Post / Brian Brainerd Dr. Frank Judson, Director of Denver Public Health will administer the smallpox vaccinations in Denver should the order be given.

Colorado initially planned to vaccinate 1,400 health workers as part of a federal program meant to get the nation ready in case of a bioterrorism attack involving smallpox.

But just two weeks before the vaccine should arrive in Colorado, hospitals of all sizes, including the 10-hospital Centura chain, Children's Hospital, St. Joseph, Presbyterian St. Luke's in Denver and St. Mary's in Grand Junction, say they still are not sure they will send anyone to be vaccinated.

"My reluctance is what happens if it goes all wrong?" asked Fort Collins paramedic Lyle Huff, 49. "What if I'm the one who dies? Who would take care of my family? The answers have not been very forthcoming."

At Poudre Valley Hospital in Fort Collins, administrators told state health officials a month ago they would send 150 people to get the shots. Now, the hospital expects to send 12.

Nine people will receive the vaccine at Denver Health Medical Center. University Hospital will likely inoculate between 15 and 20. Neither hospital would say how many people they had planned to send.

"When they read through all the caveats and concerns about compensation and the vaccine, the numbers have dropped," said Dr. Ted Eickhoff, medical director of infection control at University Hospital. "People are increasingly concerned about the safety."

About 15 in a million people who get the vaccine will become gravely ill. But many health care workers worry the contagious scab the shot creates will pose risks to their families and patients.

And so far, no one has promised to take responsibility for health care workers, their patients or family members if they become sick from the vaccine.

Nationally, at least two hospitals posted policies refusing to inoculate employees because there was no known credible risk of the deadly disease. Dr. Mark Edmond at Virginia Commonwealth University Hospital in Richmond said he didn't think the risk of transmitting vaccinia, a contagious illness contracted from the smallpox vaccine, to patients was worth it.

"We have a lot of HIV patients, and we have a lot of really sick people in this hospital," Edmond said. "It could be very bad."

Absent an actual case of smallpox in the world, hospital administrators are unsure about putting their employees through the health risks of the vaccine.

"We're not just going to come out and say, 'Yeah, we'll do it,"' said Laura Weigsheid, spokeswoman for Centura Health. "It doesn't seem clear if the benefits in the case of an unknown threat outweigh the risks."

Centura, which includes St. Anthony Central, the state's largest hospital, is looking into what its workers' compensation plan would cover and how doctors and nurses feel about the vaccine's potential drawbacks, Weigsheid said. A decision should be made this week.

Dr. Frank Judson, director of the Denver health department, plans to get the vaccine, but he said he understands why many people are hesitant.

"If this vaccine causes me harm, who is liable for my medical care, my lost work, my long-term rehabilitation or death?" he asked. "I think that will turn a lot of people off when it comes down to doing it."

As hospitals and health workers discuss the nuances of the federal plan, announced by President Bush and Secretary of Health and Human Services Tommy Thompson on Dec. 13, government agencies are trying to find solutions.

Officials with the federal Centers for Disease Control and Prevention say they have not decided whether to set up a victims' compensation fund or whether the federal government will shoulder the cost for health care workers and their families and patients, should they get sick.

"Discussions are ongoing every day. I think eventually there will be a decision made," said Von Roebuck, a CDC spokesman.

At the state health department, Dr. Ned Calonge is waiting until vaccination day, which could be as early as Jan. 24, to see how many doctors and nurses will actually come down to a designated smallpox vaccination site, sign the consent waiver and get the shot.

"I don't know how many we'll end up with," said Calonge, acting medical director for the state. "Unless we get some of these issues worked out, I think the number of people who initially said they will get it will drop significantly."

State labor officials are trying to figure out how workers' compensation would cover vaccine-related illness because the federal smallpox program with health care workers is voluntary, said MaryAnn Whiteside, director of the division of workers' compensation at the state's Department of Labor and Employment.

Usually, for insurers to cover an injured or sick employee, the person has to be engaged in work that was required of them - not voluntary like the smallpox vaccine.

Because few people across the country have yet to figure this all out, hospital lobbying groups have asked the federal government for help, said James Bentley, senior vice president of the American Hospital Association.

"We have been pushing and pushing as politely and as vigorously as we can," he said. "If the president and the government really feel like this is essential, why don't they address a compensation fund?"

Illness aside, hospitals feel they are in a tough position because of liability. Administrators say they worry about getting named in a lawsuit should a patient or a health care worker's family member get sick from the vaccine.

But a federal government technicality to be decided Jan. 24 could save them from that blame.

That day, when the Homeland Security Act takes effect, hospitals and states could be immune from potential lawsuits if the Department of Health and Human Services designates the smallpox vaccinations as a "federal emergency," according to state health officials.

The inoculations already have been given to members of the military. It is the same vaccine that was given in the 1960s and 1970s, but there are more problems with the population now, which makes the vaccine's risks more perilous, Edmond said.

AIDS wasn't around 40 years ago; neither were patients on immune-suppressing drugs used to treat people with rheumatoid arthritis and those who have received donated organs. People with eczema also should not get the vaccine, and incidence of that skin disease is up sevenfold, health officials say.