As Hawaii’s vaccine rollout entered a new phase Monday, the effort so far has been governed by a hodgepodge of rules, with the state in some cases screening people individually but in others providing only broad categories of “essential” workers and leaving it up to companies to decide who fits.

As a result, the state cannot even say how many people in each of its approved categories have been vaccinated.

The state acknowledges that the hospitals and clinics that vaccinate people have sometimes bent the rules to the breaking point, by inoculating someone outside the current phase, for instance, but say they have little recourse.

“It’s hard because sometimes the hospitals are the ones allowing that, so we try to follow up and say work with us please because otherwise it causes chaos,” Dr. Libby Char, director of the state Department of Health, said during a state Senate hearing last month. “I guess the recourse would be that we just stop giving them vaccines, and that would be really unfortunate, so we’re trying to work with the hospital association to get them to respect the tier we are in.”

Lorinda Riley, a University of Hawaii professor who specializes in health ethics and law, said employers of essential industries have been given wide discretion to decide who is offered vaccines, leading to the possibility of some companies lumping in everyone, whether they work directly with the public or not.

“Essentially, this system delegates the decision to employers and individuals who have a vested interest, rather than leaving it to the government,” she said. “A clerk at a grocery store would not have the same risk of exposure as its human resources manager who normally works in the store, but can work at home. So, one store may limit vaccines to clerks while the other opens it up to all employees.”

Some also question whether even the state’s broad categories were fair to begin with.

Hospital staff who do not work with patients, substitute teachers and hundreds of lawmakers and their staff, along with Gov. David Ige’s entire cabinet and staff, have been among those who got vaccinated under the state’s 1b phase. Hospitality workers and other service workers who interface with the public every day were not — but are now eligible under Phase 1c, beginning Monday.

Jungmin Kim, a 42-year-old front desk clerk who works at the DoubleTree hotel in Waikiki, said she doesn’t understand why she had to wait for so long since she interacts with travelers and hotel guests who often go unmasked.

“They’re always breaking the rules,” she said. “We need to ask them 100 times to wear the mask. I’m really stressed watching them every day.”

State health officials have provided broad categories of jobs and industries that make the cut, such as government employees, teachers and critical utilities or transportation infrastructure employees — and the pool widened Monday under Phase 1c to include industries such as hotels and hospitality, food service and banking and finance, among others.

Char told the Senate hearing that she could not provide a list of the jobs the state agency deemed critical in the 1b phase, simply because there were so many.

“We tried to list general categories of people, but it’s really tough because even if we were to list occupations, there would be a hundred more that wouldn’t fit in there,” she said.

Instead, she said, the health department offered general criteria. “Frontline essential workers are critical infrastructure workers, people who can’t telework, people who are working within 6 feet of one another, either coworkers or public. That’s the definition we’ve been going on.”

At the same time, the state has been vetting lists of employees submitted by employers and sending the names of approved workers to clinics. But officials also acknowledge the state is entrusting hospitals and clinics to schedule appointments and put shots in arms according to the priority guidelines they set.

The state has received 15,000 applications to date, said health department spokeswoman Janice Okubo. She declined to specify how many of those applications were approved and what industries they represented.

Almost 25,000 government workers, including Department of Education and University of Hawaii employees, have been offered the chance to get vaccinated, Okubo said.

Honolulu officials say that number includes about 3,000 police officers, fire department staff and EMS employees, and 4,200 Department of Education employees who got their shots at the Leeward Community College clinic run jointly by the city and state health department. Even more people who are employed by the University of Hawaii, TheBus, Hawaiian Electric, Hawaiian Telcom and Spectrum have attended the Leeward clinic, said Michelle Yu, a city spokeswoman.

Hospitals Say They Follow State Guidance

The health organizations running the largest vaccine clinics in the state — Hawaii Pacific Health and The Queen’s Health Systems — say they’re following DOH’s lists of essential workers closely.

Hawaii Pacific Health, for example, has received nearly 9,000 names of individuals classified in the essential worker category by the health department, according to spokeswoman Kristen Bonilla. But not all of them have followed through to make an appointment at the Pier 2 Vaccination Center, she said.

“We do not track them by employer or whether they are public or government workers, so we do not have that information available,” she told Civil Beat in an emailed statement.

Jason Chang, the chief operating officer of The Queen’s Health Systems, said it receives a list of approved organizations and their employees from the health department. Queen’s has administered more than 88,000 vaccine doses — and among those were more than 14,000 essential workers.

The hospital’s staff contacts people individually to invite them to make an appointment online, he said. The system uses a name and email address verification to “ensure only those who have been invited to make an appointment are allowed to do so,” he said, and they’re also required to bring proof of employment when they arrive.

Kaiser Permanente spokeswoman Laura Lott said Kaiser uses DOH’s lists as well, in addition to Kaiser’s own essential eligibility verification appointment application online.

Asked why Kaiser provided vaccines to Piggy Smalls restaurant staff, as reported by KITV, Lott cited the need to not waste extra doses.

“Our care teams have worked very hard to use every dose of this precious resource and occasionally non-priority individuals are vaccinated rather than having a shot go to waste,” she said.

Hospitals have offered vaccines to everyone on staff, not just those who deal directly with patients in clinical settings, as seemed to be intended by the state’s definition of “frontline essential.”

Chang said The Queen’s Health Systems invited all of its employees, “clinical and non-clinical,” to get vaccinated. About 80% have taken the opportunity and got at least one dose to date.

“All of our employees are classified in the 1a health care worker category, regardless if they are working from home or otherwise,” he said. “Giving all of our employees the opportunity to get vaccinated ensures that we are taking the necessary steps to prevent the spread of COVID within our hospitals and clinics.”

At Kaiser, about three-quarters of staff have received at least one dose of vaccine.

The vast majority work in patient care roles like nurses, medical assistants and pharmacists, Lott said. “Many have been volunteering at our mass vaccine event so needed to be protected. There are some non-patient care staff, like me, that were vaccinated because we have jobs that require us to visit facilities or be available during emergencies like a pandemic surge.”

Government officials also have been getting the vaccines, although it’s not always clear that all of those inoculated are dealing directly with the public in front-line positions.

About 500 lawmakers and Capitol staff were invited to receive vaccines. Hawaii Senate Communications Director Jacob Aki said more than 400 opted in and attended the first clinic in January and second clinic in February. To qualify for a shot, staff had to work three or more days per week at the Capitol building, he said.

“Not everyone in the Capitol registered to get the vaccination but every single Capitol staff member was offered the opportunity,” he said. “To our understanding no one was turned away.”

Gov. David Ige’s cabinet, including 65 staff, as well as his wife, were invited to get vaccines on Feb. 22.

When asked why the governor’s wife was deemed essential, Ige’s spokeswoman Jodi Leong responded, “I can’t answer that. We all got vaccinated together. I’m not the one who planned this whole thing. I was just one of the employees who got vaccinated.”

Okubo also declined to provide an explanation.

“It’s extremely challenging to vaccinate 1.4 million people as quickly as possible and certainly things will happen along the way and lessons will be learned,” she said. “We wish we could move faster and vaccinate even more people but we are constrained by how much vaccine we are receiving. Hopefully that will change.”

Civil Beat Reporter Anita Hofschneider contributed to this article.