Further, patients of One Medical who were ineligible to be vaccinated based on local guidelines were also permitted to book vaccination appointments through an online portal. So was at least one executive of a partner organization with One Medical. Internal communications show that providers trying to get eligible health care workers vaccinated were instead told to put them on a waitlist.
"Why are young patients without health problems, on a trial membership ... allowed to book and receive a covid vaccine while health care workers are being waitlisted?" one medical professional asked in January. "I just saw two appointments for such."
There were also shortcomings with the company's vaccine sign-up system. A question asking patients whether they were in an eligible category was not added to the online portal until Jan. 14, though One Medical started vaccinating patients on Jan. 1. During this two-week period, COVID-19 cases in the United States reached their highest peak.
Following this, the internal documents show that in January, even if patients noted that they were not in an eligible category for vaccination, some could continue to book an appointment for the COVID-19 vaccine. Suggestions on how the tech-heavy company could use algorithms to scan for ineligible patients were turned down.
One Medical said that blocking ineligible patients from booking vaccination appointments would have called for a complete overhaul of their system and was too technologically difficult to rebuild in the required time frame.
The documents also show that in January, One Medical was not verifying the eligibility of patients it vaccinated by requiring ID or other evidence at the point of vaccine administration.
"I have questions about our approach of not requiring [patients] to bring proof of vaccine eligibility," said a One Medical staffer. "A quick Google search indicates that this is not consistent with many states' requirements. ... I am concerned about advertising an overly permissive approach."
As ineligible patients began to get vaccines, staff started raising concerns that word was spreading about One Medical's lax enforcement of eligibility requirements.
"I've had a few patients straight up tell me that once they realized there was no screening that they would be telling their friends," another medical provider in California wrote. "My partner and I were shocked when we got ours through One Med ... that at no point were we asked if we met criteria — let alone asked to prove it."
Employees were told not to try to enforce the rules barring ineligible patients. "Scanning schedules and cancelling appointments [for ineligible patients] is not recommended," Spencer Blackman, the director of clinical education at the company said in a communication to a range of staff. He added in another note to a doctor, "If this person sees themself in a tier that is being vaccinated they can attest to that and make an appointment. You don't get to make the decision if someone 'gets' [a] vaccine or not."
"We are not policing," Blackman wrote in January, setting off objections in internal company communications.
When asked why One Medical did not verify eligibility, Chief Medical Officer Andrew Diamond said, "There was never guidance that said 'do not verify'... that would be counter to our principles." When told NPR was in possession of communications that indicated otherwise, he responded, "That's clearly not the guidance, nor is that the intent of the guidance. We've been far clearer since then."
In fact, many localities require medical providers to check for eligibility documentation. In Los Angeles County, where One Medical has been provided thousands of doses, vaccination is limited currently to health care workers, long-term care facility residents and persons over the age of 65. Proper documentation of eligibility is required for vaccination. "Providers are then responsible for confirming eligibility responses and requesting accepted documentation of eligibility, once [the patient] arrives for onsite appointment," an L.A. County Department of Public Health spokesperson said.
And in Alameda County, where the company was given close to 1,000 doses, the public health department said that personal ID and proof of a health care role is "required" for the vaccine doses that One Medical received.
As Forbes was preparing a story about One Medical's practices, One Medical leadership sent out a note to staff warning of consequences, threatening them with "disciplinary action, up to and including termination" if they leaked internal communications. One Medical disputed this characterization. "One Medical is not, and has never been an organization that threatens its staff," a spokesperson said, characterizing the note as merely "reminders about our business code of conduct."
Regulators Take Action
It is not clear how many ineligible vaccine doses were distributed, and One Medical declined to provide a figure on how many total doses it had administered. But the company has likely provided tens of thousands of doses: Of the few jurisdictions that produced information on the doses it allocated to One Medical, San Francisco said it had provided the company with 12,000 doses, while Los Angeles County said it had provided them nearly 6,000 doses.