A national health care provider has administered COVID-19 vaccinations to people deemed ineligible for the scarce vaccine by local health departments, including people with connections to company leaders and customers of its concierge medical service, according to internal communications leaked to NPR.

San Francisco-based One Medical has been allocated thousands of vaccine doses by local health departments in some of the areas it provides medical services. Ineligible individuals with connections to company leadership were set up with vaccine appointments, and patients who were disqualified from receiving the vaccine were nonetheless permitted to skip the line ahead of other high-risk patients.

The problems have occurred in numerous company locations across several states. The Washington State Department of Health, citing a complaint it received this month, told NPR it had halted COVID-19 vaccine distribution to the company. Other regulators have also received complaints or stopped providing the vaccine.

One Medical has branded itself as a high-end health care provider serving a relatively affluent clientele, with each customer paying a $199 fee annually to receive easy online access to appointments, telemedicine and access to a streamlined, tech-focused medical experience. The company went public with an initial public offering in January 2020, with a valuation in the billions of dollars.

One Medical’s shortcomings take place amid broader anecdotal evidence that suggests patients throughout the U.S. are skipping the line due in part to loose enforcement. The situation highlights a serious ethical issue: determining who is entitled to a vaccine at a time of scarce availability and who is responsible for enforcing eligibility rules.

Experts say an appropriate system for vaccine distribution focuses on first targeting those most at risk for serious consequences from COVID-19. “We’re trying to focus on those individuals who are most likely to develop severe illness or death and to most likely be exposed to the virus,” said Gabriel Lázaro-Muñoz, who teaches medical ethics and health policy at the Baylor College of Medicine. “The overall goal is to save as many lives as possible, and with that we are not valuing any life over another.”

One Medical claims that it does not allow for ineligible patients to be vaccinated knowingly and that it was confident that it was “doing everything reasonably in our power to ensure … our adherence to state and local department of health vaccine eligibility guidelines.” But NPR obtained internal communications that tell a different story.

“We are not policing”

Messages among doctors, other medical practitioners, administrative staff and leadership show that multiple staffers across One Medical locations in several states — Washington, Oregon and California — privately raised the alarm about what they believed were lax oversight and inappropriate practices within the organization. They also show what appear to be favors done for those close to the organization’s senior staff.

“It seems if you don’t screen out those jumping the [queue], then many will jump in the line and push those that need the vaccine further behind, delaying a potentially life saving injection. This could impact MANY members,” one doctor in California wrote to his colleagues in January, according to the internal documents.

“I have had two [patients] today, both in their 20-30s without risk factors and are tech workers who have gotten their covid vaccines. One was thru us,” wrote another One Medical doctor in Washington state. “I’m curious how these [people] are able to sign up for vaccines when we have a long list of higher priority [patients]? … I just want to understand how they can be prioritized for a vaccine when those at higher tiers have to wait.”

These internal communications indicate that ineligible friends and family of One Medical leadership were vaccinated, as were work-from-home administrative, support and IT staff from its headquarters in San Francisco. While health care workers waited in line in January, One Medical made the decision to offer the vaccine to any of its San Francisco County staff members, regardless of whether they were patient facing.

Lázaro-Muñoz, the ethics professor, said that offering the vaccine to all staff members regardless of whether they see patients was unethical.

“There might not be regulations stopping this company from giving [the COVID-19 vaccine] to their employees. But from an ethical standpoint, when you look at what is right and wrong, this is wrong,” Lázaro-Muñoz told NPR. “Your life and the life of your co-workers and those who work in this company is not any more valuable than the life of the elderly people that are not getting access to that vaccine, thanks to your criteria and system of distributing that vaccine.”

One Medical said that it had asked some of its staff to volunteer time in its clinics. However, all of its staff members in San Francisco County were provided an opportunity to receive the vaccine, regardless of the nature of their job.

Further, patients of One Medical who were ineligible to be vaccinated based on local guidelines were 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 providers trying to get eligible health care workers vaccinated but instead being 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 healthcare 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 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 a patient noted that they were not in an eligible category for vaccination, some could continue to book an appointment for a COVID-19 vaccine. Suggestions on how the tech-heavy company could use algorithms to scan for ineligible patients were turned down.

The company said that blocking ineligible patients from booking vaccination appointments would have called for a complete overhaul of its system and that it was too technologically difficult to rebuild the system 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 an 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.”