member Silva, quickly and brusquely said he would call a reporter back before hanging up the phone and never returning the initial call.
It should be noted, that as Edward described this scenario of moving from one group to another to use those “extra” vaccines, he said this was an example of the “roster” he believes the county Public Health Department should have been providing all along, that is, a detailed list of what secondary group should be called in to be vaccinated in the event a priority person or group is not available or refuses the vaccine.
Edward said he has had several nurses and staff members opt out of being vaccinated. Nationally, the Associated Press reported earlier this week that as many as 20 percent of front-line healthcare workers in the United States are refusing to be vaccinated.
Edward himself received the vaccine on a Facebook Live video in December, as the rollout commenced at ECRMC. Technically, Dr. Edward, as an administrator, was not part of Phase 1A Tier 1 either.
As for the circumstances surrounding the vaccination of Dr. Vo and his staff, that calls into question some of Edward’s prior explanations in his Jan. 7 interviews.
Dr. Vo said on Friday, Jan. 8, that Edward had been asking him and his wife to come down and get vaccinated for a couple weeks, but he said he didn’t feel right doing so without some of his key staff.
Vo said Edward later told him to bring down his medical staff to be vaccinated on a Sunday, Jan. 3. In subsequent communications with Edward, Vo said the hospital CEO kept expanding who Vo could bring, including nonmedical office staff earlier in the day Jan. 3.
Vo’s volunteers became part of the picture that Sunday night, when some of his paid staff did not show up, and some of the volunteers, like Cardenas and Dorantes, and others, were down in the parking lot.
Dr. Vo said Edward allowed the volunteers to come up and get vaccinated as well. All told, that amounted to between 30 and 35 people not part of Tier 1 — 20 to 25 of Vo’s paid staffers and around 10 volunteers, Vo said.
Vo said during the interview that he knew he was not part of Tier 1, because he operates an urgent-care clinic, which is part of Tier 2, but he thought it would be all right, and he believed it was justifiable considering how close he and his staff come to the COVID-afflicted in testing and treatment at his offices.
During a joint press conference on Thursday, Jan. 14, between the Imperial County Public Health Department and the Valley’s two hospitals, a reporter from the Associated Press questioned Public Health officials about reports of people being vaccinated outside the tiers, to not waste vaccine.
He then asked ECRMC’s Dr. Adolphe Edward to respond to the Calexico Chronicle’s story specifically.
Director Jeanette Angulo answered first.
She said the practice at the Public Health Department has been that at the end of the day, if there were vaccines left in the vial, then those nurses administering the vaccines would take them, only at the end of the day. “Again, to avoid wasting any vaccine.”
“That’s been our practice, to just hold off vaccinating our own until the vaccine clinic is over, and if there’s any remaining, like I said, or close to expiring, then that’s when we go in … as long as they belong in the tiers, and that’s when staff gets vaccinated,” Angulo said.
Dr. Munday, again, spoke on the state’s Calvax general guidelines and what is stated in the agreements signed by vaccine providers, although not by program name. He also was a bit more pointed in who should not be getting vaccinated.
“If you actually look at the document that they (the state) put out in regard to (Phase) 1A, and you scroll down, there’s sections B and C, and C actually talks about exactly that, not wasting any doses of this very precious resource. It, in particular says, that if you have doses that are going to expire and that you need to use them on somebody who otherwise would not be in that tier, then it’s acceptable to do so,” Munday explained.
“What I would say is, it’s meant to be done in a thoughtful way,” he continued, referring to Angulo’s process of choosing those who are nurses only after the shift is complete.
“The expectation would be that you would have some sort of reasonable plan to reach a population, you want to make sure you do it in a way that’s fair and transparent,” Munday said.
“For example, if I was vaccinating, and I had a few doses left over, it would not be acceptable for me to call my wife or my kids, or my parents to have come in for me to vaccinate them. The expectation would be that I would reach out to an appropriate person to offer the vaccine to them. That’s the general principle.”
He added that because the state knew the Pfizer-BioNTech vaccine could go bad so quickly, there was the process built into the agreement to move to other groups of individuals.
“But again, it’s meant to be transparent and fair,” Munday said.
When Dr. Edward was asked to respond to the story, he did not. Rather, he said he wanted to get the media’s attention, and made a related statement.
“The American Hospital Association today (Jan. 14) they released, all 5,000 hospitals have signed a letter indicating that the effort must be large and multi-faceted in vaccinating the public. It requires exceptional leadership and coordination to ensure none of the vaccine is wasted.
“I also urge the media to look at the letter that was sent to the federal leadership on vaccination distribution that encourages to ensure urgency and to move the process that the tiering of the system that’s been expedited to actually be eliminated. That’s all the comments that I’ll have to make,” Edward said.