TABLE 3

Reviewing Medical Exemptions

SubthemeQuote(s)
Reasons for actively tracking“From a purely public health perspective, we also wanted to see what the trend was going to be–what was going to be on the medical exemptions, were we going to see a spike in permanent medical exemptions from all vaccines? Which schools were going to be involved? So, where would our pockets of vulnerability be? I realized that we should probably be looking at these medical exemptions so that we could help the schools determine which ones did and did not meet the law.” Health officer, urban jurisdiction, medium PBE rate, medium household income.
Legal repercussions for actively tracking“When they named me and my boss and our county [in a federal civil lawsuit], it was really a way to try and scare us away from doing our job and to signal to other local health officers that this is what they have coming to them if they continue to do their job. We carried on with looking at all the medical exemptions throughout the year…. I do continue to get harassing messages, e-mails on social media, and I ignore them.” Health officer, urban jurisdiction, medium PBE rate, medium household income.
Reason for not actively tracking“Pretty early on, there was another California county that ran into problems with that [actively tracking medical exemptions], which we were all aware of. And we decided to just kind of wait to see how it would roll out on its own and see how the state reports came out. And if we felt that there was a problem or if we’d heard that there was a specific problem at a specific school, we would deal with it then, but we kind of wanted to see what would happen on its own.” Health officer, rural jurisdiction, high PBE rate, medium household income.
Verifying“We’re not the auditors of the physicians. If a licensed physician in California says this child has a medical exemption, we’re not going to go do investigative work to say oh no, that’s not valid. That would be an entirely different role for the health department that I don’t really think we should be in. So, we trust their judgement that there’s a medical exemption….” Health officer, urban jurisdiction, low PBE rate, high household income; “We usually reach out to that physician and/or the parent to try to understand what–there is 1 doctor that will write allergies but nothing more specific. So, if they write that, then we do reach out and say, ‘What do you mean exactly to allergies?’” Public health nurse, urban jurisdiction, medium PBE rate, medium household income.