Tag: medical exemptions

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

Which Part of the Herd Gets Protected by Community Immunity?

You are a part of the herd.

“I don’t care that you call people a herd. And I don’t care that some people consider themselves to be part of a herd. I am not in a herd. I am not a farm animal.”

Del Bigtree

Of course, we are talking about herd immunity.

Which Part of the Herd Gets Protected by Community Immunity?

What if you aren’t vaccinated and protected?

Del Bigtree is a "free thinking human being," who whether he appreciates it or not, benefits from herd immunity protections.
Del Bigtree is a “free thinking human being,” who whether he appreciates it or not, benefits from herd immunity protections.

Then you are protected by those who are!

“A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community.”

CDC Vaccine Glossary of Terms

That’s what herd immunity is all about.

In a community, “the herd” includes those with immunity and those trying/needing to “hide in the herd:”

  • those with natural immunity
  • folks who are vaccinated and protected
  • some people who are too young to be vaccinated or fully vaccinated
  • the people who’s vaccines didn’t work
  • anyone who can’t be vaccinated, because they have a medical contraindication

And it also includes those who are intentionally unvaccinated. The free-riders. Those who could be vaccinated, but simply choose not to, often because they have been scared by things they have heard or read about vaccines.

Baby deer need protection from the adults in the herd, but that doesn't mean that they aren't a part of the herd too.
Baby deer need protection from the adults in the herd, but that doesn’t mean that they aren’t a part of the herd too.

This all makes even more sense when you think about it as community immunity, the term that is more commonly used today.

Don’t want to think that you are in the herd?

That’s OK.

The herd still protects you. At least it does if enough folks in the herd are vaccinated and protected.

More on Community Immunity