Wasn’t SB 277 enough?
No. While SB 277 was successful in raising immunization rates across the state, the percentage of kindergartners with medical exemptions has more than quadrupled (from 0.2% in 2015-16 to 0.9% in 2018-19). According to public health officials, the rise in medical exemptions is associated with an increase in physicians issuing exemptions for children without medically-justified contraindications. While the vast majority of physicians continue to uphold standards of care, there are small number of unscrupulous doctors who have monetized their medical license by providing large numbers of exemptions for profit. As a result of concentrated pockets of unvaccinated individuals, measles outbreaks are on the rise in California.
If there are only a small number of physicians acting unethically, why is this bill necessary?
It only takes a few physicians abusing the medical exemption process to have a big impact on local public health. Even a single physician can create large clusters of unvaccinated individuals in a community. These clusters can lead to vaccine rates falling below the 95% needed to prevent outbreaks of the most contagious vaccine-preventable diseases (i.e. measles), leaving many people susceptible to the disease.
Does SB 276 undermine parental or physician’s rights?
No; under SB 276, parents will continue to have the right to seek exemptions and physicians will continue to have the right to issue exemptions whenever there is a medical necessity. Current law states that to issue a medical exemption, physicians must provide a written statement that the child’s physical condition or medical circumstances are such that “immunization is not considered safe.” If passed, SB 276 will ensure consistency and quality by weighing all medical exemptions against the same safety guidelines and requiring public health oversight in instances where public health is most at risk.
Does the bill specify which conditions are acceptable for receiving a medical exemption? Will exemptions only be accepted based on CDC guidelines?
No. While SB 276 references guidelines published by the Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP), it does not specify conditions within the law. Following recent amendments, exemptions may be accepted for reasons outside these guidelines if they align with standard of care. Family medical history may also be included in the evaluation of exemptions, and previous medical exemptions will remain valid long as they are consistent with standard of care.
If I provide information on my child’s medical history, can you tell me whether their exemption will remain valid?
No, we cannot comment on individual cases or specific exemption requests. The requirement that exemptions will be reviewed by clinically trained staff is foundational to our bill. We are happy to discuss details of the legislation, but physicians and clinical public health officials are better equipped to review medical exemptions. There are a wide variety of reasons that a medical exemption may be warranted and approved by CDPH—these include all precautions and contraindications including the ACIP guidelines, the AAP Redbook guidelines, and any other reasons that align with standard of care, including family medical history.
Are physicians limited to only 5 exemptions?
No, there is no limitation on the number of medical exemptions that a single physician can write. However, exemptions issued by physicians and surgeons who submitted five or more medical exemption forms in a calendar year will be reviewed. CDPH will additionally notify the California Medical Board of any physician who submits an exemption that is denied or revoked, and of any physician from whom they are not accepting exemptions.
Will this deter physicians from wanting to issue exemptions at all, even for legitimate reasons?
No. SB 276 is sponsored by the California Medical Association (CMA) and is supported by physicians. Physicians who write medical exemptions that are consistent with standard of care and align with CDC, ACIP and AAP guidelines will not have a difficult time getting the medical exemption accepted. There is no limit to the number of exemptions a physician may submit, and no penalty for issuing more than five exemptions per year.
Does the bill specify a timeline or deadline for exemption approval?
No. The only timeline or deadline specified within SB 276 is that existing exemptions must be filed with the California Department of Public Health (CDPH) by January 1, 2021. Students will be able to attend school during the CDPH review process as well as during any appeal process.
Has this model been implemented elsewhere?
Yes, the medical exemption process outline in SB 276 is very similar to the process West Virginia has had in place since 2015. Similar to California, West Virginia does not allow personal belief or religious belief exemptions. West Virginia, however, requires approval from a public health official for all medical exemptions. Under SB 276, medical exemptions will be reviewed by a public health official only if they are from: 1) a school with an overall immunization rate of less than 95%; 2) physicians and surgeons who submitted 5 or more medical exemption forms in a calendar year; or 3) schools and institutions that do not report immunization rates to the department.
Will all exemptions be reviewed?
No. Under SB 276, medical exemptions will be reviewed only if they are from: 1) a school with an overall immunization rate of less than 95%; 2) physicians and surgeons who submitted 5 or more medical exemption forms in a calendar year; or 3) schools and institutions that do not report immunization rates to the department.
What happens to existing exemptions?
Existing medical exemptions must be submitted to CDPH by January 1, 2021 in order to remain valid. Existing exemptions will be reviewed according to the same thresholds and standards as future exemptions.
Can’t the California Medical Board just go after the “bad apple” doctors?
The California Medical Board’s process is not designed for this situation and has not been effective in preventing abuse of the exemption process. Previously, the Medical Board was only aware of cases that were specifically reported. SB 276 empowers the Medical Board by requiring CDPH share information to the Medical Board of California on physicians whose medical exemptions pose a public health risk. The Medical Board recently voted to support SB 276, because the bill will give them the information they need to hold doctors accountable who are abusing the process.
Is this an invasion of privacy? Can CDPH maintain confidentiality?
Both the CMIA (California Confidentiality of Medical Information Act) and HIPAA (federal Health Insurance and Portability and Accountability Act) allow health care providers to disclose confidential medical information to state and local health officials for purposes of preventing or controlling disease. The CDPH regularly oversees confidential and sensitive vital records, such as birth and death records, and has a strong record of maintaining confidentiality with no known issues or breaches of those databases.
Last updated 8/12/2019