Children Enter School Without Physical Exam : Health: Last year many parents used a loophole that allows waiver of the checkup for religious or cultural reasons.

Nearly 10,000 children in Orange County entered first grade last year without proof of taking a state-mandated physical examination, in many cases because of widespread abuse of a loophole that allows parents to waive the exam for religious or cultural reasons.

A June report by the Orange County Health Care Agency revealed that in the 1989-90 school year, more than a third of the parents in some school districts sidestepped the Child Health and Disability Prevention program by signing the waivers, bringing the districts into overall compliance with the law but possibly denying thousands of children the chance for early diagnosis of medical maladies.

The report also showed that more than half of the parents in some districts failed to submit either proof of an examination or a signed waiver, leading county health officials to estimate that perhaps as much as 32% of first-graders countywide were not medically checked. Of 30,000 new first-graders in the county, 20,279 received physicals, 3,245 presented signed waivers and 6,434 had no documentation.

The health program, which started in 1975, mandates a physical examination that includes developmental and physical assessments, blood tests, hearing and vision exams and tests for a wide variety of ailments. The program is intended to detect, prevent or treat disabilities or developmental problems that could affect a child’s ability to learn.

Many parents, however, are getting around the law by using a provision that allows them to sign a waiver exempting their children from physical examinations. The exemption was added to the law for parents whose religious or cultural beliefs prohibit them from taking their children in for medical tests.

Marian Ryan Henry, a health educator in the child health unit of the County Health Care Agency, said that countywide, more than 3,000 parents, or nearly 11%, turned in waivers last year, but health officials estimate that less than 5% of the county’s population has legitimate religious or cultural prohibitions to medical tests.

The waivers “legally meet the requirements in terms of the law, but they undermine the (child health) program,” Henry said. “They are supposed to be (used) only for reasons of deeply held personal beliefs, not convenience.”

The percentage of parents signing waivers in Orange County far surpassed statewide figures. During the 1988-89 school year--the lastest for which statewide figures were available--76.4% of first-graders throughout the state received medical exams, and waivers were submitted for only 5.3%. No documentation was submitted for the remaining 18.3%.

As an example of overuse of waivers, the County Health Care Agency report cited the Placentia Unified School District. While the district was 100% in compliance with the law, only 57% of the children were actually examined. Waivers were submitted for the remaining 43%.

Sharon McHolland, an assistant superintendent of the district, said that the provision of the law allowing parents to sign waivers also prohibits districts from verifying whether parents have legitimate religious or cultural reasons for doing so. The district, she said, can do little more than attempt to educate parents on the need for medical examinations.

“We try to approach this from the educational standpoint that it’s good to do this for your child,” McHolland said.

In districts where few parents signed waivers, the rates of compliance were substantially lower. The Huntington Beach City School District, where just one parent signed a waiver, 57.4% of the first-graders did not have documentation of a physical, the highest rate of non-compliance in the county. In the Santa Ana Unified district, just 15 of 4,451 first-graders brought in waivers, and parents who complied with the law were about equal to the number that did not. “We don’t encourage signing waivers because we think it’s important to encourage parents to get an examination for their children if at all possible,” said John Bennett, assistant superintendent in charge of the Santa Ana district’s elementary division.

Henry and other health officials said low rates of compliance or excessive use of waivers is partially attributable to misunderstanding of the law by parents. Henry said that many parents are unaware that any physical examination done within 18 months before a child’s enrollment in first grade qualifies under the Child Health and Disability Prevention program.

Parents may also be unaware that physical examinations can be obtained at no charge, Henry said. She also said that increased funding from Proposition 99, the state surtax on cigarettes and other tobacco products, has provided enough money for the county to expand the program to all low- and moderate-income children through age 18. Previously, exams were available only to children up to age 6, and no follow-up treatments were funded.

PHYSICAL EXAM COMPLIANCE IN COUNTY SCHOOLS

1989-90 Number of % % * % District 1st-Graders Examined Waivers Undocumented Capistrano Unified 2,088 82.8 17.2 0.0 Placentia Unified 1,624 57.0 43.0 0.0 Brea-Olinda Unified 389 74.0 25.7 0.3 Cypress 582 87.6 10.8 1.6 Ocean View 953 72.3 25.9 1.8 Laguna Beach Unified 146 83.6 13.7 2.7 Centralia 667 67.3 28.5 4.2 Irvine Unified 1,685 87.3 6.2 6.5 Fountain Valley 576 89.0 0.9 10.1 Anaheim City 2,222 72.3 12.7 15.0 Saddleback Valley Unified 1,991 74.2 9.0 16.8 Fullerton 1,225 79.6 2.4 18.0 Westminster 947 74.2 7.3 18.5 Magnolia Elementary 733 56.5 23.2 20.3 Buena Park 504 51.0 28.2 20.8 Garden Grove Unified 3,188 74.7 4.1 21.2 Savanna 293 52.2 25.9 21.8 Newport-Mesa Unified 1,304 74.4 3.6 22.0 La Habra City 533 72.6 4.3 23.1 Los Alamitos Unified 445 74.2 2.0 23.8 Tustin 862 57.5 6.7 35.7 Orange Unified 1,947 48.2 11.4 40.4 Santa Ana Unified 4,451 50.3 0.3 49.4 Huntington Beach City 603 42.5 0.1 57.4 TOTAL 29,958 67.7 10.8 21.5

1989-90 ** Total District Compliance Capistrano Unified 100.0 Placentia Unified 100.0 Brea-Olinda Unified 99.7 Cypress 98.4 Ocean View 98.2 Laguna Beach Unified 97.2 Centralia 95.8 Irvine Unified 93.5 Fountain Valley 89.9 Anaheim City 85.0 Saddleback Valley Unified 83.2 Fullerton 82.0 Westminster 81.5 Magnolia Elementary 79.6 Buena Park 79.1 Garden Grove Unified 78.8 Savanna 78.1 Newport-Mesa Unified 77.9 La Habra City 76.9 Los Alamitos Unified 76.1 Tustin 64.2 Orange Unified 59.6 Santa Ana Unified 50.6 Huntington Beach City 42.6 TOTAL 78.5

* Denotes percentage of children who entered first grade without a signed waiver or proof of medical examination.

** Denotes total percentage of children with signed waivers or proof of medical examination.

Source: Orange County Health Care Agency