When the mother of an 18-month-old visited Dr. Charles Goodman's practice last week, he explained that under his new policy, the toddler would have to be immunized to remain a patient.
The mother walked out of his office.
Amid the current measles outbreak, Goodman and a growing number of other pediatricians nationwide are turning away parents who refuse to vaccinate their children.
Of the more than 100 people who have contracted the virus so far, the majority were 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 has immunized 50 to 100 more 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.
Last week, providers at Southern Orange County Pediatric Associates decided to forgo new patients who don't plan to adequately vaccinate their children. Current patients are required to either develop a plan to catch up or find another doctor in 30 days.
Like Goodman's policy, required vaccines are for diseases that can be easily transmitted in the office or the community, including those for measles, whooping cough and chickenpox, said Dr. Eric Ball. So far, only a few parents have left as a result.
"If we allow parents to be in our practice who don't vaccinate their kids, we're passively telling them that it's OK," Ball said. "It's not OK for those families, the community and for other patients."
In setting the policy, however, Goodman and Ball are at odds with an American Academy of Pediatrics recommendation that pediatricians work with parents who refuse vaccines and not discharge patients.
"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 Dr. Mark Sawyer, a member of the AAP Committee on Infectious Diseases. "The hope is that we'll eventually get them to be immunized."
About five years ago, prompted by an increasing number of parents refusing immunizations, Dr. Aviva Biederman decided against accepting unvaccinated patients at her practice in Beverly Grove.
"I hope that some of the parents who refuse immunizations because of misinformation or because they just want to be contrary realize they're putting their children at risk," Biederman said. "It's like they're playing Russian roulette with their own children."
Beverly Hills Pediatrics has had a policy to only accept fully vaccinated patients since 2006.
"Our practice is a vaccinating practice, which means we don't see it as a controversial issue. Vaccines save lives," Dr. Inessa Grinberg said. "Most of our families are relieved to have a practice where they don't have to worry about meeting measles in the waiting room."
But other pediatricians fear that a policy of turning away children who don't receive all the recommended vaccines could eliminate the possibility of educating parents and helping them to eventually choose to vaccinate.
Dr. Monica Asnani, a pediatrician with the Medical Arts Pediatric Medical Group on Wilshire Boulevard in the Miracle Mile area, 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, haemophilus influenzae type B, pneumococcal conjugate, polio and measles, mumps and rubella. She said she doesn'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."
Natasha Richard, 40, held her squirming 1-year-old son Kristian as he received his hepatitis A and measles, mumps and rubella vaccines last week in Asnani's office. Richard said she follows all of the recommendations Asnani makes and believes vaccinations are important.
"Moms should get their babies vaccinated," Richard said. "This is not a game."
But some people feel the decision should ultimately be left in the hands of a child's parents — not a doctor. One mother, who asked that her name not be used due to potential backlash, said she has no plans to vaccinate her 18-month-old and her 3-year-old, after spending countless hours researching vaccines. As a result, she was dropped from a practice that will no longer accept unvaccinated children.
Because her family also visits a family physician, who specializes in homeopathics and alternative medicine, she said they didn't have to look for someone else to replace her pediatrician.
"If I didn't have another doctor I'd be really scared, because no one is going to be accepting any unvaccinated patients right now, I would think," she said. "Every doctor should be able to have their own opinion, but having it forced upon people … it's just not right."
Dr. Leila Bozorgnia doesn't turn away children who aren't vaccinated, but she said all of her patients are vaccinated. Bozorgnia, the primary pediatrician at California Kids Pediatrics on Sepulveda Boulevard on the Westside, attributes that to meeting early with parents and making it clear that she believes it's harmful not to vaccinate.
Bozorgnia said she keeps patients who delay vaccinations because she doesn't want them to go somewhere in which 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 willing to help parents who refuse to vaccinate find another doctor. Although Goodman initially feared that he would lose up to a quarter of his practice, he said that so far he has lost only five to 10 patients and has 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."