North Memorial Medical Center has told employees that, because of safety concerns, it is not recommending they get the smallpox vaccine during the first phase of a federal inoculation program.

The Robbinsdale hospital is the only one in the metro area, and one of only a handful of major hospitals nationwide, to publicly resist the program now because of worries over safety. Federal officials are expected to begin offering smallpox vaccine in a few weeks to select health care workers who have volunteered to be on smallpox care teams in case of a terrorist attack.

In Minnesota, in addition to North Memorial, seven small, mostly rural hospitals have told state officials that they do not want to participate, according to assistant state epidemiologist Richard Danila.

The hospitals, including those in Mora and New Prague, opted out for largely logistic concerns, according to hospital officials. Some said they weren't sure that they had the right facilities to care for smallpox patients.

But at North Memorial, vice president Jerry Moen said Wednesday that he and others are not comfortable with the vaccine's risks to staff members and to patients, even though federal officials have said the risks can be minimized.

A small number of vaccinated people may develop severe reactions; and anyone vaccinated could expose others to side effects through close contact during the first few weeks.

"This could place our patients and staff at risk of exposure," the hospital said in a memo to staff members Jan. 2. "At this time, North Memorial does not encourage any of our employees, full or part time, to receive the vaccine."

Those who do get the vaccination, such as members of the National Guard, "may be restricted in their work activities at North Memorial," the memo said. However, Moen said, they would not be docked in pay or penalized. They could be reassigned temporarily to avoid contact with seriously ill patients.

Moen said the hospital is "delaying participation" in the early vaccination program, but hasn't yet made a decision. In any case, he said, it is going ahead with some preparations, such as seeking volunteers willing to treat smallpox victims. He said the hospital would vaccinate staff members if an outbreak occurred.

"We're being extra cautious without compromising our ability to respond," he said. "There's more than one right way to do this."

Health officials say North's decision should not harm planning efforts. "If any one hospital didn't participate in Hennepin County, I think we could manage well," said Allain Hankey, who directs emergency planning for the county health department. "However we'd sure want to keep everyone else moving ahead on the plan."

So far, 52 Minnesota hospitals have agreed to participate, including the rest of those eligible in the metro area, Danila said. The first phase will involve only hospitals with isolation rooms that can accommodate smallpox victims.

Hospitals participating in the program have not been named, in accordance with federal security rules. The Star Tribune surveyed hospitals across the state to identify ones that had opted out.

"What we're trying to do is make sure that the entire state is prepared," said Dr. Harry Hull, the state epidemiologist. One strategy, he said, "is to have a team in every appropriate hospital. But one of the key points that has to be made here is that a vaccination can occur after exposure for up to four days. In most scenarios we would be able to protect the people even after exposure."

Danila added that smallpox vaccinations are voluntary, so any employee or hospital can opt out.

He said a national vaccine advisory group in October recommended precautions to limit exposure, including covering the vaccine scab with special bandages.

Last month, Grady Memorial Hospital in Atlanta and Virginia Commonwealth University in Richmond, Va., announced they wouldn't take part in the program, saying the risks were too great.

Elsewhere in Minnesota, some hospitals said they just weren't prepared to join in the program. At Queen of Peace, a 20-bed hospital in New Prague, officials said that they have the required isolation rooms, but not all the proper equipment, and that no one has been trained to use them.

"We have not had the need to use them," said Nancy Wolf, the hospital's quality management director.

At Kanabec Hospital, a 42-bed facility in Mora, a committee decided it wasn't practical to join the program, said Chris Kimbler, the chief operating officer.

Its isolation room needs updating, she said, and hospital officials were concerned that almost a third of their employees soon would need to get vaccinated.

If many of them got sick, the hospital might not have enough workers to care for patients, Kimbler said. Nevertheless, she said, the decision "is not cast in stone." She said the hospital would reconsider if the Health Department said it was needed.

Even if individual hospitals opt out, all health care workers will be eligible for smallpox vaccines in the second phase of the national program, which could follow in a matter of months.

Some hospitals have said they agreed to cooperate in the plan, despite unresolved questions, such as who will pay if employees miss work.

"It's patriotic and all of that and we want to participate and we will," said Kendra Calhoun, a spokeswoman for Allina Hospitals & Clinics, which operates 14 hospitals, mostly in the metro area. But she said the first phase could cost Allina and its hospitals $200,000 if employees need time off to recover from side effects.

At North Country Hospital in Bemidji, officials say they're particularly worried about getting sued if someone is harmed because of the vaccine. Right now, the law is unclear.

If that's not resolved soon, "we may hold back at the end, we just don't know," said Mary Thompson, the hospital's risk management director. "It depends on what other hospitals are doing and what the government decides."

But despite the uncertainties, most hospitals said they felt they had to participate. "We just feel that that's part of our obligation, part of our mission," said Robert Stevens, president of Ridgeview Medical Center in Waconia.

-- Staff writer David Shaffer contributed to this report.

-- The reporters are at mlerner@startribune.com.

>jburcum@startribune.com.