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Category: Vaccination Issues

“New California school vaccine rules have left nurses, doctors and parents confused” AS WELL THEY SHOULD BE!

“New California school vaccine rules have left nurses, doctors and parents confused” AS WELL THEY SHOULD BE!

A few days ago, the LA Times published an articled titled, “New California school vaccine rules have left nurses, doctors and parents confused”

Here it is:

https://napavalleyregister.com/news/local/new-california-school-vaccine-rules-have-left-nurses-doctors-and/article_e6352b96-51c1-5eeb-94b2-68e5cfebff07.html

It is a good and very informative piece, as they all are when they are written by this journalist.

It’s been suggested that I comment about it, and, because of the basic point, I am getting many requests from parents and some physicians to explain the law, since the only thing everyone seems to agree with is that the new law is confusing. (Actually Senator Pan doesn’t seem to think it is confusing, but…..).

I confess that I also do not completely understand the new law, but before I tell you what I do not know/understand about the law, let me tell you what I do know and am confident about, and I am telling you this because misinformation is being provided which needs to be corrected.

Here is what I know about the law:

If your child is enrolling in a new grade span in the fall 2020, your child needs a 2020 dated ME. A pre-2020 grandfathered ME will not allow your child to be enrolled in a new grade span in the fall of 2020.

I am 100% certain that this is the CDPH’s position, because it has said so.

Here is the language from its FAQ’s

“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.”

here is my prior post which discusses this issue. It has the pdf of the whole CDPH explanation.

https://rickjaffeesq.com/2019/09/23/caesar-has-spoken-the-cali-department-of-public-health-provides-answers-to-some-of-your-questions-about-vaccine-medical-exemptions/

Continuing with what I do know: The new law does provide that physicians who have been subject to the most common forms of medical discipline can/will have their ME’s revoked. I know this because that’s what the law says. Here it is, specifically 120372 (d)(4) provides:

“(4) Medical exemptions issued prior to January 1, 2020, shall not be revoked unless the exemption was issued by a physician or surgeon that has been subject to disciplinary action by the Medical Board of California or the Osteopathic Medical Board of California.”

So that is what I do know.

Here is what I don’t know or can’t say for sure under the new law:

1. Are these revocations automatic or does the process of revocations for 2021 (and later) ME forms apply?

Here are some of 120372 (d)(4) immediately preceding and subsequent provisions. You tell me whether families who have grandfathered ME’s from disciplined doctors can avail themselves of the revocation process set forth in the statute.

“(3) (A) The department shall identify those medical exemption forms that do not meet applicable CDC, ACIP, or AAP criteria for appropriate medical exemptions. The department may contact the primary care physician and surgeon or issuing physician and surgeon to request additional information to support the medical exemption.
(B) Notwithstanding subparagraph (A), the department, based on the medical discretion of the clinically trained immunization staff member, may accept a medical exemption that is based on other contraindications or precautions, including consideration of family medical history, if the issuing physician and surgeon provides written documentation to support the medical exemption that is consistent with the relevant standard of care.
(C) A medical exemption that the reviewing immunization department staff member determines to be inappropriate or otherwise invalid under subparagraphs (A) and (B) shall also be reviewed by the State Public Health Officer or a physician and surgeon from the department’s immunization program designated by the State Public Health Officer. Pursuant to this review, the State Public Health Officer or physician and surgeon designee may revoke the medical exemption.
(4) Medical exemptions issued prior to January 1, 2020, shall not be revoked unless the exemption was issued by a physician or surgeon that has been subject to disciplinary action by the Medical Board of California or the Osteopathic Medical Board of California.
(5) The department shall notify the parent or guardian, issuing physician and surgeon, the school or institution, and the local public health officer with jurisdiction over the school or institution of a denial or revocation under this subdivision.
(6) If a medical exemption is revoked pursuant to this subdivision, the child shall continue in attendance. However, within 30 calendar days of the revocation, the child shall commence the immunization schedule required for conditional admittance under Chapter 4 (commencing with Section 6000) of Division 1 of Title 17 of the California Code of Regulations in order to remain in attendance, unless an appeal is filed pursuant to Section 120372.05 within that 30-day time period, in which case the child shall continue in attendance and shall not be required to otherwise comply with immunization requirements unless and until the revocation is upheld on appeal.”

This last highlighted provision strongly suggests to me that the families with Bob Sears’ ME’s should be able to avail themselves of the full process.

To the extent that the current law remains in effect in 2021 (and as I’ll discuss, I have my doubts about this), this should be a major battle ground.

Every single Bob Sears exemption (and the exemptions of any other physician sanctioned in 2020) should be contested. That will probably require some concerted action, perhaps through the entry of a new national player with more resources than the current vaccine concerned groups. More about this another time.

But again, every single grandfathered exemption which the CDPH attempts to revoke under 120372 (d)(4), should be vigorously contested.

Here is something else I do not know:

Under SB 276, so called grandfathered exemptions would only be valid if they were filed with the CDPH. The filing requirement was removed in SB 714. That creates an administrative hole in the law because while grandfathered ME’s from disciplined physicians are revoked or revocable, under the current law, there is no formal mechanism by which grandfathered ME’s are forwarded to the CDPH. So how does that agency find out about those ME’s? Practically speaking, I suppose the schools on an ad hoc basis forward them, but, as indicated in the comments in the LA Times article, schools like systems, process and guidelines, and there are none now.

My guess (or maybe my hope) is practically speaking, most grandfathered exemptions even most written by Bob Sears are safe for this and at least the first part of the next school year. But come the beginning of 2021, all bets are off.

update: comment that parent on Facebook was told their Sears exemption was no longer valid: That may well increases as a result of the LA Times article, but it’s not clear that is legal.

My Prediction
Based on the LA Times article, we know that Senator Pan thinks and wants all of Bob Sears’ ME’s to be revoked now.

There is zero chance he is going to sit out this legislative session. So expect a new bill from him next month. I have no special access or secret knowledge, but I do not how to read the tea leaves and learn from the past, like the creation of the false PR narrative of fraudulent ME’s and how he exploited the Disneyland measles thing.

Coronovires is the perfect panic for him to exploit. So expect his new bill to, in all but in name rescind the SB 714 protections, require all grandfathered ME’s to be filed with the CDPH, and to clean-up/clarify the revocation provision for grandfathered ME’s from disciplined doctors. You also should start preparing for this next round.

Rick Jaffe, Esq.

Coronavirus: The Elephant in the Room the Vaccine Concerned Need To Get in front of

Coronavirus: The Elephant in the Room the Vaccine Concerned Need To Get in front of

In under three weeks, Ken Stoller’s Medical Board case for writing medical exemptions from infectious disease immunization beyond the ACIP guidelines will go to hearing. For sure, if you haven’t donated to his legal defense fund, please do. Here is the link.

https://gogetfunding.com/dr-ken-stoller-and-his-medically-vaccine-exempt-patients-need-your-help-again/

Given all the international fear about the possible pandemic, the quarantines, restrictions on travel and the increase of protective measures around the world and even here in the US, it might be less than an ideal time to try this case. But you play the cards are you dealt. Sure, in a technical sense, coronavirus may be irrelevant to the actual issues in the case, but still…
Because of how I roll, we will confront the issue directly in the case. You’ll have to wait and see how we do it.

Thinking about how we are going to address the issue in the hearing got me thinking about how the VC community is addressing and should address the issue.

I spend some, but not a great deal of time on social media. I have seen discussion from the primary blogger Larry Cook talk about Vitamin C or Liposomal. I think a discussion about possible natural treatments is a good thing. There is a lot of talent out there, and anyone who is raising awareness of inexpensive, natural, harmless possible treatments is doing a public service, as long as they do not minimize the seriousness or risks of the disease, because doing so would play into the rabid provaxxer view that all these “anti vaxxers” are wackos!

So, my advice is to get the medical information out there, but don’t feed into the pro vax “wacko” narrative.

As a related aside, I handeled an FDA felony criminal case a dozen or so years ago defending the inventor of arguably the most popular cold remedy, who subsequently invented a treatment for avian flu during its outbreak. It was a combination of a couple different herbal extracts, like teas, echinacea, and some other stuff, each with literature based proven effects on parts of the viral replication cycle. He did some lab work and tested it out at a prominent Hong Kong Hospital, with apparently amazing results. Unfortunately for him, the epidemic ended in Asia, so he tried to reimport it into the US, and that’s where he got into trouble with the feds, primarily because he called it a bird flu treatment, which is a no-no under the FDA law. He got indicted on multiple felony counts. Eventually he pled out to a misdemeanor with no jail time which isn’t a bad result since the US Attorneys’ office are “felony factories” and they usually don’t do misdemeanors.

I hope some of my more biochemically inclined maverick docs and lab scientists are working along those lines, but if they are, a word of advice from an FDA criminal defense lawyer: don’t call it a cure or treatment!

Back to the matter at hand. Based on TV reports over the past few days, the Coronavirus is becoming the dominant news story, and once it gets to the US ( and per CDC “it’s not if, but when”) the story and disruptions it will cause will become an ever-present and all encompassing force in American life for some undetermined time.

The thought leaders in the vaccine concerned movement need to get ahead of this. The wacko fringe may start promoting conspiracy theories. Some luney-tune is going to claim it’s a big pharma hoax to promote current or future vaccines. I hope the community will shut down that crap when it arises (as I’m sure it will).

I actually see this as an opportunity for the community to show itself as thoughtful, responsible and flexibly adapting to life’s circumstances. When you have a fire on a ship in the middle of the ocean, you don’t have a debate on the environmental impact of the fire retardant and you don’t argue about whether it is really is a fire, or just the fire retardant industry’s ploy to sell more product, because if you do, and don’t act, then the fire will end the debate, and natural selection ultimatley gets rid of the terminally stupid and clueless.

So, to the thought leaders, you may not have the hard deadline I have to get in front of this (and in truth, I’ve already had to deal with this problem in other matters, but I can’t talk about that now). However, it behooves you all to get ahead of this and turn it into the opportunity to both be part of the solution and help advance the process of educating the public.

For what it’s worth.

Rick Jaffe, Esq.

What does the Medical Board’s Recent Action Against the San Diego School District Mean?

What does the Medical Board’s Recent Action Against the San Diego School District Mean?

Recently, it has been reported that the Cali. Medical Board has sued the San Diego School District to order the releasae of vaccine medical exemptions records in its possession.

Here is an article explaining it, which provides a telling statement from the School District. See if you can spot it and what you think it means.
https://www.nbcsandiego.com/news/local/state-medical-board-sues-sdusd-over-release-of-vaccines-exemption-records/2269015/

So, what’s going on?

Less than meets the eye.

First, a point of legal clarification. School records are not HIPAA protected, rather they are protected by another federal statute FERPA. So, don’t bother complaining that your child’s school records are federally protected by HIPAA, because they are not, as HIPAA only protects medical records, and once the doctor’s medical exemption is tendered to the school, the federal protection changes from HIPAA to FERPA. Got it?

Next important point (and the most important point). California citizens have a state constitutional privacy right to have their medical records remain private. That privacy right was extended to include medical records in a case in the late 1970’s. However, in the last dozen years or so, that right has been eroded by the medical board’s successful efforts to obtain patient medical records over patient objection.

This has happened by way of the medical board filing special proceedings/motions to compel compliance with investigative subpoenas. These special proceedings are not full lawsuits. There is no discovery. There is no evidentiary hearing (technically there could be but they are never granted). There is just some paperwork submitted to a “Law and Motion Judge”. These judges are very, very busy. There are usually 10 to 20 motions on the judge’s docket on the day these motions are heard. The day before the so called “hearing,” a “tentative decision” is issued, which gives the result, and explains the reasoning. If the losing party wants to tell the judge why he/she is wrong, he or she can attend the “hearing.” Good luck with that.

The standard for granting these motions to compel compliance with the board’s investigative subpoena is “good cause.” It is established by the board submitting a declaration (affidavit) from a doctor who says that she has reviewed what ever information she has reviewed and it seems like the doctor has violated the standard of care for whatever reason (in these cases, for giving a ME which is not in compliance with ACIP guidelines), but the board needs the patient medical records to be sure. It’s very hard to counter argue. It’s not the judge’s job to weigh medical opinions, even if you put in a counter opinion. Bottom line, now that the board has figured out what it has to say to get the medical records, the courts just grant the board’s request and issues the requested court order.

I am aware of three such motions against physicians issuing ME’s. I was the attorney on one of them. All three resulted in an order forcing the doctor to turn over the records. One case went up on appeal (not my case, as I wouldn’t appeal this kind of special proceeding with the limited record) and that resulted in an appellate court saying some very harsh words about the doctor, and now there is negative appellate court authority on the issue which is a bad thing.

OK so what’s the deal with the action against the San Diego School District Thing?

As I said, the state constitutional privacy right belongs to the patient/family. It does not belong to the doctor or possessor of the information like the school district. So, while the doctor has been given the legal standing to assert the patient’s rights, arguably, neither the physician nor the school district have the authority to waive these rights, that is to say, produce the records without a court order.

So, out an abundance of caution, the San Diego school district is refusing to comply with the board subpoena absent a court order to do so. A court order will give the school district perfect and absolute protection from irate parents who object to the release of their child’s school records.

This is exactly what happened in NorCal about a year ago when the board filed motions to compel a school district and a HMO to produce FERPA and HIPAA protected records. They basically told the court that they needed a court order to produce the records. And in those two cases, they were the entities that filed the complaints. So, I think it’s fair to assume that the reasons the student records are being subpoenaed from the San Diego school district is because someone (probably in the nurse’s offices) filed complaints with the board about permanent medical exemptions for seemingly healthy (or very healthy) students. I cannot think of anyone else who would have access to this school information, other than the school itself.

So, what does not mean that the medical board has sued the San Diego School District for the release of medical exemption records?

It means that this is how the game is played. The board is giving the school district the legal cover to provide the records that the school district wants the board to have, so the board can investigate the complaints filed by the school district, and get these kids vaccinated or removed from the school district. And that’s all it means.

Rick Jaffe, Esq.

Post Pre-Hearing Conference Update on Ken Stoller’s Medical Board Case

Post Pre-Hearing Conference Update on Ken Stoller’s Medical Board Case

here it is: click on the update page

https://gogetfunding.com/dr-ken-stoller-and-his-medically-vaccine-exempt-patients-need-your-help-again/

Rick Jaffe, Esq.

The Final Stretch in New Jersey’s Race to Eliminate Religious Exemptions to Childhood Vaccination

The Final Stretch in New Jersey’s Race to Eliminate Religious Exemptions to Childhood Vaccination

Like many, I have been following the battle by the vaccine concerned against New Jersey Legislature’s attempt to remove the religious exemption to childhood vaccination. Last year, New York removed religious exemptions by strong-arming one legislator to change his previously cast vote in opposition. In New Jersey, it’s coming down to a last-ditch compromise to carve out or preserve religious exemptions for families who can afford to send their children to private schools where the schools will allow/honor religious exemptions. I have to say, that’s a new one to me.

Here is the way one news story describes it:

“The compromise would end religious exemptions for vaccines in public schools and day care centers — but allow private institutions to admit children whose parents declined to have them vaccinated, according to Sens. Joe Vitale, the bill’s sponsor, and Declan J. O’Scanlon.
Private schools would be required to post outside the building the number of unvaccinated children at each facility.”
https://www.northjersey.com/story/news/new-jersey/2020/01/09/nj-bill-limiting-religious-exemptions-vaccines-may-pass-after-deal/4423562002/

My guess is that the posting of the number of unvaccinated on a school’s building is a way to not so subtly pressure private schools to reject accepting the religiously vaccine exempt. It’s like a giant scarlet letter or a sign saying “Caution: this is a leper colony. Enter at your own risk!” I find this requirement fairly appalling. It may work for schools which do not have a significant percentage of religious exempt students, but I know from my dealings with similar issues in California, that some schools are not financially viable if they lose all their vaccine exempt students to home schooling or departure from the state. So, I believe that if the bill passes, some schools will become safe-havens for the religiously exempt.

What about families who don’t have the money to send their children to private schools?

Well they are out of luck under the bill. Whatever rights the richer among us have to exercise our religious rights/freedoms do not apply to the poor, as many in the community have lamented.

I guess that is just tough luck for them. Sucks to be poor. It’s too bad there is no law against that kind of blatant discrimination.

Oh wait, there is. It’s called the Constitution, and specifically the parts that talk about religious freedom and the equal protection under the law. As many of you might know from past posts, I am not a big fan of lawsuits challenging the removal of the personal belief or religious exemptions to vaccination. All past constitutional challenges have failed, and I have repeatedly predicted that future challenges will also fail, so long as we are talking about the complete removal of that right.

However, I am equally certain that a law which only removes the right for those too poor to send their kids to a private school will be struck down on constitutional grounds.

I think what happened is that in a desperate attempt to pass the bill through the Senate, they came up with this ill thought out, idiotic idea. That fact that the Dems are proposing a bill which so obviously discriminates against the poor, shows how that the irrationality of the issue has caused politicians to lose sight of their core values. But as indicated, the New Jersey courts will not let this stand.

To all you braving the cold tomorrow, (including my Cali. Latinas friends, the New Yorkers and Oregonian health freedom fighters) keep up the fight! If it doesn’t work out, a slew of lawyers will soon be joining you for the next phase.

Rick Jaffe, Esq.

The Next Vaccine Medical Exemption Battle

The Next Vaccine Medical Exemption Battle

https://gogetfunding.com/dr-ken-stoller-and-his-medically-vaccine-exempt-patients-need-your-help-again/

Rick Jaffe Esq.

Stoller Civil Suit Update

Stoller Civil Suit Update

Today, the court granted the Medical Board’s Demurrer and dismissed the complaint against it. It was not entirely unexpected, per my previous update.
https://wp.me/p7pwQD-Bs

The basis of the decision is that since the Board now has an administrative action against Dr. Stoller, the issues raised in the civil suit should be initially addressed in the administrative proceeding. The decision is consistent with basically all prior attempts to pursue a civil lawsuit against an administrative agency during the pendancy of an administrative action. We initially added the Board to our lawsuit against the San Francisco City Attorney before the Board filed charges against Dr. Stoller, but once it filed the administrative case, the “failure to exhaust administrative remedies” doctrine applied, according to the court and precedent.

In addition, the courts are not anxious to become involved in the vaccine and medical exemption issue, unless there is no choice, and in this case, the court had a choice.

We do not intend to appeal the decision, and will focus on the upcoming board administrative case. Stay tuned for an announcement about that case.

Although it would have been nice and interesting to be able to pursue a civil case against the Board, we did originally file this case to stop the San Francisco City Attorney’s office from obtaining Dr. Stoller’s medical records of the patients for whom he wrote medical exemptions. So while the case is over, the medical records were never turned over to the City and the patients’ privacy rights were protected. That is plenty good in these difficult times.

Rick Jaffe, Esq.

November 21, 2019 Update on the Stoller Civil Lawsuit against the Medical Board

November 21, 2019 Update on the Stoller Civil Lawsuit against the Medical Board

Here is the most recent update on Ken Stoller’s civil lawsuit against the Medical Board (formerly against the San Francisco City Attorney).

https://gogetfunding.com/blog-single-update/?blogpre=6112639&single=43538

Here is our response to the Board’s dismissal motion.

ResponseDemurrerSAC

Wish us luck!

Rick Jaffe, Esq.

Into the roots of the weeds of quarantine and isolation in Los Angeles

Into the roots of the weeds of quarantine and isolation in Los Angeles

My prior post suggesting that people should calm down about AB 262 because the law does not directly affect the public might have been too subtle or maybe just too abstract. I indicated that what the state and county can do to people during public health crises is determined by other state and country laws and regulations, not AB 262. But again, that might have been too abstract. So let’s get into the roots of the weeds, so you can read with your own eyes what, when and how a large county public health office can deal with a communicable disease based public health crises.

Here is the Los Angeles Communicable Disease Control Measure, Part 1 which sets out, among other things, the circumstances the country health department can quarantine and isolate people based on having or being exposed to certain communicable diseases.

http://publichealth.lacounty.gov/acd/procs/b73/B73p1.pdf

It’s a long document, but you should take a quick look just to see what are the reporting requirements for which diseases and so forth. But for the lazy, the ADD or if you’re just pressed for time, here is what and when LA Country Quarantines:

“SECTION 14: QUARANTINE (CCR, Title 17, Sections 2514, 2520; Health and Safety Code, Section 120175) A. DEFINITION: “Quarantine” is defined as the limitation of freedom of movement of persons or animals that have been exposed to a communicable disease for a period of time equal to the longest usual incubation period of the disease, in such manner as to prevent effective contact with those not so exposed. Contacts to cases with reportable communicable diseases may be subject to quarantine at the discretion of the SPA Medical Director. Quarantine shall be used routinely only for the diseases or circumstances listed in this section. The SPA Medical Director shall determine which contacts require quarantine, specify the place of quaran-tine, and issue appropriate instructions. B. Violations of quarantine or “pass” privileges must be reported immediately to the Chiefs of ACDC and Public Health Investigation. C. Contacts to cases of communicable diseases may be quarantined according to one of the following classifications. 1. COMPLETE QUARANTINE: This is defined as the confinement of persons or domestic animals exposed to a communicable disease for a period equal to the longest usual incubation period of the disease, in a manner that shall prevent contact with unexposed persons. Complete quarantine is required for contacts of persons with the following diseases. Viral hemorrhagic fever (e.g., Lassa, Ebola, Marburg, Crimean-Congo, etc.) Plague (until contacts, clothing, etc. have been disinfested and prophylactic medication administered) Relapsing fever, louse-borne (until disinfested) Typhus, louse borne (until disinfested) Control Measures for Complete Quarantine: a. Post the QUARANTINE PLACARD (H-734) at the site of quarantine. b. No passes shall be issued to a contact while a case patient with the disease in question is on the premises.c. The SPA Medical Director shall arrange for the daily observation of contacts, delivery of groceries, and other necessities and shall supervise the release of contacts from quarantine. d. When a case patient is off the quarantine premises, the procedures listed in Part IV for each disease shall be followed.”

Here is when a modified quarantine is initiated:

“2. MODIFIED QUARANTINE (CCR, Title 17, Section 2518): This is defined as a selective or partial confinement of persons or domestic animals that were exposed to a communicable disease, based on differences in susceptibility and potential for disease transmission. Modified quarantine is required for the following diseases and situations: Animal rabies, for an animal that has bitten a person in an unprovoked attack, and for a domestic animal bitten by a wild mammal capable of transmitting rabies. Post ANIMAL QUARANTINE PLACARD (H-733). Diarrhea in newborns (hospital nurseries only). Diphtheria. Post DIPHTHERIA QUARANTINE PLACARD (H-734). Staphylococcal disease (hospital outbreak only). 3. Release from complete or modified quarantine: To release from quarantine, follow procedures in Part IV foreach specific disease. 4. Dairy quarantine (CCR, Title 17, Sections 2528, 2530) a. A dairy quarantine is imposed when: a milk supply is suspected as the source of a communicable agent; or when a person who resides at a dairy has or is suspected of having a disease transmissible through milk.b. The County Health Officer, as an agent for the U.S. Department of Agriculture, shall prohibit the sale, use, or disposal of milk until the following measures are observed: The patient must be isolated. Water used in processing milk must be free of the agent. Household members must be free of infection and must not expose dairy workers or facilities used in processing milk. c. The milk must be pasteurized off the premises until (a) the patient is removed and the household contacts are cleared according to specific disease requirements; and (b) the producing herd is declared free of infection by the U.S. Department of Food and Agriculture.”

Here is when LA County isolates people:

“SECTION 15: ISOLATION PRECAUTIONS (CCR, Title 17, Sections 2515, 2516, 2518, 2530) A. DEFINITION: “Isolation” is defined as the separation of infected persons from other persons for the period of communicability of an agent, in such places and under such conditions that will prevent further transmission of the agent. Isolation may be strict or modified.Isolation measures depend on the mode of transmission of the disease and the potential threat to susceptible persons. See recommendations for each disease in Part IV. Modified isolation precautions may include: 1. Exclusion from school.
Exclusion from work in general or specific kinds of work (e.g., a cook with chronic typhoid infection) or exclusion from contact with specific populations (e.g., a daycare attendant with shigellosis). 3. Exclusion to avoid exposing pregnant women to communicable diseases with known risk to fetus (e.g., rubella, chicken pox). 4. Standard infection control precautions. 5. Abstinence from sexual contact, or proper use of protective measures during sex. B. Typhoid Fever Carrier Isolation 1. The SPA Medical Director shall issue specific written orders to the patient or contact who must comply. 2. The SPA Medical Director shall issue the TYPHOID CARRIER AGREEMENT (CDPH 8563, DHS 8563)(English, Spanish) to convalescent and chronic carriers. C. Isolation in Skilled Nursing Facilities 1. Patients with certain communicable diseases should not remain in skilled nursing facilities (SNFs).2. Asymptomatic carriers, e.g., typhoid carriers, are not permitted in SNFs unless prior written approval is obtained from the Chief, ACDC. D. Special Isolation Precautions A patient with a communicable disease may be confined to his home, a hospital, sanitarium, jail facility or other specified location. Cooperative patients may be voluntarily isolated at home or in a hospital. An ORDER OF ISOLATION (H-475) served by Public Health Investigation may be necessary for uncooperative patients. SECTION 16: OTHER RESTRICTIONS ON PERSONS OR ANIMALS A. Personal Surveillance (CCR, Title 17, Section 2522) 1. Observation as used in this manual, refers to the frequent check upon the person under observation in order to promptly recognize signs and symptoms of illness without restricting their movements. It does not mean the isolation or quarantine of the individual. 2. Diseases requiring personal observation (see Part IV for duration of surveillance for each disease): Yellow fever Cholera Smallpox Plague (after disinfestation and prophylactic medications are administered) B. Animal Restrictions for Diseases Other Than Rabies: For specific details concerning animal restrictions, consult with DPH Veterinary Public Health Program. 1. The possession of skunks and any mammal related to ferrets, weasels, and minks are illegal in California (CCR, Title 17, Section 2606.8; Fish and Game Code, section 2118[b], respectively). Such animals are a menace to public health and safety. 2. MUSSEL QUARANTINE: A seasonal quarantine from May 1 to October 31 prohibits the taking, sale or the offering for sale of all species of mussels from the ocean shore of California, except for use as bait. Mussels that are used as bait shall be broken at the time of taking or prior to sale. This quarantine applies to sport harvesting only; commercially harvested shellfish are regulated by other means.

For bird owners, here’s what you have to worry about:

“BIRD QUARANTINE: Birds having, or suspected of having, a disease transmissible to human shall be quarantined and placed on medicated feed for 45 days (California Code of Regulations Title 17, Section 2603).4. TURTLE RESTRICTIONS: It is unlawful to sell, offer for sale, or distribute to the public any live turtles with a carapace less than four inches in length (California Code of Regulations, Title 17, Section 2612.1).”

Here is how a quarantine and isolation are effectuated:

“SECTION 17: QUARANTINE AND ISOLATION PLACARDS A. Neither quarantine nor isolation is established legally until a placard is posted and/or written instructions are given to the patient or contact. B. When a residence is quarantined, the SPA Medical Director or designee shall attach a placard(s) at the front or principal entrance. Placards must identify the disease, name of the SPA Medical Director, signature of the deputy posting the placard, date of posting, and the address and telephone number of the district health center. C. The individual who establishes a quarantine or isolation by placard or issues passes shall report the details to the Chiefs of ACDC and Public Health Investigation. D. All correspondence with other health departments which concerns violations of quarantine or legal orders of isolation is handled by the Chief of Public Health Investigation.”

Here is how a quarantine/isolation ends:

“SECTION 19: RELEASE FROM ISOLATION OR QUARANTINE (CCR, Title 17, Section 2534) A. A Public Health Laboratory that is approved by the State Department of Health Services must perform laboratory tests that are required for release from quarantine or isolation. In Los Angeles County, laboratories of the County of Los Angeles Department of Public Health, the City of Pasadena Health Department, and the City of Long Beach Health Department are approved as such. B. The NOTICE OF RELEASE TO RETURN TO WORK (H-1066) shall be issued by the SPA Medical Director, a designee, or Public Health Investigation.C. The Chief of Public Health Investigation shall terminate an order of isolation in writing.”

I hope this helps put AB 262 in context.

Rick Jaffe, Esq.

Everyone should calm down about Cali. AB 262

Everyone should calm down about Cali. AB 262

On October 19, the Governor signed AB 262 which deals with the responsibility of local health officials during a public health crisis due to a communicable disease.

Here is the text of the new law:
https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB262

Many parents have expressed concern if not downright fear that their pets will be removed, or that quarantines will be imposed. I do not think the bill will significantly change things. However, the concern is understandable in light of the on-going negative PR campaign against the vaccine concerned and the bill’s timing; It was introduced and passed during the same session as SB276/714.

Here is the bill summary:

“Existing law requires the State Department of Public Health to examine into the causes of communicable disease in man and domestic animals occurring or likely to occur in this state, and to establish a list of reportable diseases and conditions. Existing law requires a health officer knowing or having reason to believe that any case of the diseases made reportable by regulation of the department, or any other contagious, infectious or communicable disease exists, or has recently existed, within the territory under the local health officer’s jurisdiction, to take measures to prevent the spread of the disease or occurrence of additional cases.
This bill would require a local health officer, during an outbreak of a communicable disease, or upon the imminent and proximate threat of a communicable disease outbreak or epidemic that threatens the public’s health, to notify and update governmental entities within the health officer’s jurisdiction about certain communicable diseases that may affect them, if, in the opinion of the local health officer, action or inaction on the part of the governmental entity might affect outbreak response efforts. The bill would require the local health officer to make any relevant information available to those governmental entities, as specified, and would require both the local health officer and the governmental entities to comply with applicable state and federal privacy laws with regard to information that the health officer provides to the governmental entities. The bill would authorize the local health officer to issue orders to other governmental entities within the local health officer’s jurisdiction to take any action the local health officer deems necessary to control the spread of the communicable disease.
By imposing new requirements on local health officers, this bill would create a state-mandated local program.”

So, what does it mean for the vaccine concerned?

The first thing I would say is that I do not see the new law as creating any new powers of local public health officials over the public. What the state and local governments can do in terms of responses to public health crises is set out in state and local health laws. Prior to AB 262, public health authorities had significant powers to deal with public health crises involving humans and animals in certain defined public health communicable disease outbreaks. I do not see AB 262 as directly expanding the powers of the local governments over the public.

There are two operative parts to the bill. The first is innocuous, the second might not be, and might in some cases indirectly affect the public. Let’s take a look at the specifics:

The bill imposes a reporting requirement on local health departments to report outbreaks or imminent outbreaks, and specifically:
120175.5.
***
“(1) Promptly notify and update governmental entities within the local health officer’s jurisdiction about communicable diseases listed in Section 2500 of Title 17 of the California Code of Regulations that may affect them, if, in the opinion of the local health officer, action or inaction on the part of the governmental entity might affect outbreak response efforts.”
(2) Make any relevant information available to governmental entities, including, but not limited to, the locations of concentrations of cases, the number of residents affected, and the measures that the governmental entities should take to assist with outbreak response efforts.”

I do not see any problem with this. Disseminating information about communicable diseases is not a bad thing (in and of itself).

Here is the second thing:

“(b) In addition to the actions required under subdivision (a), the local health officer may issue orders to other governmental entities within the local health officer’s jurisdiction to take any action the local health officer deems necessary to control the spread of the communicable disease.”

I read this part as saying that the local public health department runs the show in terms of a local health response to a public health crisis based on a communicable disease.

Isn’t the language that the local health official can “take any action” *** [he/she] deems necessary to control the spread of the communicable disease” horrible?

I don’t think so. I read this in the context of the public health laws which set out the responses and powers of the public health departments during public health crises. So again, I do not see this bill as expanding the powers of the public health department over the public. Rather, it sets out the chain of command, and puts the public health official as the decision maker over all other local officials.

Some context

All of you are understandably focused on vaccines and what public health officials can do to your unvaccinated children. However, the public health department’s mandate is much broader than that and includes protecting the public from non-vaccinatable fatal human disease like anthrax and Ebola which actually could create a public health crisis. Regardless of how much personal freedom you might think you are entitled to, no one has the right to be the next Typhoid Mary, and spread a fatal communicable disease, and no court will ever create/uphold such a right. Admittedly, that begs the question about what could happen in a measles epidemic, like the recent one in New York.

Under what conditions can the public health department issue public health orders to local officials?

The somewhat vague answer is in the beginning of the new law:

“(a) During an outbreak of a communicable disease, or upon the imminent and proximate threat of a communicable disease outbreak or epidemic that threatens the public’s health, a local health officer shall do both of the following:” [the two provisions are discussed above]

Obviously, the concern is what is an imminent and proximate threat of a communicable disease outbreak or epidemic.” How many cases? That’s a good question, but I don’t know the answer.

What about your pets?

Some public health crises involve animals, especially those in the food supply, and the public health departments have the authority to issue orders relating thereto. However, I don’t see the public health department going after your dog or cat in a measles outbreak.

The Big Question: What can the local public health department do to you under AB 262 if there is a measles “public health crisis”?

My answer: the same thing it could do to you under the old law, (except that the new law clarifies the chain of command), so no sense worrying about the new law.

Rick Jaffe, Esq.