Kids are the ones stuck in the middle over health records

Ottawa’s health unit will start ordering children suspended from school over their vaccination records in the new year, even though its top managers know that’s just about the worst thing they can do for kids whose parents haven’t gotten them their shots.

Suspension punishes kids, many of whom live in chaotic households where parents can’t or won’t keep up. There were a few hundred cases like that last year, Ottawa Public Health believes.

The first round of this year’s warnings has gone out over the past couple of weeks, about 28,800 of them, to households where children are in school but don’t have up-to-date records with the health unit. Its job is to make sure that children who can’t be vaccinated aren’t endangered by kids who can be but aren’t. Many of these are just paperwork problems: kids get vaccinations against things like measles and polio and chicken pox from doctors and nurses at clinics, but it’s up to parents to tell the health unit about them.

That was why I got a letter — over a shot my kid got in 2013 but that we neglected to report.

“It’s a little bit silly,” acknowledges Dr. Isra Levy, Ottawa’s medical officer of health. “I realized that when I received one of those letters myself.”

But for privacy reasons that prevent doctors from reporting on their patients’ health to the authorities, parents have to do the work. Levy and his unit try to make it easy — you can do it online, over the phone, by mail, using an app. Those who are still delinquent in the new year can expect to get notices of impending 20-day suspensions for their children, and if they still don’t catch up, the kids will be barred from school in February or March.

Parents can get their children exempted from vaccinations for specific medical reasons or on religious or philosophical grounds. You have to talk to a public-health nurse and swear out an affidavit testifying to your beliefs, which costs money, but practically every parent who objects to vaccines for such reasons fills out the forms to get the health unit off his or her back. Exemptions cover about two per cent of Ottawa students.

Last year, the second in an aggressive catch-up campaign, the health unit says it sent out about 59,000 warnings. Those led to 26,800 suspension notices and 7,850 actual suspensions. Most didn’t last longer than a day or two. The few hundred that did got individual attention from the health unit, starting with phone calls to the parents.

“They don’t have a physician, they’re not sure what to do, there’s some other issue with the family,” says Marie-Claude Turcotte, the health unit’s manager for vaccine-preventable diseases. Sometimes all it takes is reassuring parents that vaccinations are free and telling them where the nearest walk-in clinic is. They just need a nudge, maybe in a language other than French or English.

“In some situations, we have found parents who are struggling with life,” Turcotte says.

Some parents are ill. Some are working three part-time jobs and helping a sick grandparent, and it’s all they can do to keep the kids fed and clothed. A phone call from a nurse usually gets these cases sorted out.

Sometimes the parents are neglectful or abusive, they’re in and out of the house, the Children’s Aid Society is involved, and in the swirl of madness the children haven’t been to a doctor in years. If they look at the mail at all, some parents figure, wrongly, their kid will be able to go back after the 20 days are up.

At the other extreme: “We had some cases where parents were away on vacation and the kids were left with a babysitter. We were able to put exemptions in so those kids were able to get back to school without waiting,” Turcotte says.

Public-health nurses give shots by appointment at the unit’s Centrepointe headquarters; last year so many kids were on the warning list they had open clinics. Just about the only thing they can’t do is go out to a child’s home with a syringe and vials. “We can’t do that for safety reasons, because we need to have access to medical care if there’s a reaction,” Turcotte says.

Whatever’s going on, the kids in the middle are innocent. School can be an important island of stability, maybe their best way out of chaos they didn’t create.

“These are kids that need to go back to school,” Turcotte says.

We had some cases where parents were away on vacation and the kids were left with a babysitter.