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After Major Changes to California Vaccine Bill, Skeptical Governor Supports It

The legislation sharpened its focus on unscrupulous doctors while easing the list of medical conditions that physicians could cite in allowing schoolchildren to skip required immunizations.

gavin newsom
California Gov. Gavin Newsom
(TNS/Los Angeles Times/Dania Maxwell)
By Melody Gutierrez

A key California lawmaker has amended contentious vaccine legislation amid a national measles outbreak, sharpening its focus on unscrupulous doctors while easing the list of medical conditions that physicians could cite in allowing schoolchildren to skip required immunizations.

Tuesday's amendments to Senate Bill 276 follow negotiations with Gov. Gavin Newsom, who raised concerns earlier this month that the bill would create an immunization bureaucracy that could interfere with the doctor-patient relationship. With the changes, Newsom will now formally support SB 276, easing the bill's chances as it makes its way through the state Legislature.

"The Governor would like to thank Dr. Pan for his leadership and for partnering with the Administration on these amendments," said Health and Human Services Secretary Mark Ghaly, referring to Sen. Richard Pan, in a statement.

These amendments, Ghaly added, will ensure the bill "protects the doctor-patient relationship, strengthens the state's ability to target doctors who abuse the medical exemption process and gives state public health officials the tools to identify and protect schools and communities where herd immunity is in danger."

SB 276 by Pan (D-Sacramento) faces a vote in the Assembly Health Committee on Thursday, where it is expected to draw large crowds of opponents. If it passes there, the bill would go to the Assembly Appropriations Committee, which is chaired by Assemblywoman Lorena Gonzalez, a co-author of SB 276. From there, the bill would go to the Assembly floor and, if passed, would return to the Senate, where the previous version of SB 276 passed last month.

The amendments Tuesday did not pacify groups opposed to the bill or the scores of parents who have flooded the Capitol in protest. Many parents took to social media, where they said the bill is worse, arguing that new penalties could have a chilling effect on the willingness of doctors to write medical exemptions.

One opposition group called Educate.Advocate wrote that the amendments were "verbose, contradictory and complex," and will only ensure "mass confusion and varied implementation."

"Doubling down on mandates with sweeping generalizations and no consideration for individualized medicine and health care will not yield compliance, but continue to foster distrust of public health officials and legislators at great cost to public education revenues in California," the group said in a statement.

SB 276 would make it more difficult for doctors to exempt children from shots required to attend public or private school by granting the state Department of Public Health oversight authority.

The bill originally allowed for the health department to review and potentially reject any child's medical exemption approved by a doctor. As now modified, SB 276 would allow for such reviews only at schools with immunization rates of less than 95% or for doctors who grant five or more medical exemptions in a year.

A doctor would have to certify, under penalty of perjury, that the medical exemption is "true, accurate and complete."

The bill is also less prescriptive on what medical conditions qualify for an exemption, including consideration of family medical history. The bill now requires that an exemption only "fall under the standard of care."

In applying for a medical exemption, parents and doctors would have to agree to turn over a child's medical record to prove skipping all or some shots is warranted.

Anti-vaccination advocate Robert F. Kennedy Jr. has been actively fighting the "draconian proposal," visiting the Capitol to lobby last week with actress Jessica Biel.

Many public health advocates support tougher immunization laws, and a recent poll reported that 3 of 4 Californians also support strong requirements amid a major measles outbreak that has infected more than 1,000 Americans.

But opponents of mandatory vaccinations for schoolchildren have been more active and vocal than proponents, leading to some of Tuesday's amendments, meant to counter their arguments.

Among the amendments aimed at opponents' concerns: Any medical exemption rejected by the state would have to be reviewed by a doctor in the state health department. Opponents had questioned the qualifications of state employees who would be able to reject a doctor's medical opinion.

California already has some of the strictest childhood vaccination laws in the country, with the state requiring immunizations to attend public or private schools. A doctor can excuse a child from some or all vaccinations if there is a medical reason to do so, but questions have been raised on whether some doctors are improperly approving exemptions.

Pan, a medical doctor, has said the bill is needed in order to target "unscrupulous physicians" who are profiting off granting unneeded exemptions from vaccines. SB 276 would not allow a doctor to charge patients for filling out a medical exemption under Tuesday's amendments.

"The first goal of the bill is to try to keep our schools safe," Pan said in an interview last week. "We know the root of the problem are these physicians."

Under the bill, the state would have the authority to bar certain doctors from writing medical exemptions for up to two years if the health department determines they pose a risk to public health. Doctors with a pending investigation by the Medical Board of California or Osteopathic Medical Board of California related to vaccines would also not be allowed to write new exemptions until it is resolved.

The state would track all rejected medical exemptions and share that information with the licensing boards.

"SB 276 is important legislation that will protect our communities by preventing outbreaks of preventable disease," said Leah Russin, executive director of Vaccinate California.

An opposition group made up of doctors and lawyers, Advocates for Physicians' Rights, said it still has concerns with the state interfering with the doctor-patient relationship. Instead of making the bill more palatable, the group said new problematic provisions were added, such as limiting what fees a doctor can accept for providing medical exemptions.

"SB 276 is targeting the very professionals who save our children's lives," the group said.

(c)2019 the Los Angeles Times

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