Bill would strengthen vaccination laws, checking up on doctors who write exemptions

State Sen. Richard Pan, center, discusses his proposed measure to tighten California's law requiring childhood vaccinations.
(Rich Pedroncelli / AP)

California legislators introduced a bill Tuesday that would tighten the state’s childhood immunization law, already one of the strictest in the nation.

Children in California must be fully vaccinated to attend public or private schools, unless a doctor says they have a medical reason not to have all their shots.

But since California’s tough inoculation law was passed in 2015, the number of children with medical exemptions has grown, while physicians have been accused of excusing children from immunizations for questionable reasons such as for having asthma or diabetes.


The new bill, SB 276, would address this loophole by requiring the state health department to vet each medical exemption form written by physicians. The department would also maintain a database of exemptions that would allow officials to monitor which doctors are granting the exemptions.

The bill was introduced by Sen. Richard Pan (D-Sacramento), a pediatrician who authored the 2015 vaccine law, as well as Assemblywoman Lorena Gonzalez (D-San Diego). The California Medical Assn. is sponsoring the bill.

Currently, no regulatory body in California is charged with ensuring the exemptions are valid, leaving the decision fully in the hands of physicians, Pan said.

“Unfortunately, a few unethical physicians advertise medical exemptions for cash,” Pan said at a news conference in the state Capitol.

During the 2017-18 school year, at 105 schools in the state, 10% or more of kindergartners had a medical exemption. That dropped their collective immunity below the 95% threshold that physicians say is needed to prevent outbreaks of highly contagious disease such as measles.

Though vaccination rates have jumped overall in California, the number of kindergartners with medical exemptions spiked 441% after the law took effect.

Eric Ball, a pediatrician from Orange County representing the American Academy of Pediatrics, said he fears a measles outbreak is on the horizon as medical exemptions increase. His county was at the epicenter of a major outbreak in 2015 linked to Disneyland, which prompted California’s tough vaccination law.

“What we are seeing in our community and in our state is that our vaccination rate for the first time is going down,” Ball said at the news conference. “We are seeing that because of the increase in bogus medical exemptions and by false information being spread across the internet.”

But Rebecca Estepp, who was part of a group that opposed the original vaccine law, said she feels medical exemptions are facing undue scrutiny. Though some schools have higher medical exemption rates, only 0.7% of kindergartners have a medical exemption statewide, she pointed out.

“This just seems like overkill,” Estepp said in an interview. “It’s oppressive and burdensome, and the fact that [Pan is] going to insert bureaucrats in between the patient-doctor relationship is really troubling.”

Under the law, officials would rely on federal guidelines to determine which reasons are valid for vaccine exemptions, according to the bill’s text.

Doctors would be unable to exercise “their education, their history and their relationship with the patient,” something that legislators who passed the original vaccine law had said they would not ban, Estepp said. Gov. Jerry Brown’s signing message for the law specifies that exemptions are left up to “the judgment and sound discretion of the physician.”

Estepp also worried that a state-run database of exemptions would frighten physicians out of writing them for valid medical reasons, such as a child undergoing chemotherapy.

“What doctor is going to want their name on a database?” she said. “It’s going to be very difficult to have a doctor want to write an exemption under this sort of scrutiny.”

California is one of three states — the others are West Virginia and Mississippi — that does not allow parents to get out of vaccinating their children for religious or personal belief reasons.

In West Virginia, each exemption must be vetted by the public health department. Their medical exemption rate is half of California’s.

California’s bill would create a standardized form for requesting the medical exemptions that would include the reason for the exemption, physician’s name and license number. The bill also calls for all exemptions currently on file at schools to be sent to the public health agency by July 1, 2020 for possible review.

“It’s not often that we say in California that we are going to meet the Mississippi and West Virginia standard — but that is what we need to do now,” Gonzalez said at the news conference.

Gonzalez said she was struck by reports that a doctor in San Diego had written nearly one-third of medical exemptions in the San Diego Unified School District.

Since the 2015 vaccination law was passed, only one California physician has been sanctioned for fraudulently writing medical exemptions. Orange County-based Dr. Bob Sears was put on probation last year for excusing a 2-year-old from all vaccines.

The medical board, however, is investigating many more doctors. In addition to the complaint that launched the Sears investigation, more than 50 others have been filed against physicians who are accused of improperly writing exemptions in the past four years, according to the state medical board.

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