California Medical Board Supports Enabling Investigation of Doctors Granting Fake Medical Exemptions

Senate Bill 276 will strengthen oversight of the medial exemption process, which some doctors in the state are abusing by selling medical exemptions to parents

May 29, 2019

SACRAMENTO – As our country is experiencing the greatest number of measles infections in 25 years – 940 cases this year to date – the California Medical Board voted on Tuesday to support requirements in SB 276 that there is a review of medical exemptions and allow the Medical Board to receive medical exemption data to allow investigations of unscrupulous physicians.

“I appreciate that the Medical Board of California voted to support requiring reviews of medical exemptions,” said Dr. Richard Pan. “SB 276 addresses barriers to the Medical Board’s ability to perform their duty to protect the public, and the Medical Board recognized that they need SB 276 to investigate unprofessional behavior on the part of physicians violating standard of care and endangering the public by selling inappropriate medical exemptions.”

“I am pleased the Medical Board recognizes that current law is not sufficient to protect children and communities,” said Leah Russin, a mother from Palo Alto and co-founder of Vaccinate California, a group of parents who volunteer their time and energy to support vaccines in California. “The thousands of parents of Vaccinate California agree that oversight of medical exemptions is necessary.” 

Under our current review system, the Medical Board can only act after the fact— they cannot prevent or invalidate unjustified medical exemptions. This system allows measles and other vaccine-preventable diseases to take hold and spread in communities with low vaccine rates. 

The Medical Board’s staff analysis for SB 276 emphasized further barriers that currently exist that have prevented the Board from investigating unethical physicians selling medical exemptions: “For all quality of care cases, the Board must obtain authorization from the patient or their parent or guardian (if the patient is a minor) to release the medical records. For medical exemption cases, many times the parent or guardian does not want the Board to investigate the physician who issued their medical exemption, so the parent will not sign an authorization. This has created barriers to the Board investigating these cases because for most of these medical exemption cases, the Board does not have enough evidence to subpoena the medical records. Without the medical records, the Board’s physician expert cannot review the case to determine if the physician acted within the standard of care.”

Under SB 276, physicians will submit information to California Department of Public Health (CDPH), including the physician’s name and license number and the reason for the exemption, which CDPH will check to ensure they are consistent with the Center for Disease Control’s precautions and contraindications to vaccination. The physician must also certify that they have examined the patient in person.

Additionally, under SB 276, CDPH will create and maintain a database of medical exemptions. CDPH and County Health Officers will have the authority to revoke medical exemptions granted by licensed physicians if they are found to be fraudulent or inconsistent with contraindications to vaccination per CDC guidelines. This authority will give state and county health officers the tools necessary to contain and prevent further outbreaks. Data on physicians writing large numbers of inappropriate medical exemptions will be provided to the Medical Board of California, to investigate unprofessional conduct.

As the Medical Board’s staff analysis of SB 276 pointed out, the Board is only aware of cases that are specifically reported. Even when a physician is reported, the Board usually doesn’t have enough information to investigate questionable exemptions unless the parents choose to share information, which will not happen in these situations because the parents are working in concert with the physician. In fact, since the passage of SB 277, the Board has only completed one investigation related to medical exemptions.

As a result of the implementation of Senate Bill 277, which abolished the personal belief exemption in California, overall vaccination rates increased sharply to more than 95 percent statewide.  That is greater than the 94 percent vaccination rate necessary to achieve community immunity to prevent the spread of a measles outbreak.

The increase followed the dramatic increase from 92.9 percent in the 2015-16 school year to 95.6 percent in the 2016-17 school year after implementation of SB 277 in 2016 and a vaccination rate of only 90.7 percent in 2010-11 when Dr. Pan entered the legislature and authored AB 2109. AB 2109 required parents to be counseled before they opted out of legally mandated vaccines.

Despite the success of SB 277 in increasing the overall immunization rate of kindergarten students, California has also experienced a dramatic increase in the number of medical exemptions. Since the passage of SB 277, the rate of medical exemptions has more than tripled (from 0.2% in 2015-16 to 0.7% in 2017-18). Low vaccination rates in certain pockets of the state have put children and communities at risk.

A very small percentage of the population, less than 1 percent, suffers from qualifying medical condition, such as a severe allergic reaction to a vaccine component that would lead to the granting of medical exemption.

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