TABLE 4

Medical Exemptions That Were Perceived as Problematic

SubthemeQuote(s)
Suspicious conditions listed as contraindications for immunization“Let me read one off the top. This is today’s pack. “To Whom It May Concern…In my opinion, this patient meets the criteria described in SB277 for a temporary exemption for vaccinations including…” – he enumerates them all, through July 2030, so that’s one hell of a temporary exemption – ‘…for the following reasons: family history of adverse effects include autoimmune disorders, inflammatory bowel disease, allergic disorders, neurologic problems, neurodevelopmental disorders, psychiatric disorders. I agree that due to this patient’s physical condition and medical circumstances, there could be a severe reaction.’” Health officer, urban jurisdiction, low PBE rate, medium household income.
Charging a monetary fee for a medical exemption“I’m getting a very high volume of medical exemptions from one provider, and from what I understand, for all intents and purposes, she’s selling these medical exemptions. They’re not charged for the office visit; they’re charged to view a video. So, they watch a video on vaccine safety, and then they have an office visit, and they leave with a medical exemption. She used to just give permanent medical exemptions, and now she’s giving temporary for 3 months. So, now families have to go back every 3 months and pay $300 to get their temporary medical exemption updated…. So, these kids have medical exemptions that are expired, and they can’t get into school because they can't get an appointment with her…. So, the parents are being basically duped. They’re being told you have to renew this every 3 months. Well, that’s not true it all. It’s just her decision. It’s a business decision on her part.” Immunization coordinator, urban jurisdiction, high PBE rate, high household income; “We’re seeing specialists that aren’t supposed to see kids signing these. And they’re not pediatricians, they’re not generalists, they’re not family docs…and when we talk to the parents, come to find out they never actually were examined by this physician. They just made a phone call and got this letter for $100.” Communicable disease director, urban jurisdiction, low PBE rate, high household income.
Types of physicians and health care providers signing medical exemptions“There’s one who’s like a medical marijuana dispensary. And I’m like, really? He’s a primary care physician for these kids? My suspicions are just always like, I don’t believe that this is where this child is going for primary care.” Immunization coordinator, urban jurisdiction, low PBE rate, high household income; “But by the doctor’s signature line, a nurse practitioner had signed it. So, I told the school staff…they needed to go back and tell the parent to go back to the office and have the physician sign it.” Immunization coordinator, urban jurisdiction, medium PBE rate, high household income.