As an RN formerly working in an emergency room of a small community hospital, the attending physician and I contracted pertussis from a patient. I then gave it to my husband. Luckily, I did not pass this on to my son or to any infant I was caring for at the time. This was several years ago, and Tdap was relatively new. I had thought that when I was next due for a Td, I would request the Tdap. Who knows how many others the physician and I exposed due to this unfortunate situation. My husband and I coughed nonstop for 3 months. We were both fully immunized as children, as was my son who was 11 at the time and the only one who did not get whooping cough. This case [“Legal Advisor,” Fired for refusing vaccination] was settled exactly how it should have been, as I am not convinced that this woman would have been at any risk receiving the vaccine. But she would have put countless others at risk by not having it.—Kathleen Charette, RN, MEd, MSN, North Grosvenordale, Conn. 

This is an excellent rule. Doctors have to be held accountable for their “excuse notes” medically, legally, and morally. That doctor knew that there were no actual contraindications when he wrote the note. He knew that having an unvaccinated healthcare worker puts everyone in the hospital at risk. If this nurse had an issue with the new vaccination requirements of her employer, she could go find a new one. The doctor who wrote that ridiculous excuse should be ashamed, and the hospital is correct and appropriate to adhere to their guidelines. Great case! Keep up the good work of ridding the healthcare field with these problematic employees.—Sarah Recupero, PA-C, RRT, MCMSc, San Francisco

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These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.