Vaccinations for Children a Must at My Medical Practice

June 8, 2013

Here is why my pediatric practice requires 100 percent vaccination for patients and does not accept alternative schedules from parents.

To vaccinate or not to vaccinate? That is a big question.

I read the responses to the recent query about unvaccinated children in a medical practice. This is a hot button issue, both for and against vaccination and is vigorously debated whenever it comes up. I am going to share our practice’s response to and long experience with this issue.

A few years after I joined my current practice in 1993, I read about a malpractice case in California where a high-risk adult patient had been repetitively counseled about getting vaccinated for Hepatitis B and refused each time. After contracting the infection, suffering liver failure, and receiving a liver transplant, he successfully sued his previous medical providers for not vaccinating him to prevent all his subsequent medical events. Let me repeat part of that sentence: He successfully sued his doctors for not vaccinating him! As physicians, of course, we should be held liable for our mistakes. But to be held liable for not preventing a preventable event in an individual that refused the prevention is just not right. But with our current legal system, this is a possible outcome for vaccine-preventable diseases.

That legal precedent was (and still is) terrifying. It was shortly after that time we made the decision to require 100 percent vaccination in our patient population.

Vaccines are a modern miracle. These diseases are real; they are dangerous; they can easily be prevented and with the exception of smallpox have not gone away.  If you have never spoken with someone that has survived polio, I suggest you find such a person and have a chat. Currently there is a huge measles epidemic in England due to the poor vaccination rates with MMR due to the fraudulent study mistakenly linking this vaccine to autism. Unfortunately there has been the death of one child in Wales due to measles …a completely senseless preventable death.

Vaccines are not perfect - but neither is your seat belt. Even with air bags, anti-lock brakes, and consistent use of seat belts, you can still be seriously injured in a car accident. Even if vaccinated for influenza, you could still get the infection. Vaccines and seat belts are not perfect, but clearly better than using nothing. The real conundrum is that you can never know when the vaccine worked because you never got the illness.

Simply stated, our practice will not be a good fit with parents that refuse vaccination. The parents will be pressured frequently by us about vaccinations and the providers will feel uncomfortable with our pediatric patients being unprotected (just like we would feel if the parents don’t use car seats).

We also don’t accept any alternate schedules. In our experience, most parents get off schedule and the children get very behind in their protection.  When asked to create the alternate schedule, I first ask the parents to choose their most beloved child. Of course this is an impossible question. But is it really so different with immunization? By choosing to use one vaccine before another is to leave the child vulnerable. What if that child is exposed to whatever they are not protected against, gets sick, and even possibly dies? Both the parents and I will feel horrible. But I will also be liable.

So why not just have the parents sign a waiver saying they know and accept the risks of not vaccinating? Due to that previous case in California, I am afraid that the legal system will not protect me or my practice no matter how many pieces of paper are scanned into an e-chart, especially if there has been a bad outcome for the child.

I know that it is a difficult decision to not accept unvaccinated children in our practice and it is not recommended by the American Academy of Pediatrics. However, it is not unethical. Parents absolutely have the right to make decisions that they consider in the best interest of their children. My practice spends a great deal of time educating parents in order for them to understand vaccination like we understand it. We give the parents a month or two to change their minds. However, if at the end of this grace period, they still choose to not vaccinate, we ask them to choose another medical practice that will be more comfortable with their choice.

The vast majority of my patients’ families are very happy knowing that we have done all in our power to make sure that their children are not sitting in our waiting room next to a child with measles or chickenpox.

I know that our practice policy will invite heated comments from the readers and will not be popular with many. However, we have chosen to practice medicine by our principles and live by our convictions in the protective power of vaccination.