Cal­i­for­nia broad­ens in­ves­ti­ga­tion over vac­ci­na­tion ex­emp­tions

The Fresno Bee (Sunday) - - News - BY BAR­BARA FEDER OSTROV Cal­i­for­nia Health­line

The Cal­i­for­nia agency that reg­u­lates doc­tors is in­ves­ti­gat­ing at least four physi­cians for is­su­ing ques­tion­able med­i­cal ex­emp­tions to chil­dren whose par­ents did not want them im­mu­nized.

The Med­i­cal Board of Cal­i­for­nia’s in­ves­ti­ga­tions are un­fold­ing amid the na­tion’s worst measles out­break in more than a quar­ter-cen­tury, as Cal­i­for­nia law­mak­ers con­sider con­tro­ver­sial leg­is­la­tion to tighten the re­quire­ments for ex­empt­ing chil­dren from the vac­ci­na­tions re­quired to at­tend schools and day care cen­ters.

Last month, the Depart­ment of Con­sumer Af­fairs, which over­sees the med­i­cal board, sued in state court to ob­tain med­i­cal records for pa­tients of Sacra­men­toarea pe­di­a­tri­cians Dr. Kelly Sut­ton and Dr. Michael Field­ing Allen.

In the past nine months, the board also has sought pa­tients’ records in con­nec­tion with two Santa Rosa physi­cians un­der in­ves­ti­ga­tion for writ­ing al­legedly in­ap­pro­pri­ate ex­emp­tions.

The state acted on the Sut­ton and Allen cases fol­low­ing com­plaints to the med­i­cal board from Dr. Wendy Cerny, as­sis­tant chief of pe­di­atrics at a Kaiser Per­ma­nente clinic in Ro­seville, court doc­u­ments show. (Kaiser Health News, which pro­duces Cal­i­for­nia Health­line, is not af­fil­i­ated with Kaiser Per­manante.) Cerny con­tacted the board about Sut­ton in Fe­bru­ary 2017 and fol­lowed up with an email about Allen 15 months later, ac­cord­ing to the doc­u­ments.

Cerny be­came con­cerned af­ter seeing per­ma­nent med­i­cal ex­emp­tions for Kaiser Per­ma­nente pe­di­atric pa­tients writ­ten by Sut­ton and Allen that cited rea­sons in­clud­ing “a per­sonal his­tory of genetic de­fect,” food and en­vi­ron­men­tal al­ler­gies, “neu­ro­log­i­cal vulnerabil­ity” and a fam­ily his­tory of men­tal health dis­or­ders, ac­cord­ing to the le­gal doc­u­ments.

The doc­tors un­der in­ves­ti­ga­tion are not Kaiser Per­ma­nente doc­tors, but par­ents went to them for vac­ci­na­tion ex­emp­tions. In one case, Sut­ton is­sued a “life­long med­i­cal ex­emp­tion from all vac­cines” to a boy be­fore his fam­ily joined Kaiser Per­ma­nente, ac­cord­ing to Cerny’s com­plaint. When one of Cerny’s col­leagues re­fused to write sim­i­lar ex­emp­tions for the boy’s two younger sib­lings, the mother said she would go back to Sut­ton to get them, the com­plaint says.

“We feel this doctor and per­haps her col­leagues … are mak­ing easy money on these ex­emp­tions that are not based on true med­i­cal need and are ac­tu­ally putting chil­dren and other peo­ple in the com­mu­nity at risk for con­tract­ing and spread­ing serious in­fec­tious dis­eases,” Cerny wrote in her com­plaint about Sut­ton.

A physi­cian ap­pointed by the med­i­cal board to re­view ex­emp­tions is­sued by Sut­ton and Allen de­scribed them as “ei­ther of ques­tion­able va­lid­ity or patently with­out med­i­cal ba­sis.”

Vac­cine ex­emp­tions for med­i­cal rea­sons should be rare, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. They are typ­i­cally reserved for chil­dren with se­verely com­pro­mised im­mune sys­tems, like those be­ing treated for can­cer or those who are al­ler­gic to a vac­cine com­po­nent or have pre­vi­ously had a se­vere re­ac­tion to a vac­cine.

A spokesman for the med­i­cal board de­clined to com­ment on the cases. The agency gen­er­ally does not ac­knowl­edge in­ves­ti­ga­tions pub­licly un­less a for­mal ac­cu­sa­tion is filed against a physi­cian.

But the board’s le­gal ef­forts to ob­tain patient records sheds rare light on how the agency han­dles such com­plaints.

It “tells me that there are doc­tors who are giv­ing problemati­c ex­emp­tions and the Med­i­cal Board of Cal­i­for­nia is taking this is­sue very se­ri­ously,” said Dorit Reiss, a pro­fes­sor at University of Cal­i­for­nia Hastings Col­lege of the Law in San Fran­cisco who re­searches vac­cine law.

Sut­ton and Allen did not re­spond to phone calls and emails seek­ing com­ment.

Sut­ton, based in Fair Oaks, is known as a go-to doctor for med­i­cal vac­cine ex­emp­tions. She of­fers a $97 “pro­gram” that pur­ports to “help pro­tect your child from the ‘One Size Fits All’ Cal­i­for­nia vac­cine man­date.”

Cerny sub­mit­ted copies of ex­emp­tion let­ters by Sut­ton and Allen in the com­plaints she filed with the med­i­cal board, but the names of the pa­tients were blacked out. The board wants the names of those chil­dren and their par­ents, and it asked the court to com­pel the Per­ma­nente Med­i­cal Group, a sub­sidiary of Kaiser Per­ma­nente, to hand over unredacted ver­sions of the let­ters.

The board also wants Kaiser Per­ma­nente to hand over the pa­tients’ med­i­cal charts, which it be­lieves will help de­ter­mine whether the ex­emp­tions writ­ten by Sut­ton and Allen were in­deed un­mer­ited.

In June, Su­pe­rior Court Judge Ethan Schul­man or­dered the Per­ma­nente Med­i­cal Group to dis­close the names of the pa­tients known to have re­ceived med­i­cal ex­emp­tions from Allen, as well as the names and ad­dresses of their par­ents. He has not yet is­sued a rul­ing in the Sut­ton case.

Kaiser Per­ma­nente said it would comply with court orders.

“We take the health and safety of our mem­bers, pa­tients and com­mu­ni­ties very se­ri­ously,” said Dr. Stephen Par­odi, as­so­ci­ate ex­ec­u­tive direc­tor of the Per­ma­nente Med­i­cal Group, via email.

In a case sim­i­lar to Sut­ton’s and Allen’s, a judge or­dered the Per­ma­nente Med­i­cal Group in November to pro­vide the names of pa­tients and par­ents sub­poe­naed in a med­i­cal board in­ves­ti­ga­tion of Dr. Ken­neth Stoller, a Santa Rosa physi­cian who gave vac­cine ex­emp­tions to chil­dren who were Kaiser Per­ma­nente pa­tients, as well as to oth­ers in the Mam­moth Uni­fied School District.

Stoller, who is not af­fil­i­ated with Kaiser Per­ma­nente, is also be­ing in­ves­ti­gated by the city at­tor­ney of San Fran­cisco, where he used to prac­tice. He didn’t re­spond to a re­quest for com­ment.

In April, Judge Schul­man granted a pe­ti­tion from the state or­der­ing Dr. Ron Kennedy to hand over the med­i­cal records of chil­dren to whom he had is­sued vac­ci­na­tion ex­emp­tions. Kennedy, a psy­chi­a­trist who runs an anti-aging clinic in Santa Rosa, has writ­ten nu­mer­ous ex­emp­tions for kids, ac­cord­ing to court records.

Kennedy’s lawyer, Michael Machat, said his client has handed over the records as or­dered.

“The med­i­cal board has adopted the prac­tice of think­ing it can in­vade peo­ple’s pri­vacy and search chil­dren’s pri­vate med­i­cal records to see whether or not the doc­tors are fol­low­ing the law,” Machat said. “Where does this stop?”

To date, the only doctor sanc­tioned for in­ap­pro­pri­ate med­i­cal vac­cine ex­emp­tions is South­ern Cal­i­for­nia pe­di­a­tri­cian Robert Sears, the well­known au­thor of “The Vac­cine Book.”

In 2015, Cal­i­for­nia banned all philo­soph­i­cal and re­li­gious ex­emp­tions for im­mu­niza­tions in the wake of a large measles out­break that orig­i­nated at Dis­ney­land. It is one of four states to have done so, and its vac­ci­na­tion rate rose sharply for three years af­ter the law was tight­ened. But vac­ci­na­tion rates have de­clined in the past two years, in part be­cause many par­ents op­posed to vac­cines have found doc­tors willing to write ques­tion­able med­i­cal ex­emp­tions — some­times for a fee.

Cal­i­for­nia’s vac­ci­na­tion poli­cies are once again draw­ing na­tional at­ten­tion in the wake of the na­tion’s re­cent measles out­break, which to­taled 1,095 cases as of June 27. In Cal­i­for­nia, 55 cases were re­ported as of June 26.

A bill pend­ing in the Cal­i­for­nia Leg­is­la­ture, SB-276, would im­pose more oversight on vac­cine ex­emp­tions writ­ten by doc­tors. Af­ter it passed the state Se­nate in May, it was soft­ened to ap­pease Gov. Gavin New­som but would still al­low the state Depart­ment of Pub­lic Health to re­view some ex­emp­tions. It also would prevent doc­tors who are un­der in­ves­ti­ga­tion for writ­ing un­war­ranted ex­emp­tions from is­su­ing new ones.

New­som has said he will sign the leg­is­la­tion if it lands on his desk. This story was pro­duced by Kaiser Health News (KHN), which pub­lishes Cal­i­for­nia Health­line, an ed­i­to­ri­ally in­de­pen­dent ser­vice of the Cal­i­for­nia Health Care Foun­da­tion. KHN is not af­fil­i­ated with Kaiser Per­ma­nente.

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