Caesar Has Spoken! The Cali. Department of Public Health Provides Answers to (Some of) Your Questions about Vaccine Medical Exemptions

Caesar Has Spoken! The Cali. Department of Public Health Provides Answers to (Some of) Your Questions about Vaccine Medical Exemptions

A couple days ago, the California Department of Public Health (“CDPH”) Immunization Branch (the head of which is otherwise hopefully soon to be known as “Defendant” in Ken Stoller’s lawsuit) published “Vaccinations and Medical Exemptions Questions and Answers.”

Here it it. Every vaccine concerned parent should read it.

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Vaccinations-Q-A.aspx

The good news is that it gives authoritative answers to many, but not all of the questions that I have seen circulating in the California vaccine concerned community.

Here is the most important FAQ, and answers parents’ questions about how long a current ME is good for:

“My child has an existing medical exemption. Do they get to keep it?

Yes, all existing medical exemptions continue to be valid except as explained below.

• Parents of students with existing medical exemptions will need to submit a new exemption when the student begins a new” grade span.” Grade spans are: birth to preschool, kindergarten (including transitional kindergarten) and grades 1-6, and grades 7-12.

• The only existing medical exemptions that could be revoked are those that were written by a doctor subject to disciplinary action by the Medical Board.”

The good:

If you’re child is currently in transitional kindergarten though the 5th grade, you child’s current ME is good for the 2020-2021 school year (except for possibly exemptions written by a board sanctioned physician).

The bad:

If your child is currently in the “birth to preschool” grade span, or is in the 6th grade, you will need a new ME to enroll your child in the next grade span for the 2020-2021 school year. Meaning whatever ME you have in your hands today will not be accepted next fall. You will need a 2020 medical exemption to enroll your child in the next grade span. People, this is not hard to understand, though it may be hard to accept.

What about switching schools in the middle of a grade span?

There is nothing in the CDPH FAQ’s which state or imply that switching schools requires a new medical exemption. I don’t see that in the law. I know there is talk/concern about switching schools being a “check point”. A “check point” might be something from a prior iteration of the law, but I do not see it in the new law, and neither does the CDPH. Which is not to say that a school might not misapply the old law or read into the new law such a requirement. What I am saying (and the CDPH apparently agrees with me) is that switching schools in the same grade span does not trigger a requirement for a new ME under the current law.

The illusion of broader than CDC guideline-based exemptions:

Consider the following two FAQ’s and their answers:

“My child has a health condition that is not listed in the federal Centers for Disease Control guidelines. Can they still get a medical exemption?

SB 276 and SB 714 do not limit the types of medical conditions that would qualify for a medical exemption. Medical exemptions can be granted for reasons outside of the Centers for Disease Control (CDC), Advisory Committee on Immunization Practices (ACIP), and American Academy of Pediatrics (AAP) guidelines including family medical history, if they are consistent with the standard of medical care for that condition. Doctors issuing a medical exemption will provide a description of the medical basis for the exemption.”

“Does this change in the law prevent or limit doctors from granting medical exemptions?

No. Doctors will continue to have discretion to determine whether a child should get a medical exemption. When a medical exemption is issued, the doctor will describe the medical basis for the exemption. That basis must be consistent with the standard of medical care for a particular medical condition or align with CDC, ACIP, and AAP guidelines. Medical exemptions will only be reviewed when the immunization coverage at a school falls below 95% or the doctor has issued 5 or more exemptions in a year beginning January 1, 2020 or the school where the child with a medical exemption attends fails to provide immunization reports to CDPH.”

I call this an illusion because the so called “standard of care” is the CDC, ACIP and AAP guidelines, the most detailed explanation of which is in AAP’s “Red Book” of pediatric infectious diseases. This is the gospel according the AAP and sets out from on-high, the standard of care for all things infectious disease related. To talk about the conventional “standard of care” which is not in the above lettered groups/standards or in the Red Book is a set with noting in it.

My view is that there are very few, and probably no current medical exemptions written by vaccine-aware physicians which meet these standards. One of the reasons I think this is that the conventional standard of care does not recognized the concept of a medically or vaccine fragile child for which it is too dangerous to give any vaccine over the course of childhood. The new law makes clear that exemptions have to be vaccine specific based on the above guidelines which is the (conventional) standard of care.

Most conventional vaccine exemptions are temporary, based on a child being drug induced immunocompromised (chemotherapy for example) and once the therapy clears the system, the reason for the exemption ends. All childhood-based exemptions are for specific vaccines based on a reported and usually treated serious adverse event to a vaccine or a multiple vaccine shot. Conventionally, (wrong as you might think it is) a serious adverse event to one vaccine shot does not medically justify an exemption from all vaccines throughout the duration of childhood.

In short: despite the hopeful language in the FAQ answers, my view is that essentially none of the exemptions written by the vaccine aware physicians are compliant with the conventional standard of care, as set forth in the Red Book and the above lettered organizations or standards.

The big unanswered question:

Will the ME’s written by physicians who have been sanctioned be automatically revoked?

I have dealt with that in a prior post. I do not see a definitive answer in the CDPH FAQ’s, probably because they haven’t figured it out yet and they want to keep their options open.

Rick Jaffe, Esq.

25 thoughts on “Caesar Has Spoken! The Cali. Department of Public Health Provides Answers to (Some of) Your Questions about Vaccine Medical Exemptions

  1. Mr Jaffe:
    THANK YOU for your continuous updates on this vital matter.
    My question is for your opinion: if the schools “creatively read” into the law of grandfathered ME student while switching schools within the grade span that student cannot be enrolled would you suggest LEGAL ACTION against such school/s?
    Many thanks.

  2. “if the schools “creatively read” into the law of grandfathered ME student while switching schools within the grade span that student cannot be enrolled would you suggest LEGAL ACTION against such school/s?”

    yes I would.

  3. My only issue with the CDPH Q&A is the it doesn’t state a starting date for these grade spans. And I’ve sent an email to my assemblywoman asking: does this apply to the grade span they are in now, the one they will be in next year, or the one after the new system is put in place in 2021. They have yet to be able to answer this question. I know you are reading it as the current grade span, but am i wrong in thinking it doesn’t explicitly state that? Our school has actually issued a much more hopeful interpretation which I’m really hoping will work out for us.

    1. Hi Laura
      You mentioned that your school has issued an interpretation. I am literally stunned cause we are seeking meeting with the principal at this point to have some questions answered and even that is not an easy going (we are in private school).. did you request this from your school or they did it on their own? any chance you can – i know its a lot to ask – post it redacting parts pertaining to school name etc? I really appreciate! We can ask our school too then or be more successful in our asking..
      thank you!!

  4. I think the FAQ is clear about that: It doesn’t have to say a starting date:
    “My child has an existing medical exemption. Do they get to keep it?

    Yes, all existing medical exemptions continue to be valid except as explained below.

    • Parents of students with existing medical exemptions will need to submit a new exemption when the student begins a new” grade span.” Grade spans are: birth to preschool, kindergarten (including transitional kindergarten) and grades 1-6, and grades 7-12.

    • The only existing medical exemptions that could be revoked are those that were written by a doctor subject to disciplinary action by the Medical Board.”

    If you child has an existing medical exemption, it is not valid if next year your child is entering a new grade span, as defined in the statute. I don’t know how it could be any clearer than that. I’m no longer going to answer this question. Sorry.

    1. I know you said you didn’t want to answer the similar question anymore, but hopefully you can clarify this: if a student entering a grade span/ checkpoint needs a “new” exemption and the new exemptions do not start until 2021, then wouldn’t that also go into effect 2021?

      1. seriously?
        assuming you are: if your child is entering a new grade span in the fall of 2020, the current ME which you have will not be good and you will need a new one, meaning a ME letter dated in 2020.
        After 1/1/21, all ME’s will be by ME forms forms put out by the CDPH which have to be filed with CAIR.
        theoretically, someone with a 2020 new ME letter, would be good up until 6/30/2021, after which a ME form will be required except for grandfathered ME’s (i.e. written in 2019 or before, and for the grade span the child is in.

        1. Yes I was being serious. Sorry to upset you, but it just is hard to understand, as it doesn’t state it is requiring a new m.e. meaning in 2020. Thank you.

  5. Can you confirm information posted on A Voice for Choice Infographics relating to medical exemptions written under SB277 dated before 2020:
    DO NOT submit any medical exemptions on file to any electronic or other database.

    This is required in SB276 but not addressed in SB714.

  6. Mr Jaffe:
    What does the process leading to disciplinary action by Med board look like? How can we protect our doctors and where is the breach happening eg on which stage and how medical board starts looking into specific doctors vs others? Is it related to disclosure of information by schools? We provided letter to our school stating non consent to any disclosures referencing HIPAA and FERPA but school says they have to obey if they have the audit or request for info from the district. These are two opposites how is it supposed to work in real
    Life, from legal view?
    Greatly appreciate your input!

  7. This Q&A is helpful, but this part is concerning:

    “Medical exemptions will only be reviewed when the immunization coverage at a school falls below 95% or the doctor has issued 5 or more exemptions in a year beginning January 1, 2020 or the school where the child with a medical exemption attends fails to provide immunization reports to CDPH.”

    Does this mean that starting this January, all ME’s can somehow be requested/reviewed if the school is 5, how will their patients be “found”?!

    Thank you so much for your guidance Richard!

    1. My opinion, and I repeat it is just my opinion, is that public schools will report to the CDPH all ME’s from otherwise healthy children, ie not undergoing immunsuppressive therapy. 2019 ME’s should be ok this year, for the most part, unless the doc has been disciplined by the Cali medical board. 2020 exemptions that don’t meet the standard of care will be reported by the schools, IMO and rejected by or revoked by the CDPH, IMO. The ones that are revoked will have the review/appeals process. The ones that are not accepted, I’m not sure.

      1. Yes, this is important… Even though the FAQs loosely say all MEs grandfathered in will remain valid until the next grade-span checkpoint, as I am reading the law as written today, ALL MEs of a school that falls under 95% and/or MEs written by a doctor who issues more than 5 in a year can be reviewed/revoked. This is an important nuance.

    1. the law changes. SB 277 regarding grade spans is no longer the law. A grade span is defined by SB 714 and that is the law and that is the definition of a grade span. It doesn’t matter what the law was before it was changed.

    2. Lisa, I think you’ve misunderstood what Mr. Jaffe wrote above. He lists three grade spans and the second grade span is kindergarten (including transitional kindergarten) AND (my emphasis) grades 1 through 6. Perhaps the list of grade spans could have been written a bit more clearly…but it actually agrees with what you’re saying it should be. The grade spans established by SB 277 are continued in SB 714.

  8. I had a question re: the following that appears in shotsforschool.org
    https://www.shotsforschool.org/laws/exemptions/

    4. To meet the chickenpox immunization requirement for TK/K-12 admission or for advancement into 7th grade, may a school accept an immunization record that indicates a “history of chickenpox disease”?

    No, this is not sufficient documentation to meet school requirements. Medical exemption documentation may be used for a child who had chickenpox disease that was documented by a physician. For more information on medical exemption documentation requirements, see questions above.

    What does this mean in light of the change to medical exemptions? Or is the ME format from sb277 applicable in this situation.

    And is there any regulatory language that addresses how showing titers affects shot requirements?
    thank you.

  9. Caveat: I don’t really deal with the titers issue, but what I can say is that in 2020, ME’s are still done by letter, so I suppose a physician record/statement if that worked before, would work in 2020. In 2021, I have to believe that will be on the ME form, maybe requiring an attachment. I don’t think the question for 2021 and after exemptions can be answered until the form is put out.

  10. Thank you for this article. Can you offer any insight on the status of the Personal Belief Exemptions that were on file with a school prior to the PBE being discontinued by SB277? Will those PBEs continue to be grandfathered even after SB276 is in effect, as long as the student remains in their current grade span? Thanks.

  11. Theoretically, a PBE should still be valid if the child was for the entire grade span, per 120335
    here it is:
    (g) (1) A pupil who, prior to January 1, 2016, submitted a letter or affidavit on file at a private or public elementary or secondary school, child day care center, day nursery, nursery school, family day care home, or development center stating beliefs opposed to immunization shall be allowed enrollment to any private or public elementary or secondary school, child day care center, day nursery, nursery school, family day care home, or development center within the state until the pupil enrolls in the next grade span.
    (2) For purposes of this subdivision, “grade span” means each of the following:
    (A) Birth to preschool.
    (B) Kindergarten and grades 1 to 6, inclusive, including transitional kindergarten.
    (C) Grades 7 to 12, inclusive.
    (3) Except as provided in this subdivision, on and after July 1, 2016, the governing authority shall not unconditionally admit to any of those institutions specified in this subdivision for the first time, or admit or advance any pupil to 7th grade level, unless the pupil has been immunized for his or her age as required by this section.

    Here is the IEP rule, that has been asked about:

    (h) This section does not prohibit a pupil who qualifies for an individualized education program, pursuant to federal law and Section 56026 of the Education Code, from accessing any special education and related services required by his or her individualized education program.

    but if a PBE child moves schools, I’ve heard PBE’s may not be accepted.

    1. A PBE that was grandfathered under SB 277 was supposed to be valid at any school in California for the remainder of the child’s grade span. Changing schools was *not* supposed to invalidate a grandfathered PBE. The mechanism for transfer of a PBE from a child’s old school to the child’s new school was that the PBE was part of the child’s cumulative educational record, and when the new school requested the child’s cum. record, the PBE would be transferred along with all the other paperwork.

      1. That has not been my experience. Each time within the gradespan that I had to move or change schools they told me that wasn’t part of the records that transfer. It’s disgusting what a target my poor girl has become over something she couldn’t help (seizure after 2 months old). Them holding education over her head is nothing short of extortion. If she had a peanut allergy she would be left alone.

        1. https://www.shotsforschool.org/laws/exemptions/#PBE

          13. Is a personal beliefs exemption still valid if a student transfers between schools in California after 2015?

          Yes, a personal beliefs exemption filed with a school before January 1, 2016 is valid until entry into the next grade span (7th through 12th grade). Personal beliefs exemptions may be transferred between schools in California, both within and across school districts.

          However, if the personal beliefs exemption documentation is no longer available, students must meet immunization requirements (see http://www.shotsforschool.org/k-12/) or be enrolled in an independent study program and do not receive classroom-based instruction or in a home-based private school (see question #1).

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