TABLE 2

Role of Stakeholders

SubthemeQuote(s)
Physicians“The way that the law is written, the physician is the one who makes the decision.” Health officer, urban jurisdiction, medium PBE rate, medium household income; “I’m not the doctor. I see some really lame reasons [for medical exemptions]. But I’m not the physician, and it’s not in my capacity to be able to say, ‘Well, that’s not a valid medical exemption,’…I may think it, but if the doctor gives these reasons and they’re writing the medical exemption, then it’s accepted as long as it meets the requirements…. It’s not my patient, and I’m not a physician.” Immunization coordinator, urban jurisdiction, high PBE rate, high household income.
Schools“It’s not a school’s expectation or role or responsibility to determine whether the medical reason is valid…. The school’s role is just to make sure everything that’s listed out in the law is met and that they file it away.” Immunization coordinator, urban jurisdiction, low PBE rate, high household income.
Local health departments“I don’t think you’ll find most local health officials feel like it is their job to enforce the law. It is to encourage compliance with the law and education about the law.” Health officer, urban jurisdiction, medium PBE rate, low household income; “As a health department, I do not have any authority to decide…whether this is fraudulent or a legitimate medical exemption or not. There’s no way that I have the ability or the authority to do that.” Health officer, rural jurisdiction, low PBE rate, medium household income.
State health department“The state immunization branch, the California Department of Public Health, had a great Web site called Shot for School, and it had an SB277 FAQ, and it had an entire section about medical exemptions; what it needs to contain, who can provide one. So, we frequently sent that link as well as copied and pasted content relevant to that question and said, ‘Please share this with the family and the provider.’ So, it was a very helpful resource for everyone.” Communicable disease director, urban jurisdiction, low PBE rate, high household income.
California Medical Board“The California Medical Board is kind of like the judicial system of medicine…. If the California Medical Board disciplines a physician for issuing a medical exemption because an aunt had asthma, and they say no, no an aunt having asthma is not a reason for issuing a medical exemption, then that would be essentially setting case law. That would be saying okay, so physicians who do this are outside of the standard of practice and are vulnerable to having their license disciplined by the California Medical Board.” Health officer, urban jurisdiction, medium PBE rate, medium household income.
  • FAQ, frequently asked questions.