Medical Provider Sign Off False Assertions and Assumptions

The Medical Sign Off proposal can seem quite reasonable at first glance due to the false assertions and assumptions made by the proponents of the bill. False assertion / assumption: There is ignorance based usage of the PE, which could be swayed in a 10 minute office visit The idea that any parent exercising a Phil Exemption (PE) is not familiar with the mainstream concepts of the purported safety, necessity, and effectiveness of vaccines is absurd. Everyone is under a constant barrage of that information, from the time they start school and ongoing through adult life in the media. No parent is thickly thinking, I have never heard of this, therefore I am not going to do it, where having the universally promoted concepts explained to them would result in an aha moment. The bulk of the parent committee testimony described parents who had started out with full faith in vaccination, and only began to question when they personally experienced or witnessed a family member or friend have a reaction to a vaccine. The exercising of a PE, and going against all of the cultural momentum is a very difficult decision to make, and not done lightly. This is illustrated by the fact that there are so FEW PEs, and that they are typically for only a single vaccine, illustrating a thoughtful approach, not an ignorant wholesale rejection of vaccination. No parent is ignorant of the represented risks and benefits of vaccines. They simply do not agree with the representations for their personal situation, either through experience or research or some combination of the two.

This is the express purpose of the Philosophical Exemption!

False assertion / assumption: There are casual exemptions, people who are only using exemptions because it is too much work to go to the Doctor When Bill proponents opened their campaign to restrict the PE, they did so using an entirely inapplicable, overblown statistic that gave the impression some 35% of parents are opting out of all shots, which, as the committee has learned, is absolutely false. That false statistic is used intentionally because if it were true, then it would be quite reasonable that of that 35% some significant number of PEs could be quite casual in their commitment. However, the fact is that there are truly only 5.4% of K parents using a PE, the majority for 1 vaccine, and that that number would be only 2% if Chicken Pox and HepB had not been added to the schedule. How likely is it that any of that small group came to their decision casually, and would be influenced in a 10 minute meeting with an HCP? False assertion / assumption: Everyone uses an authorized signer as a primary Health Care Provider, and obtaining the Sign Off is no burden Therefore, while the parent is in the office anyway for a regular visit the HCP can simply sign their form. The testimony in the committee proved that very few conventionally trained HCPs are comfortable signing an exemption. That makes sense, because the model of modern, conventional western medicine has become pharmaceutical based. How can an HCP in that treatment model sign off that a pharmaceutical he administers universally could be not indicated for some patients? Recent reports show that a significant percentage of conventional HCPs will fire patients who do not follow the schedule. Please recall that the majority of parents exercising a PE do so at great personal effort, and would typically not use an HCP authorized to sign the bill. That forces an exempting parent into trying to locate a sympathetic authorized signer. False assertion / assumption: HCP sign offs will work Most curious in the push to an HCP sign off is that the CDC has already determined that the process simply doesnt work. Hesitant Parents are a category the CDC is researching to find ways to positively influence them to follow the schedule. The CDCs own internal research states, documented in power point slides, that PE parents are older, more educated than the average parent. A PE parent often knows more about questions of vaccine safety than an average HCP. There is no insurance billing code for a vaccine safety consult, therefore no payment for the HCP. HCPs do not have the time, incentive, or new information to be effective persuaders for a parent who has come to the PE decision.

Vermont HCP Signature Sign Off Compromise Objections

The Health Care Provider Signature is an expensive, onerous burden, unworkable, and could prevent a citizen from being able to exercise his exemption. The CDC itself has identified that the clinical setting is a very poor one for vaccine education because of the time restraints, no compensation for vaccine consultations, and HCPs are often less informed than parents about vaccine safety. See attached slides from a WA DOH seminar presented at a National CDC Immunization conference regarding vaccine hesitant parents that identified these factors. Expense- There is no Insurance Billing Code for a Vaccination Consultation, making this an out of pocket expense. Citizens are being charged to execute their right to an exemption. Only 5 recognized HCP signers for exemptions. Many VT Citizens who would want to exercise their exemption do not use one of the defined HCPs for primary care, instead utilizing various complementary and alternative providers. Vermont DOH has surveyed and identified that over 30% of Vermont citizens use CAM for primary healthcare. That will force these Citizens into trying to locate a sympathetic authorized HCP to provide the signature. No recognition of Out of State HCPs. Vermont has significant border population centers where it is common for Citizens to travel across the state border for medical services. The Bill does not recognize out of state HCPs, again forcing a Citizen into trying to locate a sympathetic Vermont state licensed HCP to provide the signature. No Requirement for the HCP to Sign. An HCP with a very strong vaccination commitment may take the appointment with the intent to persuade the Citizen to his perspective, and if unable to do so he may at the end of the consultation refuse to sign the paper. A Citizen could conceivably have to make several attempts to obtain the signature needed for him to exercise his exemption right. Forces a Potentially Adversarial Interaction with an HCP and possible legal ramifications. Several recent studies document that over 20% of HCPs will fire patients who do not adhere to vaccination protocols. This dramatically illustrates how polarizing the issue of vaccination can be between HCPs and Citizens. Some HCPs are so militant in their vaccination views that they consider non-vaccination to be a form of medical negligence and will report the family to Child Protective Services, initiating a chain of events that is very difficult to interrupt. Imagine a parent who does not have an existing relationship with an authorized signer. I am not a patient, I do not want to be a patient, I simply want to come in and have you do whatever it is you must to sign my exemption paper. Ideally as quickly and inexpensively as possible, please. How is the receptionist at a busy Medical office going to handle that call?

In summary, if the State truly considers this to be a matter of education there are much superior ways to provide that education than an HCP consultation. The information the state considers to be essential for parental review can be delivered online, by dvd or cd, or even classes at county health centers.
Consider, is this truly about Public Health? 360 Children out of 6,695 Kindergartners have a Philosophical Exemption on file. There are 273 schools offering Kindergarten with enrollments from 1 to 130. 253 schools have 4 or less children with exemptions. 134 schools have ZERO children with exemptions.

These slides are from a meeting of vaccination managers trying to troubleshoot "vaccine hesitant" parents. Their conclusion- the clinical setting is very poor for trying to educate or influence parents. So why is a Health Care Provider consult being promoted by these same people as workable? The reality is this will only result in very problematic interactions between Parents and Health Care Providers.

This slide demonstrates the difficulty of trying to have a vaccine safety conversation with a conventional HCP. Many HCPs consider questioning vaccine policy as a challenge to their authority in recommending appropriate health care. Do you want your HCP providing information, or asserting authority in directing your health care decisions? Dont these slides from CDC sources identify that the HCP sign off is not a solution, but instead a recipe for problematic HCP / patient interactions?

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In what context can too much information is a detriment?

1/3 of DR.'s feel no obligation to disclose medical errors. 40% do not feel the need to disclose financial ties to drug or device companies. Is this who we want in charge of vaccine exemptions?