Wednesday, April 18, 2012

California's AB 2109: Will Vaccine-Refusing Families Have A Hard Time Finding Health Care?

Here's Dr. Bob Sears on the issue:
However, what gravely concerns me is that some doctors will refuse to sign this form. I know how doctors think. Many doctors strongly believe that vaccines should be mandatory, and that parents should not have the right to decline vaccines. Some doctors are willing to provide care to unvaccinated kids, despite this difference in philosophy. But now the power over this decision will be put directly into doctors' hands. He or she can simply refuse to sign the form. Doctors who oppose vaccine freedom of choice have been frustrated for years over this issue. Finally, they will have the power to impose their beliefs on their patients. Patients will be forced to find another doctor to sign the form, submit to vaccines, or get kicked out of public school.
Several things to notice: he's sure that only doctors can sign the form (wrong: Physician Assistants and Nurse Practioners with appropriate qualifications can sign); and notice that he doesn't quantify anything, or use any facts.  It's just "I know how doctors think" and the threat of "being kicked out of public school".

It's important to know how many vaccine providers there are (pediatricians, family practice MDs, and the county health departments' low-cost or free vaccine clinics) and how many of those would "fire" or discharge vaccine-refusing families.

The survey of physicians reported at the 2011 meeting of Infectious Diseases Society of America showed enormous regional variation in practice responses to vaccine refusal.  The survey didn't cover California or the West at all.

Let's look at some real doctors.

Heidi Roman MD is a mother and a pediatrician who practices in California.  She recently wrote Why I Won't Fire Vaccine-Hesitant Families, giving three sound reasons
....the particular issue of families who are hesitant about vaccinating their children is something all child health providers have come across. I won’t dismiss patients/families for this reason.
Wendy Sue Swanson MD practices in Washington state, but has written (and made videos) about vaccine issues.  In Pediatricians Who Refuse Families Who Don't Immunize, she wrote
I will always keep my practice open to vaccine-hesitant families. However, the waiting room risk (unimmunized kids & risk to vulnerable populations–ie infants, those too young for vaccines, and immunocompromised children) is a good one and the only compelling reason to close to patients who refuse immunizations in my opinion.
But it’s not a good enough reason for me to send families away who have questions and hesitations about the AAP/CDC schedule. All children deserve a pediatrician versed in immunization benefit/risk & deserve an expert in conversation w their parents to foster insight & understanding. Frankly, if waiting room risk is the concern, there are ways to create separate waiting rooms for kids “up to date” and kids who are not.
Roy Benaroch, MD at The Pediatric Insider develops a typology of vaccine-refusing parents, and  concludes: own philosophy that it’s not the kids fault they’re not vaccinated; and with patience and continuous discussions, I can usually get even the most stubbornly misinformed parents to vaccinate. So finally, with a lot of extra work, the kids get protected. That’s my goal.
Linda Shaw MD practices in a low-income area, and has very, very few vaccine-hesitant or vaccine-refusing families.  Given the constraints of her practice,
Our practice group has decided that caring for vaccine-refusing patients is too much of a liability risk. We will alter vaccine schedules if the parents request it, but they are informed that they may have additional out-of-pocket costs. Patients who adamantly refuse to consider immunization for their children are asked to find another provider to see them. (We will also discharge from the practice patients who chronically "no show" for appointments.)
I think that even if AB 2109 passes, the California Medical Association or the two Public Health Associations (North and South) should sponsor research into the facts on vaccine refusal and hesitancy in California.

1 comment:

  1. Gosh, Dr. Bob Sears misrepresented the landscape? Colour me surprised.

    I agree with your suggestion about surveys regarding vaccine refusal rates. I would also like to see some stats about VPDs and "vaccine friendly" physicians although getting them to comply or participate in such a study is not going to happen.