ST. PAUL — Minnesota hospitals are criticizing the state’s coronavirus vaccine distribution system as inequitable, leaving some clinics and hospitals without doses for older, vulnerable patients.

The Minnesota Hospital Association, in a letter to state Department of Health Commissioner Jan Malcolm, said some clinics haven’t received vaccine doses in days.

“Despite our ongoing partnership and our tireless efforts to work in concert with the state, we believe the vaccine allocation process has reached an untenable crossroads,” wrote the association’s President Dr. Rahul Koranne.

Initially, the hospitals served as hubs for vaccine distribution, giving the majority of doses to give to staff and then to health care providers unaffiliated with a hospital system.

In January, the state opened up vaccinations to people 65 and older with most Minnesota hospitals focusing on their most elderly patients first, leaving many people between 65 and 75 to rely exclusively on the state’s vaccination sites for shots. Those appointments are secured through a lottery system set up by the state.

“The lottery system is hurting patients and communities and allocations to health care providers must increase,” Koranne said.

In a statement, Malcolm said the hospital association was notified in an email Friday that there would be changes in a “randomized process” for small and mid-size providers.

“Starting with vaccines arriving the week of February 15, we will be transitioning to a process where the eight regional health care coalitions will work with the providers in their regions to direct COVID-19 vaccine allocations based on provider capacity, community needs and statewide priorities,” Malcolm said.