California Lawmakers Consider Crackdown on Fake Medical Exemptions for Vaccines

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A nurse loads a syringe with a vaccine against hepatitis at a free immunization clinic for students before the start of the school year, in Lynwood on Aug. 27, 2013. (ROBYN BECK/AFP/Getty Images)

State lawmakers launched debate Wednesday on a new bill targeting doctors who write fraudulent medical notes to excuse children from getting vaccinations required to enter school. The hearing coincided with the recent declaration of measles outbreaks in Los Angeles and Butte County, bringing the number of cases of the virus to more than 30 statewide this year.

State Sen. Richard Pan (D-Sacramento) made his case for SB 276, saying families are skirting existing California law that forbids exemptions from vaccines for religious or personal objections by finding doctors willing to make up bogus medical excuses.

"We witnessed physicians who advertised exemptions for cash on social media and the internet," Pan said. "We’d see some parents post on social media that their child's regular physician refused to grant their child a medical exemption so they traveled to go purchase one from a distant physician."

The new legislation would require the state health department to review all medical exemptions and either approve or deny them. It would also create a database to track which doctors are issuing a disproportionate number of medical exemptions. About a hundred doctors, medical students, parents and representatives of hospital and insurance groups lined up to state their support of the bill.

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Critics flooded the state Capitol to voice their opposition to the proposal, with hundreds and hundreds of parents, and a handful doctors, lining up for hours to complain of government overreach and interference in the doctor-patient relationship.

"I believe in vaccines. I vaccinate my patients and my own children," said Dr. Nicole Shorrock, a pediatrician from Sacramento. "But I cannot support this bill because it is too extreme. Patients have a right to have their medical treatment determined by their doctor, not a governmental appointee."

The new bill is a follow-up to Sen. Pan’s earlier law, SB 277, passed in 2015, which outlawed personal belief exemptions from vaccinations. Since then, the number of children getting medical exemptions more than tripled, from .2 percent to .7 percent.

Two other states - West Virginia and Mississippi - do not allow exemptions from vaccines for religious or personal reasons. West Virginia requires its state health department to vet medical exemptions.

Overall, California’s vaccination rate among children entering kindergarten went up in recent years to 95.6 percent, a level public health experts say is needed to create community immunity — when enough of the population is immunized to protect people who cannot be vaccinated, such as infants and people with compromised immune systems.

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However, the rising number of medical exemptions is showing up in clusters around the state — in concentrations inconsistent with the number of people who legitimately cannot be vaccinated — and that is leaving some schools with vaccination rates lower than 50 percent.

"Students at these schools are at risk for a major outbreak," said Sen. Pan, who is also a pediatrician. "These schools, with these low vaccination rates, represent the tinder for a disease wildfire that can harm the broader community. California cannot allow a handful of unscrupulous physicians to put our children in danger."

Most doctors in California support vaccination and emphasize the safety and efficacy of vaccines. The California Medical Association, a powerful physician trade group that has often resisted efforts to track or control doctors, endorsed the bill last month.

“This new legislation will close a loophole in the current law that has allowed a small handful of rogue doctors to skirt the spirit of the original law and has put millions of Californians at risk,” said Dr. David Aizuss, the medical association president. “All physicians must do their part to protect the health of children and the public at large.”

The Senate Health Committee passed the bill on Wednesday. It goes next to Senate Appropriations, then faces several more committee votes to pass the Legislature.