Tag: Kenneth Stoller

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

Is California Considering the Strictest Vaccine Law in the Country?

California is close to passing a new vaccine law, SB 276, that will help close a loophole that has allowed doctors to write inappropriate medical exemptions for vaccines.

SB276 in California will not be the strictest vaccine law in the country.
SB276 in California will not be the strictest vaccine law in the country.

But is SB 276 the strictest vaccine law in the country?

Is California Considering the Strictest Vaccine Law in the Country?

To be sure, California is one of the few states that doesn’t allow non-medical exemptions. But that was accomplished with SB 277, a vaccine law that eliminated personal belief vaccine exemptions in California back in 2015.

So why are they back with a new vaccine law?

Do you know why California needs a stricter vaccine law?
Do you know why California needs a stricter vaccine law?

Again, too many doctors were writing inappropriate medical exemptions.

But far from becoming the strictest vaccine law in the country, SB 276 simply catches California up with a few other states that don’t allow non-medical exemptions.

Several states require approval of medical exemptions, which can  help cut down on abuse.
Several states require approval of medical exemptions, which can help cut down on abuse.

I say catch-up, because unlike California under SB 277, these states have strict rules about what counts as a medical exemption.

Doctors in these states can’t abuse the system and write unnecessary or fake medical exemptions for kids whose parents are simply scared to get their kids vaccinated.

Which states?

West Virginia and Mississippi are the main states that have not allowed non-medical exemptions.

“Requests for a medical exemption from vaccine requirements shall be reviewed and approved or denied by the State Immunization Officer. “

West Virginia Medical Exemptions Information

They have recently been joined by New York and Maine.

“May be detrimental to the child’s health means that a physician has determined that a child has a medical contraindication or precaution to a specific immunization consistent with ACIP guidance or other nationally recognized evidence-based standard of care.”

New York Codes, Rules and Regulations Section 66-1.1

But since all medical exemptions in California, under SB276, won’t have to be approved, California is hardly considering the strictest vaccine law in the country.

More on Vaccine Laws

What Is Standard of Care?

Anti-vaccine folks who are talking about “standard of care” when deciding who gets a medical exemption for vaccines obviously don’t really understand what it means.

Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?
Why are these advocating against keeping kids protected against life-threatening vaccine-preventable diseases?

Maybe that’s why they put standard of care in quotes in the above infographic against SB276, a new vaccine bill in California that will eliminate fake vaccine exemptions.

What Is Standard of Care?

When we talk about standard of care in medicine, it is important to understand that it is a legal term, with a legal definition:

“That which a minimally competent physician in the same field would do under similar circumstances”

Moffett et al on The Standard of Care: Legal History and Definitions: the Bad and Good News

Does this mean that the minimally competent physicians can choose whatever criteria they want to write fake medical exemptions for vaccines?

Of course not!

“Treatment that is accepted by medical experts as a proper treatment for a certain type of disease and that is widely used by healthcare professionals. Also called best practice, standard medical care, and standard therapy.”

NCI Dictionary of Cancer Terms

Just because a few doctors do something a certain way, that doesn’t make it the proper way for it to be done.

These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.
These are among the common conditions that the AAP says should NOT delay vaccination and which are often mistakenly thought to qualify someone for a medical exemption.

And that’s why a doctor making up their own rules for what counts as a vaccine medical exemption, especially when it goes against published guidelines and advice, isn’t standard of care.

More on Standard of Care

Who Should Write Your Child’s Medical Exemption for Vaccines?

Why would anyone go visit a new doctor just to get their child a medical exemption for vaccines?

A medical exemption should be for kids who can't be vaccinated, not just because you don't want your child to be vaccinated.
A medical exemption should be for kids who can’t be vaccinated, not just because you don’t want your child to be vaccinated.

Shouldn’t they just get the medical exemption from their regular pediatrician?

Who Should Write Your Child’s Medical Exemption for Vaccines?

As lawmakers in California debate passage of a new vaccine bill, SB276, which would put help stop doctors from writing fraudulent medical exemptions, we are learning more and more about what are thought to be fake MEs and the doctors who write them.

“The exemption practices of three doctors in the records have already come under investigation by California authorities, and many are on lists of “vaccine-flexible” pediatricians circulated online by anti-vaccine parents. Three exemptions were signed by a doctor in New Jersey, and a fourth by one in Florida.”

California’s vaccine battle: Here are the doctors behind Bay Area students’ medical exemptions

One of these doctors practices at an anti-aging clinic, so it doesn’t seem like they are the regular primary-care physicians for these kids getting exemptions.

“SB277 did not substantially change the granting of medical exemptions by physicians, which expected and anticipated that each child would be evaluated by a physician who regularly cared for that child and receiving the exemption applying the standard of care.

Instead, after passage of SB277, we witnessed physicians who advertised exemptions for cash on social media and the internet. Some parents posted that their child’s physician refused to grant their child a medical exemption, so they bought one from a distant physician.”

Richard Pan SB 276 Assembly Health Committee Testimony

And that’s why a state without non-medical exemptions continues to have schools with fewer than 50% of the kids vaccinated.

Doctors who think that they are “vaccine experts” are granting kids medical exemptions because they think that everything is a vaccine injury. Or that a family history of something that they think is a vaccine injury qualifies a child for a medical exemption.

“I’ll tell you what I do personally is I charge the same amount of money for a patient who I see for a medical exemption as I do for new patients coming in to me for a check up or a consultation. I don’t charge any more. In fact, my medical exemption appointments are actually two appointments. I don’t make any more money from medical exemption appointments as anything else.”

Bob Sears SB 276 Assembly Health Committee Testimony

Most of us don’t make any money from medical exemption appointments…

“And just to follow up – is there some other… back to the idea of a specialist in this. Could there be some other standard in which a specialist could do more of these?”

Chad Mayes SB 276 Assembly Health Committee Testimony

There are certainly situations in which a specialist will be the one writing the medical exemption.

Is your child getting chemotherapy for ALL? Then his oncologist might be the one to write the exemption.

Did your infant get immunoglobulin to treat Kawasaki disease? Then her cardiologist might write a temporary medical exemption for live vaccines.

Does your child have infantile spasms? Then his neurologist might write a temporary medical exemption for DTaP.

Why Are Medical Exemption Visits a Thing?

In most situations though, it would be your pediatrician who would write the exemption.

“When we passed SB 277, again as we mentioned, we didn’t really touch the medical exemption, but what our expectation was is that it’s going to be your child’s regular doctor who knows the child granting them… And what we’re seeing is that actually we have physicians… who are not really the primary care doctor.

I mean I find this idea of having medical exemption visits kind of intriguing because you shouldn’t really have medical exemption visits. Either you’re the doctor or you’re not. If you’re the doctor you should take care of them. You have that relationship and if they have an issue with vaccines, you write them the exemption.

That’s it. That’s what’s supposed to normally happen. People shouldn’t be going out finding other doctors for exemptions. If you happen to see a specialist, and they think you can’t get vaccinated safely, then they either submit the exemption or they tell your primary care doctor, by the way, that child should not get vaccinated, we should get an exemption. That’s how it should normally work.”

Richard Pan SB 276 Assembly Health Committee Testimony

Of course, medical exemptions to get vaccines are not very common though. If your pediatrician refuses to give your child a medical exemption, it is likely because they don’t need one.

It's amazing that they didn't know their child needed a medical exemption until they went to see Dr. Stoller...
It’s amazing that they didn’t know their child needed a medical exemption until they went to see Dr. Stoller

Remember, medical exemptions for vaccines should be for kids who can’t be vaccinated, not just because you’re scared or don’t want your child to be vaccinated.

More on Doctors Writing Medical Exemptions for Vaccines