New York Gov. Andrew Cuomo has given hospitals a conundrum. Fail to use all of your COVID-19 vaccines within seven days of receipt? That’ll be a $100,000 fine. Vaccinate someone out of the state-designated order? That’ll be a $1 million fine.

Damned if you let your vaccines expire, damned if you don’t let your vaccines expire—by using them on anyone outside of the approved hierarchy.

The state’s distribution plan mandated that a slew of people receive the vaccine before the elderly, including health care workers, patient-facing employees at long-term care facilities, first responders, teachers, public health workers, grocery store workers, pharmacists, transit employees, those who uphold “critical infrastructure,” and individuals with significant co-morbidities. Such a plan is common across the U.S., and it requires a robust logistical framework to execute properly.

That hasn’t been going so well.