A hospice volunteer in Itasca County may lose her role because she's unwilling to comply with Essentia Health's mandatory flu shot policy.

"I'm pretty dedicated to this work, and I don't want to have a flu vaccine," said Noreen Hautala, 58, who lives near Cohasset and has been a hospice volunteer for close to 10 years. "I know a lot about taking care of myself."

Hautala's request for an exception in her case hadn't been resolved as of Friday, but Essentia officials say they're standing by their policy - which applies to employees, vendors, students who serve in the facilities and volunteers - as the general rule.

"We won't compromise on patient safety and care," said Dr. Rajesh Prabhu, the health system's patient quality and safety officer.

Essentia first announced to employees in September that flu shots would be required this year as a condition for working or serving with the health system, with the exception of those who obtained religious or medical exemptions. In states where such policies are common, better than 95 percent of health system personnel get flu shots, Prabhu has said. In Minnesota, where it's not a common policy, it's 81.4 percent.

The United Steelworkers, which represents about 2,000 employees across the health system, went to court to seek a preliminary injunction to prevent Essentia from enforcing the policy. A settlement conference is scheduled for 9 a.m. Tuesday in U.S. District Court in Duluth. If the matter is not resolved then, a hearing will take place at 3 p.m. Wednesday in front of U.S. Magistrate Judge Leo I. Brisbois in federal court in St. Paul.

Meanwhile, Hautala received an email about the requirement with less than 24 hours to seek a signature from a health professional or member of the clergy verifying a request for a medical or religious exception, she said. She found a pastor willing to sign her statement, and emailed it to Essentia.

A response that arrived on Oct. 20 said her exemption request was neither accepted nor denied, instead asking for additional information within five days. "Failure to provide additional information may result in a denial of your request," stated the notice, which Hautala shared with the News Tribune.

The information that was sought included identifying the specific religious beliefs preventing her from being vaccinated, describing how those beliefs conflict with vaccination and specifying "other ways that you adhere to such religious belief(s) in your daily life."

Hautala responded on the fifth day, but didn't answer those questions. She said she wondered whether it was constitutional to ask such detailed questions about a person's religious beliefs.

In her response, she also argued that she hadn't been given enough time to contact a health professional, and she said the family with whom she currently is volunteering had no objections to her not being vaccinated.

She also said she once had a "horrible" reaction to a flu shot and prefers more natural means to build up her body's immune system.

Renee Nash, who cares for her 91-year-old father who is in hospice in her rural Itasca County home, confirmed to the News Tribune that she had no objection to Hautala continuing to come without getting a flu shot. She also confirmed that she doesn't get a flu shot herself.

She added that the Essentia policy makes no sense to her when it comes to hospice patients.

"Someone's already dying," Nash said. "And hospice is just keeping them comfortable and pain-free. So what would it matter whether they had a flu shot or not?"

Hautala said the volunteer coordinator with whom she works told her that if her exemption isn't approved, she still might be able to return as a hospice volunteer after the flu season. Since hospice is designed to last no more than six months, that would mean she wouldn't return in time to resume helping Nash with her father.

"If Essentia thinks me going there as a volunteer somehow puts the patient at risk or other people who come in to care for him at risk ... I guess I have to just leave them in the lurch," she said.

Essentia values its volunteers, said Diane Davidson, chief human resource officer. But the health system is convinced the policy wouldn't be adequate if it applied just to employees or just in hospital and clinic settings. "That leaves patients too vulnerable," she said.

Essentia has consulted with health systems elsewhere with similar policies and is confident its way of handling religious objections is appropriate, she said.

Davidson and Prabhu both said they weren't surprised by the objections that have arisen to the flu shot requirement and said they believe it will be much less controversial after the first year. "This is sort of like a cultural transformation for health care in Minnesota," Prabhu said. "They're looking for someone to lead."