Who Are the Medically Fragile Children?

As SB 276 becomes law in California, one thing we have been hearing about from some folks is how it will affect medically fragile children.

No one is coming to take the medical exemptions from medically fragile children.
No one is coming to take the medical exemptions from medically fragile children…

Will SB 276 or vaccine laws in other states take away the medical exemptions from medically fragile children?

Of course not!

Who Are the Medically Fragile Children?

The first thing to understand is that when folks like Rob Schneider talk about medically fragile children, they are using the term differently than when medical professionals and most parents do.

“Medically fragile” means having an acute or chronic health problem which requires therapeutic intervention and skilled nursing care during all or part of the day. Medically fragile problems include, but are not limited to, HIV disease, severe lung disease requiring oxygen, severe lung disease requiring ventilator or tracheostomy care, complicated spina bifida, heart disease, malignancy, asthmatic exacerbations, cystic fibrosis exacerbations, neuromuscular disease, encephalopathies, and seizure disorders.

2005 California Health and Safety Code Sections 1760-1761.8 FACILITIES HEALTH AND SAFETY CODE SECTION 1760-1761.8

The medically fragile kids as defined by the California Health and Safety Code, who require skilled nursing care, are not typically the kids who are getting routine medical exemptions.

Sure, some of them might need one. A child with severe HIV disease or a malignancy being treated with chemotherapy would likely get a medical exemption for live vaccines, etc.

A child with an acute encephalopathy or uncontrolled seizures would also qualify for a medical exemption.

And since vaccines aren’t 100% risk free, there might be some kids with a vaccine injury among these medically fragile kids. It is likely not a high number though, as severe reactions to vaccines are very rare.

“CMC {children with medical complexity} are likely increasing in prevalence because of increased survival rates of infants born prematurely, those born with various congenital anomalies, and/or those with chronic conditions, as well as improved treatments for acute illnesses in fields such as intensive care and oncology.”

Cohen et al on Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

In most other cases, medically fragile kids wouldn’t need a medical exemption and would greatly benefit from being vaccinated and protected!

They would also greatly benefit if everyone around them was vaccinated and protected, especially if they did have a medical exemption.

Again, no one is coming to take their necessary medical exemptions if they have one though.

More on Medically Fragile Children

About Those Inappropriate Medical Exemptions in California

As we wait for SB 276 to be signed into law, we are still hearing a lot of misinformation about those inappropriate medical exemptions that docs have been writing in California.

No doctors have been found guilty of granting inappropriate medical exemptions? What about Bob Sears?
No doctors have been found guilty of granting inappropriate medical exemptions? What about Bob Sears?

Is it true that no doctors have been found writing inappropriate medical exemptions?

About Those Inappropriate Medical Exemptions in California

Well, it’s kind of true, but only on a technicality.

Many California docs are being investigated for writing inappropriate medical exemptions, including:

And others have been called out in the media for writing excessive numbers of medical exemptions, including Tara Zandvliet, Tiffany Baer, Sabrina Sonneman, and Lonna Larsh. And selling those exemptions!

The medical exemptions of Kelly Sutton are still under investigation.
The medical exemptions of Kelly Sutton are still under investigation. She works in the same clinic as Tiffany Baer.

So have any of them been found guilty of writing inappropriate medical exemptions?

“In recent years, however, the board has sanctioned only one doctor for inappropriately writing a medical vaccine exemption in a case that made headlines. Since 2013, the board has received 106 complaints about potentially improper vaccine exemptions, including nine so far this year, said spokesman Carlos Villatoro.

One pending case involves Dr. Ron Kennedy, who was trained as a psychiatrist and now runs an anti-aging clinic in Santa Rosa.

Medical board investigators took the unusual step of subpoenaing 12 school districts for student medical records after receiving complaints that Kennedy was writing inappropriate exemptions. They found that Kennedy had written at least 50 exemptions, using nearly identical form letters, for students in multiple communities, including Santa Rosa, Fremont and Fort Bragg, saying that immunizations were “contraindicated” for a catchall list of conditions including lupus, learning disability, food allergies and “detoxification impairment.”

Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital and the medical board’s expert witness, said that the exemptions issued by Kennedy appear to have been provided “without an appropriate evaluation,” according to court documents.

Kennedy has refused to respond to the board’s subpoenas seeking the medical records of three of his patients, according to court documents. The board has yet to file a formal accusation against Kennedy, and he continues to practice.

Exemptions Surge As Parents And Doctors Do ‘Hail Mary’ Around Vaccine Laws

They haven’t been found guilty, but maybe because the Medical Board of California has not been able to properly investigate their cases!

That is one of the things that SB 276 changes and why the Medical Board of California has supported SB 276.

“Since the passage of SB 277 in 2015, the Board has faced obstacles in investigating complaints related to medical exemptions. For all quality of care cases, the Board must obtain authorization from the patient or their parent or guardian (if the patient is a minor) to release the medical records. For medical exemption cases, many times the parent or guardian does not want the Board to investigate the physician who issued their medical exemption, so the parent will not sign an authorization. This has created barriers to the Board investigating these cases because for most of these medical exemption cases, the Board does not have enough evidence to subpoena the medical records. Without the medical records, the Board’s physician expert cannot review the case to determine if the physician acted within the standard of care.”

Medical Board of California Legislative Analysis

To say that “no doctors have been found writing inappropriate medical exemptions” is very misleading.

It would be much more appropriate to say that many doctors have been found writing inappropriate medical exemptions, but the Medical Board of California just couldn’t prove their case using pre-SB 276 guidelines.

More on Medical Exemptions

A California Pediatrician Who is Not a Hysterical Anti-Vaxxer Wrote a Letter to the Governor…

Did you think it was over, now that SB 276 has been passed and Governor Newsom said that he would sign it, as long as a companion bill with a few added amendments also gets passed?

I'm glad Elisa Song vaccinates some of her kids, but I wonder how many exemptions she has written since SB 277 passed...
I’m glad Elisa Song vaccinates some of her kids, but I wonder how many exemptions she has written since SB 277 passed…

Of course, it’s not…

Elisa Song’s Letter to Governor Newsom

While many of us wanted Governor Newsom to sign SB 276 in its original form, as he had promised, without the added amendments that weaken the law, most see it it as an acceptable compromise.

And then there are the anti-vaccine folks who want Newsom to veto SB 276 so that kids can continue to get inappropriate medical exemptions and remain unprotected and at risk against vaccine preventable diseases.

“I am a pediatrician trying to do the best I can for the children in my practice. And the best is not simply repeating that vaccines are “safe and effective.” Because they’re not 100% safe. Because they’re not 100% effective. Because parents are asking questions. Because parents are afraid and want to do the best for their children. And because we, as primary care physicians, need to be able to practice the art and science of medicine to the best of our abilities, for the child sitting in front of us, without bureaucratic handcuffs and fear of retribution.”

Elisa Song’s Letter to Governor Newsom

No one says vaccines are 100% safe and effective, but they are very effective with few risks.

Parents are afraid because of the anti-vaccine rhetoric and misinformation they see and read on the Internet and sometimes from holistic type doctors who pander to their fears.

“SB 276 continues to place the decision regarding an individual child’s vaccine risk/benefit assessment and whether or not that child qualifies for a vaccine medical exemption in the hands of the government.”

Elisa Song’s Letter to Governor Newsom

This is not true.

SB 276 simply says that you can’t make up your own reasons for why kids can’t get vaccinated and protected.

“SB 276 continues to too narrowly limit the criteria for “appropriate” vaccine exemptions to those contraindications detailed by the CDC, AAP and ACIP. These criteria do not take into account the emerging field of vaccinomics pioneered by the Mayo Clinic and the latest research on increased risk for various chronic illnesses including autoimmunity after vaccination in certain vulnerable populations. Epigenetics is making it increasingly clear that the one-size-fits-all CDC schedule will not work. “

Elisa Song’s Letter to Governor Newsom

As other states have done, SB 276 and SB 714, set rules on what counts as a medical exemption.

“SB276 continues to essentially eliminate all medical exemptions, even those consistent with the CDC, ACIP or AAP guidelines. By arbitrarily limiting the number of medical exemptions a physician may write to 4 in any calendar year before triggering investigation, SB 276 will deter physicians from writing ANY exemptions for fear of irreparable damage to their professional reputation, financial security, and emotional trauma, even if ultimately found innocent. How will a physician decide which 4 children are “deserving” of medical exemptions each year, in order to prevent an automatic investigation once they write that 5th exemption?”

Elisa Song’s Letter to Governor Newsom

Since few children should actually need a true medical exemption, the limits in SB 276 are hardly arbitrary. And since what counts as a true medical exemptions is rarely arbitrary either, doctors who write five or more true medical exemptions in a year will have nothing to fear when those exemptions are reviewed.

“A Harvard study has found that 2.6% of people vaccinated will have a vaccine injury. California’s current medical exemption rate of 0.7% falls far below this number, implying that there are many children whose vaccine injuries could have been avoided if an appropriate medical exemption were written by their physician.”

Elisa Song’s Letter to Governor Newsom

The Harvard Pilgrim Health Care, Inc. report did not find “that 2.6% of people vaccinated will have a vaccine injury.”

It actually found possible reactions in 2.6% of vaccinations. And I hope that everyone is aware that a possible reaction is not the same as a vaccine injury…

Also, in addition to the fact that current rate of medical exemptions in California is far higher than 0.7%, it is the clusters of medical exemptions in many schools that are the problem.

“Until such time when vaccine risks and benefits can be clearly defined in broader terms that take into account personal and family history and epigenetics, this risk needs to be taken on by each parent and each child. And where there is risk, there must be choice. And where there is uncertainty, the BEST person to help that parent navigate vaccines is the person who knows that child’s medical and family history best – THEIR PHYSICIAN.”

Elisa Song’s Letter to Governor Newsom

Elisa Song talks a lot about the risks of vaccines, or at least what she thinks puts kids at risk, including family history and epigenetics.

“I believe in public health, yet I care for individual children and families who sit across from me everyday, trusting that I am giving them valid, scientific, evidence-based information that will keep their individual baby safe and healthy, and believing that I am providing them with true informed consent.”

Elisa Song’s Letter to Governor Newsom

It would be great if she truly were giving her patient’s “valid, scientific, evidence-based information” and “true informed consent.”

She’s not…

“I learned how to integrate conventional pediatrics with functional medicine, holistic nutrition, homeopathy, acupuncture, herbal medicine and essential oils – and it changed my life!”

Elisa Song

Notice anything missing?

$267 for a home remedy kit filled with homeopathic treatments???

She never talks about the risks of getting a vaccine-preventable disease.

And she overstates the risks of vaccines.

“While the media and common public opinion are quick to say that the link between vaccines and autism has been absolutely disproved, they have not done their due diligence research.”

Measles: Know the Facts by Dr. Elisa Song, M.D.

It is hard to make a truly informed decision when your doc downplays the risks of natural disease, makes you afraid to get vaccinated, and tries to sell you natural therapies that we know won’t prevent infections and won’t actually boost your immune system.

More on Anti-Vaccine Pediatricians

Are the Measles Outbreaks in New York a Hoax?

Wait, why do some folks think that the measles outbreaks in New York are a hoax?

There were no confirmed cases in the measles outbreaks in New York, except the 654 measles cases that were confirmed… Some hoax!
There were no confirmed cases in the measles outbreaks in New York, except the 654 measles cases that were confirmed… Some hoax!

Oh, the usual suspects

Are the Measles Outbreaks in New York a Hoax?

Brooklyn, New York had 654 measles cases in the largest measles outbreak in 27 years.

There have been 312 confirmed cases in the measles outbreaks in Rockland, County, New York.

There have been an additional 312 confirmed, reported cases in Rockland County, New York, the longest measles outbreak since the endemic spread of measles was declared eliminated in 2000.

Were they a hoax?

“A total of 654 cases were confirmed, with rash onsets between September 30, 2018 and July 15, 2019. Serious complications included hospitalization (52), intensive unit care (19) and pneumonia (34). Multiple international importations of measles introduced into a community with prevalent delays in vaccination among young children propagated this outbreak.”

2019 Health Alert #26: Update on Measles Outbreak in New York City

Of course not!

The New York State Department of Health advises that on all suspected measles cases, “Viral specimens (nasopharyngeal swaband urine) and serology (IgM and IgG) should be obtained for diagnostic testing and confirmation.”

Were these cases all caused by vaccine strain measles, as Larry Palevesky suggests?

Of course not!

A vaccine strain has never before caused a measles outbreak. And NYC Health Commissioner Dr. Oxiris Barbot, in a press conference, stated that “Yeah, it’s, you can’t get the measles from the vaccine.”

Although anti-vax folks often focus on the measles strain when there is an outbreak, all it really helps you do is figure out where the imported cases came from.

Even though health officials didn’t tell us the specific strains involved in the outbreaks, guess what, they did tell us the sources of the outbreak, so it is basically the same thing.

The cases were imported from Israel, UK, and Ukraine.

And the CDC has told us that “All measles cases this year have been caused by measles wild-type D8 or B3.”

“We have to stop blaming, accusing, targeting, ostracizing, condemning unvaccinated children as a health risk, which would then make this subject completely moot.”

Larry Palevsky

What else do we know about the measles outbreak in Brooklyn?

  • it began in October 2018 “with an unvaccinated child from Brooklyn who acquired measles in Israel”
  • it included 15 neighborhoods in Brooklyn, with most concentrated in Williamsburg, Borough Park, and Sunset Park
  • the majority of cases were in children, including at least 91 cases in infants less than 12 months old
  • the great majority of cases were unvaccinated, with only 27 cases fully vaccinated with two doses of MMR
  • there were 52 hospitalizations, including 16 ICU admissions

And the outbreak cost over $6 million to control!

The Rockland County measles outbreak is still ongoing.

At a gathering for the New York Alliance for Vaccine Rights and First Freedoms Community, these folks, including Larry Palevsky (left) are discussing the "alleged" measles outbreaks that New York spent $6 million and 500 staff to contain.
At a gathering for the New York Alliance for Vaccine Rights and First Freedoms Community, these folks, including Larry Palevsky (left) are discussing the “alleged” measles outbreaks that New York spent $6 million and 500 staff to contain.

So why do they think they are a hoax?

“There were over 800 kids who the New York State and New York City Department of Health have said were confirmed cases of measles. The real question is, were these really confirmed as per the CDC recommendations. We do not have that data. In fact, anecdotally, New York State told the physicians not to do the tests.”

Larry Palevsky

Is this about the strains again? Is this about the fact that once you know you are in the middle of a huge measles outbreak, you might be able to start diagnosing kids clinically?

“New York State lied when they said that there were confirmed cases. We don’t know what kind of illnesses the kids had. And there’s a set of papers in the literature that specifically state that if the children are found by analysis to have a measles virus infection that is consistent with a side effect of the vaccine, it is important for the Department of Health to alert the public that it was a vaccine strain that caused the outbreak, because a vaccine strain illness should not be equated with a public health emergency. [Applause]”

Larry Palevsky

Yes, it is about the strains…

“So the reality is that when there is a vaccine strain measles outbreak, meaning that the vaccine itself was not properly attenuated, meaning it was more active and virulent than just simply giving an antibody response in the body, when that occurs an outbreak is almost always very very close to the vest, meaning that would explain why it was only seen in two communities out of 62. And if New York state had done the proper testing of the vaccine to see if it was too virulent and of the children who had the measles infection to see what type of measles virus they had, then in all likelihood this was a vaccine strain measles infection which is known to be a side effect of the vaccine and not a public health emergency.”

Larry Palevsky

Is any of that true?

Since we have never had an outbreak of measles from an MMR vaccine that wasn’t properly attenuated, I’m guessing no, it isn’t. Also remember that to control the outbreak, they gave lots and lots of MMR vaccine to unvaccinated folks in those communities…

What about his explanation for why we only saw outbreaks in Brooklyn and Rockland Counties? Well, for one thing, we didn’t. Other areas of New York and of course, around the country have seen a rise in measles. And the outbreaks in Brooklyn and Rockland Counties were caused when unvaccinated folks traveled to Israel, UK, and Ukraine and returned to an area with low immunization rates. They weren’t caused by a bad batch or mutant strains of measles in the MMR vaccine.

“So the New York State Department of Health failed to do their job and instead they lied and said the cases were confirmed and they didn’t do their due diligence to actually evaluate all the possible reasons that an outbreak could have occurred. It’s very strange that two communities where there are lots of people moving through those communities that are non-Jewish, that are outside of the state that are coming through and why just those communities got the illness. That should have raised the red flag that something else was going on and your state failed us.”

Is it possible that those other people moving in and out of those communities in Brooklyn and Rockland County were vaccinated and protected against measles?!?

One thing should be very clear.

Brooklyn may have stopped their measles outbreak, but New York still has a public health emergency on their hands.

Well, not just New York. We need to stop this kind of propaganda if we want to keep parents from being scared to immunize and protect their kids.

More on Measles in NY