Alabama’s vaccine passport law at odds with pediatricians’ policies - AL.com

The vaccine passport bill passed by the Legislature earlier this year has put a policy followed by many Alabama pediatricians at odds with state law.

The bill, signed into law by Gov. Kay Ivey in May, was aimed at preventing businesses from turning away customers because they aren’t vaccinated for COVID-19 or don’t have a document to show that they are. It says government agencies can’t deny services or entry to government buildings based on vaccination status.

But lawmakers did not limit the scope of the bill to COVID-19 vaccinations, or to any other specific vaccine.

It says: “An entity or individual doing business in this state may not refuse to provide any goods or services, or refuse to allow admission to a customer based on the customer’s immunization status or lack of documentation that the customer has received an immunization.”

Doctors, hospitals, and other health care providers are businesses that fall under the law. The Legislature rejected an amendment that would have exempted them.

Dr. Katrina Skinner, a pediatrician in Fairhope who is president of the Alabama Chapter of the American Academy of Pediatrics, said the law interferes with what many pediatricians consider a foundational part of their practices -- the vaccination series for infants and children recommended by the Centers for Disease Control.

“It causes a lot of concern because it in essence makes one of our normal, common business practices at odds with the law,” Skinner said. “More than 50% of pediatricians have office policies that require families to comply with federal vaccination recommendations.”

Skinner said the vaccination series, which infants receive at birth through 18 months, followed by boosters at ages 4, 11, and 16, is so important to children’s health that the refusal by parents to follow it undermine the doctor-patient relationship. The vaccinations protect against chickenpox, diphtheria, hepatitis A and B, measles, mumps, pertussis, polio, tetanus and other diseases. Skinner distinguishes between vaccine-hesitant parents and vaccine-refusing parents.

“When families have been counseled extensively, given multiple opportunities to follow guidance, pediatricians feel like because families don’t agree with them on that very important point, it kind of breaks down that patient-physician relationship and they are no longer in a position to carry on that relationship with the patient,” Skinner said. “So they will discharge those families from their practices. But this law makes it basically illegal for us to continue with that policy.”

That was not the intent of the bill’s sponsor.

Sen. Arthur Orr, R-Decatur, said he did not know that pediatricians had policies to turn away or dismiss unvaccinated patients at the time the bill was debated this spring and that it wasn’t part of the discussion.

The senator said he believes the Legislature needs to hear ideas from all sides on the issue and possibly revisit it when lawmakers return in January.

“That’s a policy decision I think the Legislature needs to look at and consider,” Orr said.

A mother of three who has been a health care activist at the State House says state law should prohibit physicians from turning away unvaccinated patients.

Kaycee Cavender of Cleburne County, co-owner and co-director of Health Freedom Alabama, said she has struggled to find and keep pediatric care for her children because she chose not to follow the vaccination recommendations.

“When I first found out I was pregnant, I started calling around to pediatricians’ offices and trying to schedule appointments and trying to get on that waiting list for care,” Cavender said. “And as I started talking to other mothers in the area that did not vaccinate or spread out their vaccinations, they informed me that there were certain doctors that just wouldn’t see your children if you didn’t vaccinate specifically according to the CDC schedule. And so this has been a problem I’ve had since the beginning.

“When I had my first daughter, I wasn’t even sure if I was going to decline any vaccines. I was still researching, still learning. And I decided that until I felt more at peace with my decision and until I had had a good conversation with our care provider that we chose, we wouldn’t make that decision.”

Cavender said she had a pediatrician when she lived in Baldwin County but had problems finding another after moving to Cleburne County in 2017.

“In a two-hour radius, I was only able to find one pediatrician that would see my children if we didn’t vaccinate or if we didn’t vaccinate according to the entire schedule,” Cavender said.

Cavender said that pediatrician changed policy about two years ago, forcing her to look elsewhere for medical care for her children. She said one of her children was born with a heart defect that must be monitored.

“We did find a family physician 45 minutes from our home that was willing to see us if our children were sick, or if we had concerns about my son’s heart,” Cavender said.

After the vaccine passport law passed in May, Cavender said she contacted her previous pediatrician to see if the policy would change to allow unvaccinated patients. She said the doctor eventually did make that change but she did not return to that doctor.

Cavender said she thinks most Alabama pediatricians are not changing their policies because of the vaccine passport law.

“Many pediatricians are still refusing care based on vaccine status,” Cavender said. “They cite no penalty being in the law as their reasoning. It is nearly impossible to find a lawyer to pursue these violations because there is no penalty. So, it’s left to those of us with a little know-how and the right wording to hold their feet to the fire.”

Mark Jackson, executive director of the Medical Association of the State of Alabama, which represents about 7,000 physicians, said pediatricians are the doctors most affected by the law. Jackson said he’s not sure if lawmakers intended to pass a prohibition on doctors requiring their patients to be vaccinated, but believes the law is a problem.

“I can’t speak to it, whether it was intended or not, because I wasn’t a party to that,” Jackson said. “But for our perception, it probably was an unintended consequence that more than anybody affected the pediatricians because many of those pediatricians have had long-standing policies that all their patients need to get vaccinated, whether it’s measles, mumps, whatever those childhood vaccines are that are required. So, I think it has become a problem because of the perceived unintended consequence of not knowing what was really intended from the bill and kind of interfering with the practice of medicine.”

The Legislature considered amendments to the vaccine passport law during the special session that ended last week. They rejected an amendment that would have narrowed the focus of the law to COVID-19.

Jackson said that amendment would have helped clarify the law. Jackson was asked if the Medical Association would support such an amendment when lawmakers come back for the regular legislative session, which starts Jan. 11.

“I think there are ongoing conversations as to what can be done and how best to clarify the statutes,” Jackson said. “I can’t say definitively that that’s something that we will necessarily try to do.”

Cavender has been an advocate on other health care issues. In 2017, she helped lead a lobbying effort to pass a bill to allow accredited midwives to attend home births in Alabama. She helped organize a “Save our Jobs” march at the State House and other efforts to get lawmakers to push back against President Biden’s employer vaccine mandate during the special session. Legislators eventually passed a bill prohibiting employers from firing employees who refuse to take a COVID-19 vaccine and claim a medical or religious exemption. Cavender and others in her advocacy group said the law was too weak and would not prevent discrimination against unvaccinated employees. Advocates for the bill said it was a way to try to help Alabama workers while legal challenges to the Biden mandate play out in federal court. Ivey and Attorney General Steve Marshall are among those challenging the Biden order in court.

Cavender was asked to explain her views on vaccines.

“I’m not anti vaccine,” Cavender said. “I believe everyone should have the choice to make these kinds of decisions for themselves and that parents should be making these decisions for their children. And so while I’m not anti-vaccine, given my family’s medical history, and some issues that we have had within our own family with some genetic disorders and other things, we felt that based on consultation with our first initial pediatrician that lives in Baldwin County, we felt that it was a better decision for us not to vaccinate and to instead focus on preventative care. Making sure that we do our part with cleanliness, limiting exposure, and just overall health was really important to us to prevent our children from getting something that could be spread.

“But we also support our other family members’ and friends’ decision to give their children the vaccines if they feel that that’s the best option for them.”

Skinner explained two main reasons why she believes pediatricians are on sound footing when they dismiss parents who will not follow the recommended vaccination series.

“To me, it undermines the basis of our relationship,” Skinner said. “If you don’t trust my advice about protecting your child against deadly diseases, then how are you going to trust my advice about anything else for your child? I don’t know why you would want me to be your child’s pediatrician if you can’t trust me on this very foundational thing that has so much science data and evidence behind it. It is the thing in modern public health that has saved more lives than anything else.”

Skinner said unvaccinated patients put her other patients at risk. That could be especially true for certain children with weakened immune systems, such as a leukemia patient who has received chemotherapy.

“Say for instance I have an unvaccinated patient to contract measles,” Skinner said. “And I’m reasonably sure the parents are going to want to seek health care for that. They come and sit in my waiting room and while they’re there, and measles is highly contagious, even more contagious than COVID-19 and they infect a handful of other patients in my waiting room. Some of those patients may not be old enough yet for their measles vaccine.”

Skinner said vaccine refusal is not common in Alabama. She was asked how pediatricians should adjust to the vaccine passport law.

“Pediatricians should continue to do what they always do, which is work with families to provide education and counseling them on the benefits and safety of childhood vaccinations,” Skinner said. “Because at the end of the day, that’s what we do all day every day.

“And we don’t discharge a patient willy-nilly. We don’t do that until after we’ve spent an extensive amount of time providing education and working with a family. And so it’s not until we feel like that relationship has been irreparably damaged by our differences in values and beliefs that we would move to terminate the relationship.”

Alabama Political Reporter reported on this issue earlier this week.

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source: https://www.al.com/news/2021/11/alabamas-vaccine-passport-law-at-odds-with-pediatricians-policies.html

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