LANSING, Mich. (AP) -Thinking of trying to wheedle a flu shot from your doctor even though you’re not at high-risk for flu complications?

Forget about it in Michigan. Or Washington, D.C. Or Massachusetts.

As the vaccine shortage hits home and long lines queue around the supermarket, a handful of states and the nation’s capital are threatening doctors and nurses with fines or even jail if they give flu shots to healthy, low-risk people.

Health officials downplay the punishment and say that most health care workers are following the guidelines.

“But there are people who are unsure and there are consumers who are not necessarily being as civic-minded as we would like. … This just provides us with some backup,” said Janet Olszewski, Michigan’s director of community health, who issued the order Thursday.

There are about 3.4 million people in Michigan considered a priority for a flu shot this fall – primarily the elderly, children 6-23 months, the chronically ill, pregnant women and certain health care workers. But the state only has about 2 million doses, Olszewski told The Associated Press.

Health care violators in Michigan face a misdemeanor punishable by up to six months in jail and a $200 fine if convicted, the health director said.

At least four other states – Massachusetts, New Mexico, Oregon and Wisconsin – and Washington, D.C., have issued similar orders with varying penalties.

“It’s a strong step,” agreed Dr. Gregg Pane, acting director of the District of Columbia Department of Health, whose order took effect Friday.

In Washington, violators could be fined up to $1,000, and Pane said the health department would investigate complaints. In Wisconsin, penalties include up to 30 days in jail and a $500 fine. In Massachusetts, the penalty is a $200 fine per infraction and six months in jail.

“It’s not rationing,” said Massachusetts Public Health Commissioner Christine Ferguson. “It’s being rational about how to reduce the number of deaths that could result from a serious flu season.”

The doctor for a Boston nursing home called the state order controlling what the private sector can do with its own medicine “unprecedented.” It makes it difficult for public flu shot clinics to continue, since many can’t verify a “high risk” status for patients, said Dr. John Foster. But he said the action was needed.

“I think it is a public health crisis,” said Foster, medical director for the North End Rehabilitation and Nursing Center. “They can’t wait and give vaccines out to people who shouldn’t get it.”

The nation is only getting about half the 100 million flu shots it had expected for the current flu season. One of two primary vaccine suppliers, Chiron Corp., is barred from shipping its vaccine from a British factory because of contamination problems.

The United States has no stockpile of vaccine and no authority to ration shots, a job that is left to the states, which have their own laws on public health emergencies.

Some states like Oregon and New Mexico have only civil penalties to enforce their orders that flu shots be given only to high-risk patients. In those states, fines and sanctions from medical licensing boards are possible.

Even so, “we are taking it very seriously,” Lorraine Duncan, Oregon’s immunization program manager, said Friday. “We are asking people to report an incident and we will investigate each one.”

Since Oregon’s order took effect a week ago, two complaints of healthy people getting shots have been checked out. But Duncan said there was no wrongdoing and offered an example: A 42-year-old getting a flu shot might look perfectly healthy to an outsider, but could have a chronic illness or might be a health care provider.

California’s health chief has also ordered flu shots be reserved only for those at high-risk, but that state has even less authority.

“The real value of the order is this: When a provider has a relationship with a patient who is demanding a flu shot, the provider can point to the order…said health services spokesman Ken August. “It emphasizes the seriousness of the situation, not just in California, but nationwide.”

EDS: AP writers Jay Lindsay in Boston, Heather Greenfield in Washington, Julia Silverman in Portland, Ore., and Jennifer Coleman in Sacramento, Calif., contributed to this report.

AP-ES-10-15-04 1754EDT

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