Tag: Medical Board of California

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

Will SB276 Revoke Legitimate Medical Exemptions?

Bob Sears has already said that SB276 will eliminate medical exemptions and stop doctors from writing medical exemptions.

ITP after MMR is not a reason to get a medical exemption for all vaccines…

What is he saying now?

Will SB276 Revoke Legitimate Medical Exemptions?

Bob Sears is saying that SB276 will revoke legitimate medical exemptions from children who have had “seizures, nerve injuries, and severe allergic reactions after vaccines.”

He also says that they “will be forced to continue just to stay in school.”

To be clear, neither SB276 nor any other vaccine law in the United States forces anyone to get vaccinated.

Yes Bob Sears, what do you mean forced to stay in school?
Yes Bob Sears, what do you mean forced to stay in school?

Although implying forced vaccination is a common anti-vaccine tactic, even his own followers called him out on it…

What else can you see from reading the comments to Bob’s post?

Some medical exemptions might be revoked under SB276, but it isn’t because they are legitimate.

ITP would not be a reason to get a medical exemption to all vaccines.
ITP would not be a reason to get a medical exemption to ALL VACCINES.

A rash that turned in ‘purple blobs’ after the MMR vaccine sounds like it could be ITP, which is actually a table injury.

Since the ACIP lists that as a precaution to getting another dose of MMR, you would almost certainly get a medical exemption, but not to all vaccines!

While scary for parents, ITP typically goes away on its own without treatment in about two weeks to six months.

Anyway, SB276 doesn’t revoke legitimate medical exemptions.

If you actually read SB276, as amended, what it does do is trigger a review by medical professionals to “identify those medical exemption forms that do not meet applicable CDC, ACIP, or AAP criteria for appropriate medical exemptions” if:

  • a school’s immunization rate drops below 95%
  • a doctor writes five or more medical exemptions in a single year (although that doesn’t sound like a lot, keep in mind that true medical exemptions are not very common, so the average doctor who is only writing medical exemptions for their own patients likely won’t write that many each year)
  • a school doesn’t report it’s immunization rates

And once reviewed, inappropriate medical exemptions can be revoked, although that process can be appealed by a parent who thinks that their child does indeed have a legitimate medical exemption.

Keep in mind that just because a doctor writes more than 5 exemptions in a single year, that doesn’t mean that they will automatically be revoked. That simply triggers a review. Even if the doctor writes 10 or 20, if they are legitimate exemptions, then they will be allowed.

Again, SB276 doesn’t revoke legitimate medical exemptions.

Why does Bob Sears think that it does?

Maybe because many of things that Bob Sears considers to be legitimate medical exemptions actually aren’t, which is why he is already under investigation, even before SB276 is enacted…

More on Legitimate Medical Exemptions

Does SB 276 Eliminate Medical Exemptions?

Why do some folks think that SB 276, a new vaccine bill in California, will eliminate medical exemptions to getting vaccinated?

SB 276 will not eliminate medical exemptions.
SB 276 will not eliminate medical exemptions.

Oh, more misinformation from the usual suspects…

Does SB 276 Eliminate Medical Exemptions?

To be clear, SB 276 does not eliminate medical exemptions.

So what does California’s new vaccine bill do?

“This bill pressures doctors into giving more vaccines to a child you may know might have a severe reaction, and that’s a tragedy.”

Bob Sears SB 276 Assembly Health Committee Testimony

Despite Bob Sears‘ testimony when he appeared as an expert witness for anti-vaccine folks and gave testimony against SB 276, it basically helps to stop some doctors from writing fake medical exemptions.

“I would imagine a lot of you would not want to give your child more doses of the vaccine if they had a seizure, or a nerve injury, or severe eczema, or any other kinds of dozens of other severe reactions. So that’s all under SB 277 and that’s how I’m practicing now.

My concern with this bill, is that it’s going to take every exemption I’ve ever done under those guidelines, which are not restricted to CDC contraindications – under those old guidelines, they can now review every single one of my exemptions I’ve done and disqualify each and every one of them and kick those kids out of school. They are sort of retroactively changing the guidelines – so all of the exemptions that I’ve ever done, and other physicians have ever done, and to me that’s a very very concerning precedence for a government to go back like that and negate years of medical care that’s been done legally and properly under the guidelines of 277. “

Bob Sears SB 276 Assembly Health Committee Testimony

Legally and properly?

Another complaint has been filed against Bob Sears with the California Medical Board for writing inappropriate medical exemptions.

I would imagine that a lot of parents are scared into thinking that seizures, nerve injuries, and severe eczema are vaccine reactions.

And that’s why some of them might not want to keep vaccinating their kids in these situations.

So that kids aren’t put at risk to get a vaccine-preventable disease though, it’s incredibly important to understand that these aren’t typically vaccine reactions, except maybe if a child has febrile seizures. But even then, having febrile seizures wouldn’t usually be a reason to stop getting vaccinated.

“It’s incredibly important to understand what those CDC guidelines are and that the Senator did answer that the only CDC family history guideline is if a mom or dad, a first degree relative, has a severe immune deficiency, and that the children might have that. And that only exempts you from MMR and chickenpox vaccine.

That’s the only family history factor in all the guidelines that are in this bill.”

Bob Sears SB 276 Assembly Health Committee Testimony

Since severe immunodeficiences, like SCID, can be inherited, it is important to know about a family history of a severe immune system problem before a child gets a live virus vaccine, like MMR or the chicken pox vaccine.

Fortunately, we typically do know about these conditions by the time a child is ready to get these vaccines. And no, it’s not just by asking about the child’s family history. These types of immune system problems cause severe symptoms that have usually showed up well before a child gets these vaccines.

“There’s a small family history factor about seizures. If someone’s had seizures, you can’t get this one brand of vaccines, but you can get other brands that qualify, so that doesn’t work.”

Bob Sears SB 276 Assembly Health Committee Testimony

What is he talking about?

“A personal or family history of seizures is a precaution for MMRV vaccination; this is because a recent study found an increased risk for febrile seizures in children 12-23 months who receive MMRV compared with MMR and varicella vaccine.”

Vaccine Recommendations and Guidelines of the ACIP

The warning is about febrile seizures and ProQuad, the combined MMR and chickenpox vaccine. You can safely get the vaccines though, as the separate MMR and chickenpox vaccines.

This works well!

And parents should know that if their child is having seizures, they will easily qualify for a temporary medical exemption.

“Vaccination should be deferred for persons with a moderate or severe acute illness. This precaution avoids causing diagnostic confusion between manifestations of the underlying illness and possible adverse effects of vaccination or superimposing adverse effects of the vaccine on the underlying illness.”

Vaccine Recommendations and Guidelines of the ACIP

In addition to not giving the DTaP vaccine to a child with a progressive neurological disorder or uncontrolled epilepsy, the general guidelines about deferring vaccination for children with moderate or severe acute illness would likely mean that they wouldn’t get other vaccines either.

“So there’s only one family history factor. So you guys have to realize for example, I’ll see a family, the mom had a seizure after vaccines, her first child had a seizure after vaccines — and she has a new baby and she doesn’t want to give that baby vaccines. And as her doctor, I would agree. That’s a good family history reason not to vaccinate that child — or maybe do we delay them, or do we wait until years later, I don’t know. Maybe it’s temporary exemption because they’re a baby.

There is no single CDC guideline that would allow me to write that exemption under this new law. There is no family history involved whatsoever that that would justify me writing and exemption for that family because that is not in the CDC or the AAP or the ACIP guidelines.

And I appreciate that that the assembly members have asked a lot about family history. You have to realize how narrow that is. This new amendment did not broaden that in any way except for the select few as in the ladies example. Right, so there’s so many – but I mean I could list so many severe reactions I’ve seen moms or dads have or their first kids have after vaccines that I will use as legitimate family history to write an exemption for new baby in that family that will all go away under this new bill – those will all be disqualified. I think that’s important for you guys to understand that…”

Bob Sears SB 276 Assembly Health Committee Testimony

Why does he think “that’s a good family history reason not to vaccinate that child” and leave them at risk to get a vaccine preventable disease?

What are all of these severe reactions he has seen?

Is 6th nerve palsy a vaccine injury?
Is 6th nerve palsy a vaccine injury?

Does he see a lot of serious reactions after vaccines because he thinks everything is a vaccine injury?

There is a reason that having a family history of a vaccine reaction shouldn’t be a reason to skip or delay your child’s vaccines. It certainly shouldn’t be a reason for a doctor to write a medical exemption.

And that’s simply because the risk of having a severe vaccine reaction, even if a family member has had a severe vaccine reaction, is very low.

While Dr. Bob might think a family members having seizures after they were vaccinated is a legitimate reason to put a baby at risk to get one or more vaccine-preventable diseases, it isn’t.

Not only is a family history of an adverse event to a vaccine not a contraindication to getting vaccinated, it is commonly listed a false contraindication!

These are the type of medical exemptions, only those based on invalid criteria, that would be eliminated under SB 276.

“Of the cases that the Board has investigated to date, there have been no fraudulent medical exemptions found. The idea of rampant fraud is a scare tactic to advance SB 276, and a fantasy.”

Mary Holland on SB 276 Will Violate the Doctor-Patient Relationship by Eliminating Medical Exemptions

Interestingly, Bob Sears, who is already on probation, is still under investigation by the California Medical Board for writing fraudulent medical exemptions. So are many other doctors. Why hasn’t any fraud been found? The California Medical Board has had a hard time getting medical records to prove their cases! SB 276 will change that.

More on SB 276 and Medical Exemptions

Are There 6 Reasons to Oppose SB276?

Not surprisingly, folks are pushing misinformation in trying to get support in their efforts to oppose SB276, the California bill that will help stop doctors from writing fraudulent medical exemptions.

Are There 6 Reasons to Oppose SB276?

It also shouldn’t be a surprise that none of their “reasons” hold water.

There are no good reasons to oppose SB276.
There are no good reasons to oppose SB276.

Are the guidelines for writing medical exemptions too limited under SB276?

If you consider that true medical exemptions to getting vaccinated are not common, then no, they are not.

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.

What about the high rates of vaccination and low rates of exemptions in California?

Uh, what about the schools in California where 30 to 50% of students have medical exemptions? These clusters of unvaccinated kids with medical exemptions are the concern, not the overall rates of vaccination and exemptions in the state.

And it is only the doctors writing excessive medical exemptions that will trigger an investigation.

What about the Medical Board of California?

While the system that they have in place has allowed them to investigate some doctors, it has mostly failed. While they do have the authority to investigate physicians, for some reason, they can’t get medical records unless a parent cooperates.

“Ms. Simoes provided background on Senate Bill (SB) 277, which passed in 2015, eliminating the personal belief exemption from the requirement that children receive specific vaccinations for certain infectious diseases prior to being admitted to any school or daycare center. She explained that after the passage of SB 277, the Board has had a difficult time investigating complaints related to medical exemptions since an authorization of medical records needs to be signed and many parents or guardians do not want to sign the authorization since it would identify the doctor that provided the medical exemption. She explained that this causes a barrier to investigation since most medical exemption cases cannot be subpoenaed and medical records are needed to conduct an investigation.”

Discussion and Possible Action on SB 276 (Pan) Immunizations: Medical Exemptions

And the Medical Board of California supports SB276.

Who else supports SB276?

In addition to the Governor of California, supporters include the AAP, California Medical Association, California State PTA, Children’s Defense Fund of California, County of Los Angeles, Infectious Disease Association of California, and the March of Dimes.

What to Know About Reasons to Oppose SB276

It should be clear that there is no reason to oppose SB276, unless you don’t want your kids immunized and you want to find a doctor to write them a fake medical exemption.

More on SB276