Amid a California-centered measles outbreak, a Los Angeles pediatrician has told the parents of young unvaccinated patients: Get them vaccinated, or find a new doctor.
The Northridge office of Dr. Charles Goodman will not accept new patients whose parents have decided to forgo immunizing them against communicable diseases, including measles. That includes any of the doctor's existing patients who haven't received recommended vaccines.
Goodman said Wednesday that since the policy was adopted just over a week ago he had seen an increase in immunized patients at his practice.
But some fear the policy could shut out some parents who are on the fence about vaccinations.
Goodman said the move was prompted by the current measles outbreak, which has spread to at least 119 people in eight states and Mexico, with 103 of the cases in California. The majority of people who have contracted the disease are unvaccinated, according to the Centers for Disease Control and Prevention.
"We decided that the patients who are not vaccinated are presenting a clear and present danger," said Goodman, who has been a pediatrician for more than 20 years.
"It just wasn't fair for a small number of patients to put those many patients, who either couldn't be vaccinated because they're too young or had a weakened immune system, at risk."
Since he implemented the requirement, Goodman said he'd immunized 50 to 100 patients who he believes would not have gotten the measles, mumps and rubella vaccine otherwise. Patients who refuse to abide by Goodman's policy have a month to find a new doctor.
In setting his policy, however, Goodman is at odds with an American Academy of Pediatrics recommendation that pediatricians work with parents who refuse vaccines and not discharge patients from practices solely based on parents' refusal to immunize them.
"The AAP feels that pediatricians are by far the best resource of information for parents who have concerns about vaccines and that if pediatricians are turning patients away from their offices, we're going to lose that opportunity to try and educate them," said Mark Sawyer, a member of the AAP Committee on Infectious Diseases. "The hope is that we'll eventually get them to be immunized."
Sawyer added that he believed most pediatricians felt a "crisis point" had been reached in California with unimmunized children. Policies like Goodman's are a way for pediatricians to send a message about the dangers of not vaccinating, Sawyer said.
Some pediatricians fear, however, that a policy of turning away children who don't receive all the recommended vaccines could reduce the chances of educating parents and steering them toward an eventual decision to vaccinate.
Dr. Monica Asnani, a pediatrician with the Medical Arts Pediatric Medical Group on Wilshire Boulevard in Beverly Grove, said she saw a pattern three years ago of people getting fewer vaccines for their children. Worried about a potential outbreak, she implemented a policy requiring patients to have had at least two-thirds of recommended vaccinations.
Vaccines that Asnani recommends include: diphtheria, tetanus and pertussis, influenza type B, pneumococcal conjugate, polio and measles, mumps and rubella. She said she didn't plan to require her patients to get all the recommended vaccines.
"My philosophy is that if I shut my door completely to people who maybe are on the fence about vaccines or want to do some and not all, they're just going to find another doctor who will accept them and not educate them," Asnani said. "And then I'm not able to protect that child."
Although Dr. Leila Bozorgnia doesn't turn away kids for not vaccinating, she said all of her patients were vaccinated. Bozorgnia, the primary pediatrician at California Kids Pediatrics on Sepulveda Boulevard in Rancho Park, attributes that to meeting early with parents and making it clear that she believes it's harmful not to vaccinate.
Bozorgnia said she kept patients who delayed vaccinations because she didn't want them to go somewhere they might not receive vaccinations at all -- which she fears could be a consequence of policies that turn patients away.
"I think on the one hand it kind of brings to the foreground a very serious issue we have with non-vaccinating families," Bozorgnia said. "The other side of it is that by doing that you might also be closing the door for having that open discussion and conversation and potentially converting some of these parents who have a lot of fears."
Despite concerns, Goodman said he was meeting with patients and was willing to help parents who refused to vaccinate find another doctor. Although Goodman initially feared he'd lose up to a quarter of his practice, he said that so far he'd only lost five to 10 patients and had received a mostly positive reaction to the policy.
"I would encourage other pediatricians as well as family practitioners that treat children to do the same thing," Goodman said. "Put your foot down now; tell those kids they need to get the immunizations."