After writing about the failure of state medical boards to discipline physicians who practice quackery and an apparent notable exception in Tennessee just yesterday, my attention was brought back to California and the topic of SB 277, the law enacted last year that, as of July 1 this year, eliminated non-medical exemptions to school vaccine mandates. As anyone who’s read this blog for more than a year knows (or anyone who’s just paid attention to the political battle to pass SB 277 lsat year in the wake of the Disneyland measles outbreak), once the battle was over and antivaccine activists lost, their attention turned immediately to finding ways to get around the law. Unfortunately, the law provided a way.

There are now three states in the US that do not allow nonmedical exemptions to school vaccine mandates: Mississippi, California, and West Virginia. Not surprisingly, just as antivaccine parents have tried to falsely claim religious exemptions in states that only Each of them has different standards for documentation of what is required to qualify for a medical exemption that fall into two categories. The most strict is West Virginia, where requests for medical exemptions are reviewed by an Immunization Officer, who determines if they are appropriate “based upon the most recent guidance from the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) with respect to medical contraindications or precautions for each vaccine.” In Mississippi and, now, in California, all that is required is a letter from a physician.

You might ask: So what’s the problem with just letting any old physician write a letter supporting a medical exemption to school vaccine mandates in California? It’s a system that seems to work very well in Mississippi. Here’s the problem: California is not Mississippi. One key difference is that California is has a lot more antivaccine parents; indeed, it is arguably the epicenter of antivaccine activism in the US, which is why the resistance to SB 277 was so loud and public. It’s also why I’ve said on more than one occasion that when the outbreaks occur they’ll start in California. Another key difference is that California is chock full of antivaccine and antivaccine-sympathetic pediatricians and family doctors who have seen a lucrative business opportunity selling medical exemptions to all of these antivaccine parents. Indeed, I speculated whether this would happen right around the time SB 277 passed.

So did others:

Dr. Bob, of course, is Dr. Bob Sears, the antivaccine-sympathetic pediatrician who’s’ most famous for a book full of bad advice on vaccines and, during the political battle over SB 277, prone to going full Godwin over the bill. Consistent with that, it didn’t take Dr. Bob very long at all to start giving seminars on how to get medical exemptions and avoid school vaccine mandates under SB 277. At the time, mere weeks after the passage of SB 277, Dr. Bob focused on non-evidence-based reasons for medical exemptions and ways to get around the law other than home schooling. For example, he suggested getting an Individualized Education Program (IEP) that specifies regular classroom time. IEPs are mandated by the Individuals with Disabilities Education Act (IDEA) for children with special needs. If a child receives special educations services, he must have an IEP that includes a description of how the child is doing, the child’s specific annual education goals, specific special education supports and services that the school will provide to help the child reach those goals, modifications and accommodations the school will provide to help the child make progress, and other information. To comply with federal law, SB 277 specifically stipulates that the law “does not prohibit a pupil who qualifies for an individualized education program, pursuant to federal law and Section 56026 of the Education Code, from accessing any special education and related services required by his or her individualized education program.” So Dr. Bob recommended that parents seek an IEP, even for “minimal speech delay or learning issue” when the child is 2 or 3 years old so that they have it later and will be “protected” from SB 277 for the entire child’s school career.

Less than three months ago, I learned that there was now basically a cottage industry of bogus medical exemptions, with physicians such as Dr. Tara Zandvliet, Dr. Kelly Sutton, and, of course, Dr. Bob Sears selling medical exemptions based on medical reasons not supported by science.

What I don’t talk about that much on this blog is how often people write to me about the issues I discuss on this blog. Sometimes it’s just abuse from people who don’t like my point of view on alternative medicine, vaccines, and science. Sometimes, it’s people asking for medical advice, which I really can’t give, except in general terms. Sometimes it’s people telling me their stories about encounters with quacks. Of these, reading stories of patients whose family members have chosen, for example, Gerson therapy instead of real medicine are the hardest to read and steel me to continue what I do. Sometimes people let me know about something that I might want to blog about. This was one of those times, as it was the story of a parent and Dr. Bob’s vaccine exemptions that demonstrates how bogus these exemptions are.

I won’t tell you whether this was a male or a female, and I’ve stripped all potentially identifiable information from the genuine letters generated by Dr. Bob’s office in support of medical exemptions for their children. I’m going to refer to this parent as “he” for convenience and based on the default to male pronouns in English. Basically, this story developed out of, unfortunately, divorce, where the person who wrote me is not the custodial parent. He describes himself as formerly antivaccine but now pro-vaccine, which, as described, caused a rift in the marriage to the point where his spouse left. This is, unfortunately, a story I’ve heard too many times. In any case, this person who wrote me wants the children vaccinated. His spouse, however, does not, and his spouse stymied him by getting a medical exemption from Dr. Sears. Basically, his spouse filled out an online history form, paid a fee of $180 per child, and Dr. Bob’s office spit out these two boilerplate exemption letters. Nothing about them has been altered, other than to white out the names, dates of birth, and the date of the letter. (I wouldn’t want Dr. Bob to be able to figure out who it was based on the reasons for exemption and the date issued. Let’s just say that it was within the last four months or so.) Here are the letters (click to embiggen):

Dr. Bob Sears vaccine exemption letter 1

Dr. Bob Sears vaccine exemption letter 2

Note the bogus reasons:

  • Family history of Autoimmune Disorders, Inflammatory Bowel Disease, Neurodevelopmental Disorders, Psychiatric Disorders.
  • His own current medical problems.

My reader described how he showed these letters to the children’s regular pediatrician, who was appalled. By e-mail (and, by the way, I’ve saved every e-mail), I urged him to report Dr. Bob for what, in my opinion, is highly unethical behavior and failure to meet the standard of care. After all, Dr. Bob never actually examined the patient and appears never to have verified even the medical history. Basically, he appears to have an online form that a parent can fill out and get a medical exemption for pretty much any condition. I was assured that a report to the Medical Board of California has been filed.

To be honest, given how many quacks practice in California, I’m not as optimistic as I’d like to be that anything will be done about Dr. Bob’s issuing boilerplate medical exemptions unless there are a lot of complaints. That’s the problem. The very parents who take advantage of such a “service” are the very parents least likely to complain to a state medical board about the physician providing the service. After all, such parents got what they want: an exemption from vaccinating their children. Because they are antivaccine and motivated enough to seek out such a service, they really don’t care how they got the exemption; all they care about is that they got it. Cases like this one, where one parent has become pro-vaccine and objects enough when the other parent uses a physician like Dr. Bob to obtain a medical exemption are almost certainly comparatively rare. No doubt Dr. Bob will get that new Lamborghini if he decides he wants it.

Still, I’m hopeful that publicizing this story, with the permission of my reader, will draw some attention to Dr. Bob. In the meantime, I referred my reader to people who can help find legal help if he doesn’t already have it. If ever there were a case that cried out for investigation by the Medical Board of California, this is it.

Comments

  1. #1 Chris Hickie
    July 29, 2016

    This is truly appalling. Sears needs to lose his license immediately. He’s a direct threat to public health and is practicing medicine without examining patients as well.

    If there was ever a time for other pediatricians in California including those in the California chapters of the American Academy of Pediatrics. including Dr. Richard Pan, to publicly call out a pediatrician by name and demand action by the medical board of the State of California, it is now. If you California pediatricians won’t speak up on this, then why the hell did you bother to even put SB277 on the books? — signed, an Arizona pediatrician who despises Sears for what he has done to vaccination rates in my state and can’t understand why you tolerate him and yours.

  2. #2 Liz Ditz
    Great State of California
    July 29, 2016

    Personal note here. My heart hurts for the children in this story. I am a stepmother and muy daughter’s father and I divorced when she was in elementary school. Co-parenting isn’t easy; when parents are divided, the children suffer.

  3. #3 Dorit Reiss
    July 29, 2016

    One of the lawsuits against SB277 tries to make a big issue from the counties’ effort to oversee medical exemptions, under the heading of “doctor has discretion.”

    They seem to miss the fact that medical discretion is never unsupervised or without limits.

    Part of the irony is that the opponents complain SB277 discriminates against those without means – but who are the ones who can get cash-only medical exemptions for sale? Not the ones without means.

  4. #4 Orac
    July 29, 2016

    Personally, I would complain to the Medical Board of California, as there are a number of issues that, from my perspective, could potentially put Dr. Bob’s license in jeopardy. As Chris pointed out, according to this parent Dr. Bob is making medical recommendations without actually seeing and examining patients. That alone is bad enough, but he’s also making recommendations that are not considered part of the standard of care and go against nationally accepted guidelines from various professional societies and the CDC. If the medical board actually had any balls, that would be enough to initiate an investigation and hearings.

  5. #5 MI Dawn
    July 29, 2016

    This is disgusting. Dr Sears is blatantly lying. “I am the pediatrician for XX”. No, you aren’t, you lying sack of S***. You sent out a boilerplate letter in response to an online request? What kind of pediatrician are you? I wouldn’t trust you to care for anyone or anything. They’d probably die in your care, and you’d lie to me as to what happened.

  6. #6 Eric Lund
    July 29, 2016

    For example, he suggested getting an Individualized Education Program (IEP) that specifies regular classroom time. IEPs are mandated by the Individuals with Disabilities Education Act (IDEA) for children with special needs.

    I have heard anecdotally that for several years there have been parents gaming special education requirements in order to get additional attention for their special snowflakes. You can guess where these parents fall in the socioeconomic spectrum. One side effect of SB277 will be to make this phenomenon even more pronounced.

    Part of the irony is that the opponents complain SB277 discriminates against those without means – but who are the ones who can get cash-only medical exemptions for sale? Not the ones without means.

    If you accept the faulty postulate that vaccines are always bad, the claim that SB277 discriminates against people without means logically follows. The sort of doctor who would offer medical exemptions for sale–Dr. Bob being a classic example–tends not to accept medical insurance, so only those parents who can afford to pay cash will use such services. It’s the same kind of deal as gaming special education requirements: the parents who play that game are the ones with the spare cash available to hire compliant “experts”. Poor parents don’t get medical vaccine exemptions or special education plans for their children unless the kid really needs it.

  7. #7 has
    July 29, 2016

    To be brutally honest, the blame here falls not on antivax parents or even antivax quacks, but entirely upon the medical profession itself for its persistent failure to regulate itself consistently and effectively. Grifters and incompetents will always exist in any profession; what matters is the mechanisms for identifying and ejecting them before they do harm. And for all the fantastic advances that medicine has made in other aspects of patient care, this is one area where it remains frighteningly stuck on the wrong side of Hippocrates.

    Developing more robust and effective process improvement and internal/external regulatory systems may not seem nearly as glamorous as discovering a new antibiotic or surgical procedure, but is just as critical to improving and maintaining that care; so if the health profession can’t even take out its filthiest trash then where else might it be cutting on corners? Because people suffer and die when that happens.

  8. #8 MarkN
    July 29, 2016

    Would this put Sears into RICO territory?

  9. #11 Sarah A
    July 29, 2016

    Wow – just when I think Dr. Bob can’t sink any lower, he still manages to surprise me. It’s been obvious since SB277 first passed that Dr. Bob intended to turn a profit by basically selling medical exemptions to anyone who was willing to pay for them, but I never imagined he’d do it without even seeing the children who are supposed to be his patients. I’d like to think that this will be the last straw that finally gets the medical board to take action against him; however, I notice that he carefully avoids stating that he actually examined the patients he’s writing exemptions for, instead, he states that he “evaluated the past and present medical history and family history,” which is technically true (at least, its impossible to prove that he doesn’t at least read the info provided by the parents, although I personally wouldn’t be surprised.) There’s still the fact that his exemptions aren’t based on accepted medical guidelines, but if the medical board was willing to act on that that presumably they’d have done it a long time ago.

    So where does this leave us? The entire point of SB277 wasn’t so much to improve over-all vaccination rates as to eliminate those pockets of low vaccine uptake that act as foci for new outbreaks. With exemptions this easy to get, it seems likely that those unvaccinated pockets will persist, which means that sooner or later there will be another measles outbreak in California, which antivaxxers will then turn around and use as evidence that vaccines aren’t effective.

    I looked up California’s school immunization rates for the last school year (2015 – 2016), but they include personal belief exemptions (PBEs), so apparently SB277 hadn’t taken effect yet. Does that mean we’ll have to wait until next year to determine whether SB277 worked, and where the remaining pockets of low vaccine uptake are? And if there are still counties where less than 90% of kids are still going to school unvaccinated, what can be done about it? I’m guessing the chances of amending SB277 to require oversight similar to West Virginia’s are slim to none.

    Incidentally, while several counties had worrisome numbers of PBEs (over 10% in some cases), Plumas county stood out as having an unusually high number of medical exemptions – 6% (compared to < 1% for most counties; the next highest county only has 2.9%) Any Californians here who might have an idea why that might be?

  10. #13 Sarah A
    July 29, 2016

    ^ That should be, “where less than 90% of kids are going to school vaccinated.”

  11. #14 Chris Hickie
    July 29, 2016

    @Has #7: Arthur Kaplan spelled it out clearly (to me) last yeat that the California Medical board already had sufficient reason, power and prior example to take Sears’ license, but clearly they have not. https://www.washingtonpost.com/opinions/revoke-the-license-of-any-doctor-who-opposes-vaccination/2015/02/06/11a05e50-ad7f-11e4-9c91-e9d2f9fde644_story.html

  12. #15 Liz Ditz
    Great State of California
    July 29, 2016

    The tide seems to be turning slightly, according to this Medscape poll:

    The percentage of clinicians who see a rise in the numbers of families willing to get their children vaccinated increased again in the Medscape Vaccine Acceptance Report 2016 , published today.

    Last year, when healthcare professionals were asked about vaccine acceptance over the past year in a similar Medscape survey, 42% said that overall vaccine acceptance had increased. This year, 46% believed the same. At the same time, 12% of clinicians reported that they saw less acceptance of vaccines this year.

    http://www.medscape.com/viewarticle/866754

  13. #16 Johnny
    127.0.0.1
    July 29, 2016

    …filled out an online history form, paid a fee, and Dr. Bob’s office spit out these two boilerplate exemption letters.

    Hmmmm… I wonder if I can get an exception for the neighbors dog? Anyone know where to find the portal? My Google-Fu is weak on this one.

  14. #17 KayMarie
    July 29, 2016

    @Sarah A #10

    Both of the high counties have a pretty low number of total kids so it could just be a signal to noise kind of cluster issue rather than either a doc signing off or something causing more disease.

    Might have to trend it over a few years to see if it is some odd blip or indicative of a pattern.

  15. #18 Mike Pollard
    July 29, 2016

    I know this is somewhat off topic, but are you going to be doing anything on Green candidate Jill Stein? She has apparently said “There were concerns among physicians about what the vaccination schedule meant, the toxic substances like mercury which used to be rampant in vaccines. There were real questions that needed to be addressed. I think some of them at least have been addressed. I don’t know if all of them have been addressed.” and “Like any medication, they also should be — what shall we say — approved by a regulatory board that people can trust. And I think right now, that is the problem. That people do not trust a Food and Drug Administration, or even the CDC for that matter, where corporate influence and the pharmaceutical industry has a lot of influence.”

  16. #19 Rich Bly
    Ocean Shores
    July 29, 2016

    Bogus food safety certificates going for $450 in Massachusetts. Isn’t this what the quack MD (QMD) Sears is doing. At least one food inspector is suspended and will probably be fired (and EHS License revoked) for this.

    The food store that lead to this investigation was also busted for selling Viagra; it was a butcher shop.

  17. #20 James Castle
    July 29, 2016

    Can anyone explain the link between POTS and HPV-vaccines?
    http://www.ncbi.nlm.nih.gov/pubmed/25882168

  18. #21 KayMarie
    July 29, 2016

    @James Castle #19

    I’d have to get the whole paper to really comment but I did find this commentary http://www.skepticalraptor.com/skepticalraptorblog.php/hpv-vaccine-adverse-events-this-time-pot

    I know HPV isn’t required for kindergarten, I’m not even sure it is required for middle or high school so is it even one of the vaccines mandated by sb277, and if not how is it relevant to this discussion?

  19. #23 Rich Woods
    July 29, 2016

    @Johnny #16:

    An exception for your neighbour’s dog? If you were to do that, you’d be following in a proud tradition of gifting domestic animals with uncanny human powers.

  20. #24 Liz Ditz
    Great State of California
    July 29, 2016

    HPV is not mentioned in SB277. The diseases to be prevented are:

    (a) A means for the eventual achievement of total immunization of appropriate age groups against the following childhood diseases:
    (1) Diphtheria.
    (2) Hepatitis B.
    (3) Haemophilus influenzae type b.
    (4) Measles.
    (5) Mumps.
    (6) Pertussis (whooping cough).
    (7) Poliomyelitis.
    (8) Rubella.
    (9) Tetanus.
    (10) Varicella (chickenpox).
    (11) Any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians.

    So the POTS HPV vaccine question is irrelevant here.

  21. #25 Liz Ditz
    Great State of California
    July 29, 2016

    I looked up California’s school immunization rates for the last school year (2015 – 2016), but they include personal belief exemptions (PBEs), so apparently SB277 hadn’t taken effect yet.

    That is correct. The law went into effect July 1 2016. Some California districts start as early as mid-August. California collects data from all schools and publishes said data (at the school level) in late January or early February, so we will have to wait to see then.

  22. #26 Old Rockin' Dave
    July 29, 2016

    Johnny, go for it.
    I’d love to see someone register some nonexistent kids for Dr. Bob’s exemption letter. If he issues them, he’s toast, or should be. It’s an old tactic but it works in situations like this. I can’t afford it myself, but if someone tries it, I’ll kick in the $10 that I never got around to sending Bernie (and now I’m glad I didn’t).

  23. #27 Liz Ditz
    Great State of California
    July 29, 2016

    And if there are still counties where less than 90% of kids are still going to school unvaccinated, what can be done about it?

    The county data are irrelevant, really, you have to look at the very granular school data. It gets confusing there, too, because there are a lot of charter chains especially in some of the rural counties.

    The other thing that changed in California is that the Department of Education got tough on reporting “conditional entry” — kids allowed into school who aren’t fully vaccinated for age, but who have a plan to vaccinate. A lot of the schools were doing a lousy job of following up to see if these students’ vaccine plans were actually carried out.

    Additionally there’s some anecdotal evidence that people who intended to vaccinate but hadn’t gotten around to it were offered PBEs by school administrators, rather than conditional entry — but conditional entry management is more work for the schools.

  24. #28 sadmar
    July 29, 2016

    @ Sarah A.

    The CA county-by-county %s of PBE and PME aren’t that illuminating. If you just look for the highest % of exemptions, you miss the counties that have contained vulnerable clusters: Alameda, Marin and Sonoma in NoCal, and LA, Orange and San Diego in SoCal. There are many factors at play in outbreak risk: the % of unvaxed kids in county X may mean little if they don’t come in contact with one another due to geography, social patterns, etc. etc. A more indicative stat would be the %s in actual individual pre-schools and kindergardens, though that misses the home schoolers who may mix with other kids at public places.

    As poor as county numbers are, the numbers that seem meaningful to me are the healthy increase in vax in Alameda (which includes Berkeley and is solid metropolitan Democrat), the only slight increase in Orange (Dr. Bob land, solid Reaganite Republican), and the actual decline in Sonoma (well-heeled granola-crunchers stereotype). But, for Sonoma for example, that only represents a raw number change of about 50 kids, so that’s not exactly a reliable indicator of the effect of SB277, as too many other things could be at work in the short term.

  25. #29 KayMarie
    July 29, 2016

    @Johnny #16

    It is evading my google fu as well, but I suspect with the online history form it probably is some system where you call the practice and get whatever you need to get a log in for their patient portal and then the form comes up there.

    Might need to be that way to ensure the info coming in is on a secure server ala HIPAA

  26. #30 Liz Ditz
    Great State of California
    July 29, 2016

    Plumas county stood out as having an unusually high number of medical exemptions – 6% (compared to < 1% for most counties;

    Plumas County has <21,000 residents total. The enrollment in Plumas county public schools is somewhere between 2,100 and 2,200 kids. There are a couple of alternative medicine practices in Quincy and I think one in Portola (the two towns). One script-happy doctor & a "crunchy" parents group is all it would take to swing those relatively small numbers.

    Let that be a lesson in not relying on percentages, but looking at the absolute numbers.

    In the course of advocating for SB277, we found a couple of other pockets of high numbers of medical exemptions. One resolved to being a magnet school for medically fragile children; the others were probably clusters of fearful parents.

  27. #31 Janerella
    Oz
    July 29, 2016

    So what medical history is accepted? Just the parent’s word? Do they require supporting documentation from another Dr confirming the conditions? Are naturopath reports included as valid?
    Freaking appalling.

  28. #32 Annie
    July 29, 2016

    I wish someone would start a go fund me or something just to film the process of filling out the information online to show what a scam this is.

    This is disgusting.

  29. #33 Chris Hickie
    July 29, 2016

    I do not believe Sears has gone to an electronic medical record, putting him in a now small minority of physicians. (http://giving.biola.edu/news/2015/nov/16/building-foundation/ ). I note this because with an EMR, you can’t fake a note like you can with paper charts, and I wouldn’t put it past this slimy SOB to try and fake a doctor visit for this child he didn’t see.

    Also, this video I cite gave me some insight as to why Sears really doesn’t give a sh*t about whether you vaccinate, as he clearly has this view that “knowing God made us makes me a better doctor”. Well, f*ck a duck, Dr. Bob–clearly you only went to med school to get that license and if some poor 5 week old infant died of pertussis in San Diego a few weeks ago, well that’s God’s problem and not yours.

    What a pompous, ignorant, greedy, vile POS.

  30. #34 Liz Ditz
    Great State of California
    July 30, 2016

    So what medical history is accepted? Just the parent’s word? Do they require supporting documentation from another Dr confirming the conditions? Are naturopath reports included as valid?

    All good questions. Here’s the actual text of the bill.

    120370. (a) If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician does not recommend immunization, that child shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.

    So anything a licensed physician attests to…

  31. #35 Renate
    July 30, 2016

    Dr. Bob reminds me on 2 Dutch psychiatrists, who declared healthy people to suffer from mental health problems, so they could use their falsified medical files to get income support.
    They are stripped from their licenses and can’t work as psychiatrists anymore.
    There is still some criminal investigation going on.

  32. #36 Henry Miller
    Iowa
    July 30, 2016

    Seems like that father has a good malpractice case. Judges are supposed to look at evidence and only allow scientific facts, so the case could be a simple source of money. Plus Dr Bob sears insurance company is likely to cut him off.

  33. #37 KayMarie
    July 30, 2016

    This practice seems to track to Robert Sears (unless he is listed in the medical liscence database as something else?)http://www.memorialcare.org/find-doctors/physician/robert-w-sears-md

    The only website is part of the system and the system has medical records. I dunno if he is trying to do the meaningful use and other such modern stuff that pretty much requires having an eHR and patient portal. For a lot of practices joining a practice group usually as part of a larger health system has been the way to get in.

    It is fairly odd an independent practice doesn’t have even a hint of a website. Especially given he has his information to the general public stuff website.

    If he has some other practice that is off the grid or legally has another name….I may have found the wrong place.

    If he is taking an online medical history form as suggested by the father in the main blog post it probably is through some medical portal system. If for no other reason than I can only imagine how much it would cost to hire a programmer to create your own HIPAA compliant system. I recently did my medical history through the portal here as my PCP moved to a new position with a medical school several states over and they wanted me to do one for the new doc taking over.

  34. #38 KayMarie
    July 30, 2016

    Sorry system seems to have the usual electronic medical records and patient portal.

  35. #39 Orac
    July 30, 2016

    Again, Dr. Bob’s practice is cash-only, as far as I know. He doesn’t take insurance or Medicare; so he doesn’t have to worry about meaningful use, pay for performance, etc.

  36. #40 Chris Hickie
    July 30, 2016

    I’ve never been able to find a web site for Sears’ own practice or that run by his dad and brother (both of which operate in the same physical space but his dad’s/brother’s practice does take insurance. If you are a cash-only “concierge” practice (more like “merde” practice here) like Sears that doesn’t take insurance you don’t need an EHR, nor would any outside group (insurance carriers, medicaid, etc) be able to enforce/entice you to do so). However forms could still be sent to patients via a secure web portal (hopefully HIPAA compliant) for greater ease for parents. This portal would probably not be able to be found even with the best google fu.

  37. #41 KayMarie
    July 30, 2016

    There certainly are a number of business models and it could be only some portion of the practice is in,a system (and there are concierge practices that are part of a healthcare system and aren’t always completely off the grid.)

    Even our don’t take insurance non-concierge clinics around here have much more of a web presence than the good Dr. Bob! Although none of them try to have his fame.

    Either way given what little on the web exists I’m pretty sure there isn’t going to be any easy way to get to whatever online system there is, it if is even a website vs an emailed fillable form and I’m not sure how much some people distinguish between did it on the computer through email and online at least some of the time.

  38. #42 Johnny
    127.0.0.1
    July 30, 2016

    Well, sometime in the next few weeks, I’ll give them a call, and see if I can BS my way in. It’ll give me time to come up with a good story, flesh out some details, and practice it a bit in my mind.

  39. #43 Julian Frost
    Gauteng East Rand
    July 31, 2016

    Speaking of a portal system:
    The best way to do that would be to have something that has no links to it and is accessible through typing in a hyperlink only. My employer has an employee portal. You need an ID and password to access it. If Dr. Bob is doing it like that, you would need to be supplied with a log on and password.
    Such a system would probably be to stop honeytrapping. Even if you got in, Johnny, I’m guessing you’d be made to jump through some hoops.

  40. #44 Johnny
    127.0.0.1
    July 31, 2016

    Hey, I’m retired – I have time to make a phone call, type a URL, and make up answers for a web form. The most complicated problem is going to be figuring out how to resolve the billing issues without using my real first name (in case they are reading this), and I think I have that covered. (I have no problem lying to them to get a dog an exemption, but I suspect I could get in serious trouble if I stiff them on the bill.)

    I think the two biggest problems are that they might ask a question I won’t be prepared for, or that they will want too much money. I don’t know what questions I’ll have to answer over the phone (having never had to deal with a pediatrician) or exactly how much money is too much (I’ll know it when I hear it).

  41. #45 Logical
    July 31, 2016

    Any law that takes away natural rights deserves to be defeated in any way! The right to decide what to inject into your child’s body is your right alone! Studies paid for and benefiting big pharma are irrelevant, in fact there are few if any studies that prove anything! The damage that could be done to a child’s immune system is high whether now or in the future. As with all irrelevant laws, it’s the right of all to find the loopholes just like the politicians do. If you want credible information, don’t listen to the indoctrinated allopathic medical community, they benefit from MONEY and are only educated on what the medical system wants them to know! Those who chose to exempt their children have educated themselves, found out the truth and deciphered the facts to arrive at a sensible, non evasive solution… Congratulations to those intelligent parents who use the system to save their children from tyranny!

    • #46 Dorit Reiss
      July 31, 2016

      You don’t have a natural right to send an unvaccinated child to school and risk others.

      You don’t even have a natural right to refuse to protect a child from disease by not vaccinating the child, even if your reason is misunderstanding the fact that the risk of harm from vaccine is minuscule compare to the risk of harm from disease.

  42. #47 Sarah
    La Crosse, WI
    July 31, 2016

    This is off topic, but why do doctors suck ass at following contact precaution protocols. Our policies for things like MRSA and C. diff is that we have to gown and glove up, any equipment that goes in the room most get bleached upon exiting (i.e. my mop handle) then wash our hands when we are done. I have seen so many doctors go into these rooms without gowning up, without putting on gloves, without cleaning their stethoscopes, without washing their hands. WTF. One of these days I’m going to yell at one.

  43. #48 Narad
    July 31, 2016

    The right to decide what to inject into your child’s body is your right alone!

    Might want to rethink that wording.

  44. #49 palindrom
    July 31, 2016

    With Logical @44’s comment, my bingo card is full! Where’s my prize?

  45. #50 Jane Ostentatious
    July 31, 2016

    Logical, you don’t own your child. You are sadly misled and I hope that your paranoia doesn’t kill your child one day.

  46. #51 squirrelelite
    July 31, 2016

    @Logical (44)

    I think your right to pursue the happiness of blaming any conditions you want on vaccines is interfering with your and other childrens’ right to life free protected from the threat of deadly infectious diseases.

    What method would you propose for resolving that conflict?

  47. #52 Julian Frost
    Gauteng East Rand
    August 1, 2016

    he right to decide what to inject into your child’s body is your right alone!

  48. #53 shay simmons
    August 1, 2016

    Aren’t all doctors, even concierge MDS like Sears, required to have malpractice insurance? I think that is what Henry Miller is driving at.

  49. #54 Chris Hickie
    August 1, 2016

    @ Shay #51: If you contract with health insurances, they will want proof of malpractice insurance. As Sears does not take insurances, he may not need malpractice (in California) to carry malpractice insurance ( http://www.mbc.ca.gov/Consumers/Complaints/Complaints_FAQ/Practices_and_Protocols_FAQ.aspx ) . Not carrying malpractice would be rather foolish, IMHO, but he could decide not to. If he does have malpractice, there is no requirement for public disclosure as to the name of the carrier. If he has a malpractice carrier, I don’t think the carrier honestly cares what he’s doing as a physician until it’s clear they have to settle on a malpractice case–and then they either raise your premiums or drop you.

  50. #55 Totoro
    California
    August 1, 2016

    Sears does take one insurance plan, he is a Tricare out-of-network provider, and if you search by name and city you can find his office in their directory:

    https://www.uhcmilitarywest.com/uhcmw/portal/search/providerbynameresults/

    Presumably if he takes TriCare he also has malpractice insurance.

  51. #56 Chris Hickie
    August 2, 2016

    I believe anyone can be an out-of-network Tricare provider simply by requesting to be so. Essentially if it’s what I think it is, Tricare families pay him cash at the time of service and he gives them a claim form to submit to Tricare and they have to take whatever Tricare feels like paying for the visit. I still think he would be very foolish not to have malpractice insurance but I still think it’s possible he could practice without it given his practice model.

  52. #57 Chris Hickie
    August 3, 2016

    I’m rather suspicious that Dr. Bob does not carry malpractice. First, his practice model does not require it. Second, his practice is a separate business entity from the other Sears doctors’ practice at their common physical location. That would make sense for me if I were the other Sears doctors (who do take insurance) as it would protect them from liability of “Dr. Bob” were sued. Finally, I contacted the CA medical board and they told me that in California a doctor does not have to disclose if they are “going bare” (aka don’t have malpractice insurance), which is unfortunate, as some states like Georgia and Florida do require doctors to disclose this (and I do think that is reasonable). So quack boy Bob could be flying by the seat of his pants right now, not vaccinating patients while telling others through his books and social media presence not to vaccinate as well as now “seeing” patients without actually seeing him. How nice.

  53. #58 Gray Squirrel
    August 5, 2016

    Re. Johnny @ 41:

    Find a pediatrician who can help you get your cover story together. There are doctors right here who comment frequently; maybe one of them can volunteer.

    What you’re doing is a “sting op,” similar to what law enforcement does to spot people for further investigation (terrorism, organized crime) and to catch people for specific acts (e.g. seeking to set off a car bomb).

    A few things to keep in mind:

    = Have your entire cover story down pat, and rehearse answering potential questions from your target. This is where working with another pediatrician would be helpful.

    = Keeping your interactions with your target in email and avoiding phone calls with them if possible, will give you time to check with whoever else you may be working with (e.g. another pediatrician) before you write back to your target.

    = Never ever suggest or even mention any unlawful activity to your target, and that includes not asking leading questions. Any such activity on your part can be used by your target to argue entrapment (yes, civilians can commit entrapment, it is remarkably easy to blunder into doing it) and escape legal sanctions.

    = The usual rule when going after badguys online is “observe and report only, do not interact with persons of interest.” Doing a sting op obviously requires some degree of interaction, so practice ahead of time, avoid entrapment, and try to minimize the amount of stuff you have to say to your target to achieve the desired investigative outcome.

    = Save all emails, take date/time-stamped screenshots of incoming & outgoing email, websites, etc. If you’re going for a legal outcome (shutting down an antivax quack) you might want to forward copies of everything to an attorney. If you’re going for a journalistic outcome (writing for publication to attract regulatory attention to the quack), you should still at least check with a lawyer as to what kinds of evidence preservation might be needed in case your target tries to sue you for libel. I’m not a lawyer, I can’t give you legal advice.

    = If your target catches on to what you’re doing, it’s not the end of the world, because it’ll put him on notice that he’s under scrutiny. You can still publish a story that ends with the target catching on and whatever else happens: it might inspire someone else to take up the challenge.

    Thanks for taking this on, and may the hunt be fruitful!

  54. #59 Linda burt
    Redding
    August 10, 2016

    So disturbing that any one person could justify their choice forced on another. Those commenting here have LOST SIGHT of the human rights violations they keep chanting for. These medical exemptions shouldn’t even be a requirement. they should not exist. it is a choice of the person, not yours, to decide what is put into their bodies.

    • #60 Dorit Reiss
      August 10, 2016

      As has been addressed repeatedly, these people are not choosing for themselves. In the first place, it’s their children they are choosing for – their children are not their bodies, and frankly, when I hear reference to “people have a right to decide what to inject into their bodies” when we are talking about immunizing young children, it’s troubling. It’s a very unhealthy frame of mind, not to be able to tell your child apart from your body.

      Second, they are choosing to impose a risk on their child’s classmates.

      I’ve said it before and will say it again. You don’t have a human right to force a risk of outbreak on other people’s children in school and the community by sending an unvaccinated child to school.

      You don’t have a human right to refuse to protect your child from disease, either.

  55. #61 MI Dawn
    August 10, 2016

    @Linda burt: no one is forcing you to get immunized. You have options: immunize or change jobs (for medical personnel who don’t want vaccines), don’t join the military. If you make that decision for your children, then you have options: homeschool or a private school that will take unimmunized children.

    There is no force in any of the measures. There are consequences. You can do anything you want in this world; you just have to accept that SOME actions have consequences that you don’t like. Therefore, you have to decide which actions you want to do. But no one in the US is forcing anyone to be vaccinated.

  56. #62 Narad
    August 10, 2016

    If you make that decision for your children, then you have options: homeschool or a private school that will take unimmunized children.

    Let’s be precise: SB 277 applies to private schools as well, although homeschooling collectives of some sort are allowed.

  57. #63 Narad
    August 10, 2016

    ^ Then again, Linda didn’t in fact assert that SB 277 had direct personal consequences for her at all. I have a vague sense that the demographics of the loud antivaccine brigade are trending older.

    (Which is conveniently self-serving, given my long-standing suspicion that opposition to HPV vaccination has much more to do with concerns over the pool of fresh recruits than it does with sex.)

  58. #64 Ms. Mia Wallace
    August 16, 2016

    How do you explain the high infant mortality rate in Japan until they changed their policy and didnt administer vaccines until after age 2 and their IMR’s dropped immediately? Please enlighten!

  59. #65 Ms. Mia Wallace
    August 16, 2016

    http://www.vaclib.org/basic/japanmor.gif

    Japan infant mortality rate 4th lowest in the world!
    http://www.infoplease.com/ipa/A0934744.html

    I think that it is funny that the Japanese vaccinate for Japanese Encephalitis. Why don’t they just call it encephalitis?

    Don’t Mexicans that drink Mexican Coke just call it coke?
    And don’t Swiss that eat Swiss Cheese just call it cheese?

  60. #66 Julian Frost
    Gauteng East Rand
    August 16, 2016

    Ms Mia Wallace (if you’re not yet ANOTHER sockpuppet), those claims are lies.
    Here is the schedule for vaccines in Japan. As is clearly visible, there are vaccines that are administered before the age of 2 years.
    In fact, the only source for your claims are antivaccine websites.

  61. #67 Helianthus
    August 16, 2016

    How do you explain the high infant mortality rate in Japan until they changed their policy and didnt administer vaccines until after age 2 and their IMR’s dropped immediately?

    It’s a bit more complicated than that.
    There was an issue with the MMR vaccine Japan was using in the 70’s (but it’s not our vaccine).
    And there was unfounded fears of SIDS with the DTwP vaccine.
    But then these vaccines were discontinued and not replaced, both the number of infected people and infant mortality went up.

    tl;dr: the supposed drop in Japanese IMR following vaccine discontinuation is a lie.

  62. #68 Ms. Mia Wallace
    August 16, 2016

    I found a different source that said only one vaccine, the DTP, was postponed until the second year. Allegedly, this came with a concomitant decrease in IMR’s.

  63. #69 Helianthus
    August 16, 2016

    I found a different source

    I quoted mine.

  64. #70 Chris
    August 16, 2016

    The newest sock puppet: “How do you explain the high infant mortality rate in Japan until they changed their policy and didnt administer vaccines until after age 2 and their IMR’s dropped immediately? Please enlighten!”

    It was a lie. The DTP was dropped, but more kids died. But they could not blame a vaccine that was not given:
    http://www.ncbi.nlm.nih.gov/pubmed/15889991

    Which says: “An antivaccine movement developed in Japan as a consequence of increasing numbers of adverse reactions to whole-cell pertussis vaccines in the mid-1970s. After two infants died within 24 h of the vaccination from 1974 to 1975, the Japanese government temporarily suspended vaccinations. Subsequently, the public and the government witnessed the re-emergence of whooping cough, with 41 deaths in 1979. This series of unfortunate events revealed to the public that the vaccine had, in fact, been beneficial.”

  65. #71 TBruce
    August 16, 2016

    I think that it is funny that the Japanese vaccinate for Japanese Encephalitis. Why don’t they just call it encephalitis?

    Why don’t the Germans call German measles just plain measles?

    http://www.who.int/mediacentre/factsheets/fs386/en/

  66. #72 TBruce
    August 16, 2016

    We Canadians call Canadian Bacon Back Bacon, and Canadian Whiskey Rye Whisky.

    No Canadian disease though (except frostbite maybe).

  67. #73 Helianthus
    August 17, 2016

    the MMR vaccine Japan was using in the 70’s

    I mispoke. The DTwP (non-)issues were in the 70’s, as Chris is explaining above. For MMR, issues were around 1990-1993, most likely coming from the Mumps’ Urabe strain used in the MMR vaccine.
    I got confused with the start of anti-measles and rubella immunization, which was at the end of the 70’s.

    I will just leave here another article about Japanese vaccination: the complete withdrawal of the MMR vaccination didn’t affect the rise of autism incidence.

  68. #74 Dangerous Bacon
    August 17, 2016

    And remember, it’s racist to refer to “Norwegian scabies”.

  69. #75 TBruce
    August 17, 2016

    Norwegian scabies was first reported by two Norwegian researchers, hence the name. That is unfortunate.
    BTW, do NOT do a GIS.

  70. #76 Robert Hayes
    September 2, 2016

    “It is error alone which needs support of the governments. Truth can stand by itself.”
    -Thomas Jefferson [no doubt referring to SB 277]

  71. #77 OP
    September 2, 2016

    no doubt referring to SB 277

    Suuure. Also maybe the (non-medical) exemptions are the error?

  72. […] such as “Dr. Bob” Sears, who not only promotes antivaccine pseudoscience but is basically selling highly dubious medical exemptions online to help parents get around SB 277. The AAP needs to come out forcefully to condemn such physicians […]

  73. […] I read this story, I also wondered if this action was over an incident that a reader reported to me, complete with letters signed by Dr. Sears recommending exemptions from school vaccine mandates […]

  74. […] and DVDs, and the like. Dr. Bob Sears, for instance, sells medical exemptions to vaccines based on what parents submit on an online form. One wonders if Dreger applies her same absolutist definition of a financial COI to these people. […]

  75. […] the Holocaust. More recently, Dr. Bob has decided to profit by selling dubious medical exemptions using an online form, which is part (but no means all) of the reason he now finds himself in trouble with the Medical […]

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