Does the Medical Board Overstep Their Power Here?

The article is called California doctor critical of vaccines is punished for exempting 2-year-old boy from all childhood immunizations but don’t let that fool you.  I am absolutely 100% pro-vaccine but this is insane.  Here is what the article said:

In a decision that could signal how California’s fierce vaccine debates will play out in the coming years, the Medical Board of California has ordered 35 months’ probation for Dr. Bob Sears, an Orange County pediatrician well-known for being sympathetic to parents opposed to vaccines.

In 2016, the board threatened to revoke Sears’ medical license for wrongly writing a doctor’s note for a 2-year-old boy that exempted him from all childhood vaccinations. This week, the medical board settled on a lesser punishmentSears can keep practicing medicine but will be required to take 40 hours of medical education courses a year, as well as an ethics class, and also be monitored by a fellow doctor. He also must notify all hospital and medical facilities where he practices of the order and is not allowed to supervise physician assistants or nurse practicioners.

Sears found himself in hot water because, according to the medical board, he wrote a vaccine exemption for a young boy without obtaining even basic medical information, such as the child’s history of vaccines. He took the boy’s mother at her word when she said her son lost urinary function and went limp in response to previous immunizations, according to the filing.

What struck me is the precedent here.  Taking a patient at their word is wrong?  Here is what my friend and colleague Julie Gunther MD, at SparkMD, said about this recently:

I believe vaccines are an important part of wellness. But I also believe that it is not my job as a physician to tell my patients what to do or what is best for their children. I can only educate.

More and more– doctors are being held accountable as gatekeepers to things that society isn’t sure what to do about. Workmen’s Comp., family debates about power of attorney, therapy animals.. I most recently had to validate that a patient had a large head and needed a headset so he wouldn’t continue to get headaches. Not a very good use of my time.

Not only is this exhausting, it’s one of the reasons physicians are leaving practice. Dr. Sears is being reprimanded because “He took the boy’s ( his patient’s) mother at her word”….

If listening to our patients isn’t at the forefront of our job then I don’t know what this job is anymore.

For real, people, if you want doctors to stay in practice, you’ve got to support them. My professional colleagues are dropping like flies.

I agree with Julie.  I am glad someone is pushing back on these anti-vaccine lunatics but I think the board overstepped their bounds on this one.  What do you think?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  13 comments for “Does the Medical Board Overstep Their Power Here?

  1. Richard B. Willner
    July 6, 2018 at 12:03 pm

    To me, this is a story about the uniqueness of the Medical Board in California. They have a history of a superficial investigation and then will issue an “revocation of the license, stay it, and a 35 or 36 month probation.” The difference between a 35 and 36 is that the Board will re-evaluate the 35 month probation but not the 36 month one. The conditions of probation can be difficult to meet.

  2. Chris
    July 1, 2018 at 6:33 pm

    I find this one a very odd legal situation. The State of California gives physicians the power to excuse children from vaccinations based on their professional medical judgement. But then the state medical board punishes a physician for executing that judgement contrary to the opinion of the members of the medical board. I also found the reporting on this somewhat contradictory. The story said that he excused the patient from vaccinations based on a reaction the child had to a vaccine, but then they said that he didn’t obtain a history. It sounds like he obtained a history to me, otherwise how could he assert the reason for the excuse?

    Personally, if a parent told me that their child had a syncopal spell (or was it a seizure?) when they were administered a vaccination I would excuse them from having to take another dose of that vaccination. On the other hand, if this physician advertises that you come to him and he will find a reason to get you out of having to be vaccinated then he should be sanctioned. But so should physicians who work at practices whose sole purpose is to write medical marijuana certifications to anyone who pays them $40. I am sorry, but physicians should not be allowed to cash in integrity for monetary gain.

    Recently I had to discharge a patient from my practice who insisted that I write a letter to the local housing authority certifying her pet (not service animal) as a medical necessity. After a bit of arguing I finally got her to reveal that she just wanted to avoid paying the extra cleaning fee she would have to pay to have a pet in her apartment. She ended up cursing me out so I told her not to come back.

  3. Jennifer Hollywood
    July 1, 2018 at 12:36 pm

    I also would not take the parent at their word. Many anti vaccine parents will say anything to get them out of having to vaccinate their children. Given the societal risks of not vaccinating children we need to be stronger advocates for vaccines. You don’t just put their child at risk but everyone their child comes in contact with. Their child is taking advantage of the fact that the rest of the population has received the vaccine and now the risk of the disease is low. But the more people that opt out , the higher the risk of the disease entering the population. And since no vaccine is 100% people will then get sick. Even the vaccinated ones. We’ve seen this happen over the last few years.

    As to the fact that he is being punished for this, the bigger question is why are we the police of this problem.

  4. Debbie Sutcliffe, MD
    July 1, 2018 at 11:44 am

    This doc is a nut case–and is responsible for a great deal of the anti-vax movement. BUT the Calif law does say a physcian/school or PH nurse must “consult” with the parent and provide education and then can write a note. So, it is a low bar to meet!
    That being said- I too am tired of being society’s whipping boy- support animals, work notes, etc, etc, etc. Everyone is pushing authority on docs for things we cant control!

  5. Martha oreilly
    July 1, 2018 at 11:10 am

    I agree with Dr Doug. Free choice has to have a place in the patient doctor relationship. I for one am sick of being held responsible for all the non medical bullshit. My job is to educate and encourage not to force or make decisions for my patients.

  6. Steve O'
    July 1, 2018 at 10:37 am

    I take note of what Julie Gunther had to say:
    For real, people, if you want doctors to stay in practice, you’ve got to support them. My professional colleagues are dropping like flies.
    I see this much more in the police and teaching professions. It seems that the community takes the position To Err Is Criminal. An event happened, the Investigative Authority looks into it, the press publishes a brief and often erroneous account of it, and the Jury of the People renders a verdict.
    The traditional method of reviewing actions of a professional for substandard performance is professional tort law, which has nearly vanished. Professional tort law asks – Was there a professional relationship? Was there a failure to deliver performance within the standards of the profession? Did harm result?
    That is where the current matter is alarming. The decision not to vaccinate a child for common illnesses for which a vaccination is available is obviously a poor decision on the face of it. There may be compelling medical reasons not to do so. It is not a crime, nor is it a crime to favor the request of the parents – who, after all, are the legal custodians of the child – to not vaccinate the child for albeit poor reasons. The harm of not vaccinating the child is nil. Vaccination prevents an illness, but does not fail to treat an illness. The doctor has, in a sense, been found guilty of unprofessional conspiracy to cause a non-event. There is no reason that not vaccinating a two-year-old prevents the vaccination of a 2½ year old. The physician is guilty of not enforcing primary care guidelines. What if a 1½ year old contracts a communicable illness for which she/he has not yet been vaccinated? Who is to be prosecuted in this case?
    Until physicians obtain police powers, a physician can do little but report the parents for negligence. Perhaps then the child can be taken away and vaccinated against the parents’ interests.

    In our Brave New World, all things are judged by the Jury of the People’s Opinion. That is scary. I reference Shirley Jackson’s The Lottery as a narrative of the Jury of the People’s Opinion. Neither Orwell nor Huxley, Jackson cuts closer to the mark of today’s society. Traditional punishment is in order. At least Jackson allowed for the presence of innocence.
    The matter of the aforementioned guilty Dr. Bob Sears is that the people have spoken. God save the People, if they deserve it.

  7. Bill Ameen
    July 1, 2018 at 9:04 am

    I disagree with you and Julie this time, Dr. Doug. Vaccines should be mandatory except in established allergy. This kid obviously had a syncopal episode and pissed himself due to the pain of his last shot. The Board was entirely correct to come down on this doc. If they hadn’t, it would have only given ammunition to the anti-vax movement. They’d be bringing their little darlings to him in droves.

    • Julie Gunther
      July 1, 2018 at 1:53 pm

      Bill- This discussion, in my opinion, is not about whether or not vaccines are extremely important. It’s not about the fact, also in my opinion, that robust scientifically-minded physicians uphold the highest standard of care which is that vaccines are an essential part of individual and population wellness. This discussion is about the role of the physician. I tell ALL of my patients that it is in the best interest of their children to be fully vaccinated. Do all of my parents listen to me? Yes. Do they agree with my (scientific, evidence-based) recommendation? No. So, is it then my fault as the physician- to the degree of reprimand, that their children are not vaccinated?

      I understand- Dr. Sears signed a waiver. I probably would not. But then what? Do I terminate care with patients who don’t follow my recommendations? Do I turn them over to the sate (seriously??!!?!?!?), do I say I won’t take care of anyone who won’t vaccinate their children or, more broadly, who won’t take their medication, who won’t stop drinking, who doesn’t do what I say?

      This whole issue points to a broader problem of holding physicians personally accountable to innumerable ills of society. When anything goes wrong, people don’t’ follow the rules, people chose to take medication and drive (when told not to)– it all comes down to being the physicians fault. And yet we are gradually losing not only our place in society as experts but we also have diminishing autonomy and authority.

      There’s a whole lot of things that my patients’ chose that I do not agree with. But the very nature of our role is to heal (‘physician’) and to educate (‘doctor’). We can lead a horse to water. But when they don’t drink- are we liable?

  8. William E Green III MD
    July 1, 2018 at 8:25 am

    I agree with Thomas Guastavino, taking a mom “at her word”, especially on vaccines, is ridiculous. Unless a child has a clear contraindication to vaccination (prior vaccine reaction, etc.), they should ALL receive the basic recommended vaccinations. This Doctor sounds like he’s part of the “anti-vaccination crowd”, and we have to stand up to these idiots.

    • Steve O'
      July 1, 2018 at 10:39 am

      The Doctor sounds like he’s part of the “anti-vaccination crowd”, and we have to stand up to these idiots.
      Is he? Do we know for sure? Should such questions halt the punishment? Do we trust the Board of Medicine, the Press enough to cast the first stone?

      • Julie Gunther, MD
        July 1, 2018 at 2:01 pm

        And even further- Dr. Green, if I told you something about my child and you plain-face disagreed with me and proceeded based on your own judgement– I would terminate care then and there and be extremely concerned about a return to paternalistic-doctoring that historically has harmed many.

        We HAVE to listen to our patients. And, unfortunately, we HAVE to trust them, unless we have direct evidence to the contrary. So much trust in our profession has been eroded by quick-visits, not listening and a lack of cultivation of a therapeutic environment. The California law leaves physicians between a rock and a hard place. Educate, educate, educate and if a parent insists on a waiver, either provide it (if history supports it but proceed at your own peril), ‘force’ the family to immunize the child and pray nothing goes wrong because they will sue you when it does or terminate care to protect your license. Then the child can have their healthcare…. With someone NOT under the auspices of the board of medicine who can practice without fear of reprimand. IMO, a remarkably less than ideal “solution”.

  9. Thomas Guastavino
    July 1, 2018 at 7:11 am

    For the first time I disagree Authentic Medicine. Taking patients “at their word” has led to a number os issues such as the opioid crisis. It also discounts the effects of secondary gain. For years I saw patients who claimed they had a penicillin allergy. This was a problem because not only could these patients not take penicillins they could not take cephalosporins, at time given less effective or more dangerous antibiotics. So I started to ask what was the penicillin allergy. 95 % of the time it was not a true allergy. The commonest response was “it upset my stomach” or ” it made my pee smell” My favorite was ” I took penicillin and got pregnant” Only if the patient said they got hives or a true anaphylactic reaction did I deny them the cephalosporin and i never had a problem.
    So, I would think twice before I would just take a patient at their word.

    • Julie Gunther, MD
      July 1, 2018 at 2:07 pm

      Dr. Thomas- isn’t this really a comment about time and communication?
      I find that a patients word is often mis-informed or a side-ways version of history as we would tell it. With time– more than 12 minutes face to face, we can often flush-out the many miss-truths in a patient’s chart or history, such as your penicillin analogy. You actually took your patients ‘at the word’- in the sense that they expressed what they knew about penicillin, you inquired and, with further discussion you clarified the difference between sensitivity and allergy.

      If we all moved slower- if systems let us be DOCTORS, we could do our work. And the good work we do is fundamentally dependent on being able to communicate with our patients and, after sufficient communication, to ‘take them at their word’… Or to question it, in the context of a therapeutic environment and work together at a different understanding.

      But big picture, when we go into the patient room, do our work authentically with compassion, education and time, and we make a clinical decision…. we also have to live in threat of a third party coming after our license because they disagree with the mutual therapeutic decision. I’m not advocating for physicians who have lost their way. I’m advocating for physicians who are doing their best work. And slowly dying on the vine for it.

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