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Will Your Child’s Cali. Medical Exemption Be Good When Schools Reopen in the Fall?

Will Your Child’s Cali. Medical Exemption Be Good When Schools Reopen in the Fall?

I have been getting that question a lot lately. It is understandable with all that is going on.
The answer is that I don’t know and I don’t think anyone can know for three reasons.

First, Senator Pan had to give-up some important ground at the end of the last session, via SB 714 which watered down some of SB 276’s more onerous provisions. The biggest problem (from the regulators’ point of view) with the current SB276/714 law is that there is no filing/reporting requirement for grandfathered ME’s. Under the law, ME’s written by a physician who has been disciplined by the Medical Board are revocable by the CDPH, but there is no specific administrative procedure by which grandfathered ME’s of these physicians are submitted to the CDPH. For sure, in an ad hoc manner, schools can forward these exemptions, but some might, some might not. Right now, only one high profile ME writing physician is currently under a disciplinary order which precipitates ME revocation, but by early to mid-next year, there will probably be other physicians whose exemptions are revocable. Will the CDPH find out about these docs and their revocable ME’s? My guess is it will, if Senator Pan has anything to say about it (as discussed below).

But for now, we simply cannot say for sure whether or how many of this one physician’s ME’s will be revoked and by when, or whether there are other exemptions which will be affected during the upcoming school year.

The second reason I can’t tell you whether your child’s permanent medical exemption from all vaccines will be valid for the entirety of next year is because the California Legislature is back in session and it is a good bet that Senator Pan will try to clean-up and get back what he was forced to give up to the Governor who caused the last minute inclusion of SB 714. Alas, we live in a different world now, and it is possible that there is now less daylight between Senator Pan and the Governor. Time will tell.

But I have to believe that Senator Pan is thinking hard about completely eliminating the problem of the 10-12k permanent medical exemptions, because some of these ME’s could be good for years. To the consternation of some, I have speculated about the probable and drastic/worst case scenarios of what he could do this session. Here is that post.

https://rickjaffeesq.com/2020/04/17/what-could-be-next-in-the-california-legislative-vaccine-front/

We will know more once he drops the initial version of his new bill, unless he decides to sit this session out because of the pandemic, (which to me seems unlikely).

The third reason I can’t tell you if your child’s permanent exemption will be valid and accepted next school year is because who knows how some schools will react to the pandemic.

What I can tell you is that last year, after SB 276/714 was passed, but before it went into effect, (and even before it was passed), some schools were rejecting permanent, complete vaccine exemptions for seemingly healthy but medically fragile students. It seems a reasonable guess that some, and probably more schools will, on their own, and without a direct legal basis, question or reject these ME’s regardless of whether the issuing physician is under a Board order.

Could there be a legal redress, i.e., a basis to sue? Sure, and a few such cases might be filed. Maybe some families will get legal relief, but the worse the pandemic becomes, and the closer to home it hits, the less likely a California judge is going to force an unvaccinated healthy but medically fragile kid back into school over the its objection. But this is just speculation and is based on my feeling that the school nurses are going to be even more skeptical and fearful of the unvaccinated, regardless of how irrational you all think that might be. And while none of you think this is right or fair, many of you probably also fear or think that is how it is going to play out.

What about if your child has an IEP?
Right now, legally, nothing should change, but let’s see what the new bill says, and how the schools react to current events.

So, what should you do about it, right now?
Sorry, I just don’t have any good ideas right now in advance of knowing the contents of new legislation. If there is a new bill introduced, and if it eliminates or jeopardizes your child’s ME, then there will be the lobbying and protests for sure. Also, an as yet unanswered question is whether most of California will continue to avoid the dire effects of the pandemic which other places in the Country are facing.

For now, I think the only thing to do is sit tight and wait to see what happens, but I don’t think you’ll have long to wait to at least get a sense of what is coming.

Rick Jaffe, Esq.

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.