San Francisco Marin Medical Society Blog

Provider FAQs: SB277 and California School Vaccination Law



On June 30, 2015, Governor Jerry Brown signed the SFMS/CMA endorsed SB 277 into law. SB 277 eliminates the personal belief exemption from school vaccination requirements, barring parents from skipping their children’s school-required immunizations unless they have a medical exemption from a physician. The SB 277 immunization requirements apply to students first admitted to school, child care, or entering seventh grade starting in 2016.

 

When do children need to be vaccinated?

Effective January 1, 2016, children will need the appropriate vaccinations or have a medical exemption prior to enrolling in public or private elementary or secondary schools, child care centers, day nurseries, nursery schools, family day care homes, or development centers. Physicians can find immunization schedules for the appropriate age ranges on the California Department of Public Health (CDPH) website Shots for Schools

However, immunizations are not required for children who participate in home-based private schools and independent study programs that do not require classroom-based instruction, nor does it prevent those in individualized education programs from accessing necessary special education or related services.

Can physicians sign personal belief exemptions (PBEs) after January 1, 2016?

No. Schools will no longer accept PBE forms effective January 1, 2016.

If the sibling of my patient has reported adverse reactions to vaccines, am I required to provide that patient with a medical exemption?

Medical exemption determinations are at the discretion of the licensed physician. SB 277 clarified that “family medical history” may be considered in making the determination, but there is no specific provision in the law that mandates a medical exemption based on family medical history.

What must be a part of the written statement for a medical exemption?

A written statement providing a medical exemption for a patient should state that, due to the physical condition or medical circumstances related to the child, immunizations are not considered safe for that child. The statement need to include:

  • The general nature (e.g., immunodeficiency, prior adverse reactions including allergy, medication that requires delay in vaccination) of the medical condition for which the physician does not recommend immunization.
  • Which vaccine(s) from which the child is exempted.
  • Duration of the medical exemption, and the expiration date if the exemption is temporary.

Physicians should keep in mind that a physician must make reasonable efforts to limit use or disclosure of protected health information to the minimum necessary to accomplish the intended purpose of the use, disclosure or request. (45 C.F.R. §164.502(b)(1).)

Does SB 277 affect existing personal belief exemptions?

If a personal belief exemption has been submitted prior to January 1, 2016, a child will be allowed to remain enrolled until entry in the next grade span. These grade spans are defined as:

  • Birth to Preschool.
  • Kindergarten and grades 1 to 6, including transitional kindergarten.
  • Grades 7 to 12, inclusive.

Can students take PBEs with them when they switch schools?

Students who have a PBE on file before January 1, 2016, may take it with them if they switch schools until they enter a new grade span.

Will a personal belief exemption from another state or country be valid if the student enrolls in a California school?

No.

If a student has a conditional admission, where the student is allowed to attend school while they catch up on one or more immunization? Can the physician decide what the catch-up schedule will be or is there a specifically required catch-up schedule?

California Department of Public Health (CDPH) does have a conditional admission immunization schedule for schools that lays out a catch-up schedule when children are conditionally admitted, but are not fully immunized prior to admission. Physicians can find information on conditional admission and related immunization schedules at http://www.shotsforschool.org/laws/conditional-admission. However, physicians always have the discretion to adjust the schedule based on the particular patient’s needs and the physician’s professional judgment.

Can a physician be held liable for providing—or not providing—a child with a medical exemption from vaccination requirements?

SB 277 does not alter current law regarding physician liability for medical exemptions from vaccine requirements. No applicable provisions protect a physician from liability for providing or not providing a medical exemption. Physicians must continue to exercise their professional judgment in providing or not providing any medical exemption from the vaccination requirements to ensure that it falls within the standard of care.

What do I do if a parent or guardian terminates the physician-patient relationship as a result of my decision not to provide a medical exemption?

When a patient expressly discharges you, you should follow up with a letter:

  • Confirming that the patient has terminated the relationship;
  • Emphasizing the need for follow-up care; and,
  • Where possible, referring the patient to other sources of care.

For which diseases is vaccination required?

When medical exemption is not provided, SB 277 requires vaccinations for:

  • Diphtheria
  • Haemophilus influenzae type b
  • Measles*
  • Mumps*
  • Pertussis (whooping cough)
  • Poliomyelitis
  • Rubella*
  • Tetanus
  • Hepatitis B
  • Varicella (chickenpox)*

* Indicates vaccines are not needed if the patient has proof of immunity (e.g., serology or in some cases physician diagnosis. The law also allows CDPH to include additional vaccinations it deems appropriate; however, the law allows for personal belief exemptions if the vaccinations are added to the list above by CDPH.

Is the adult immunization schedule also mandated?

No. There is no mandate for all adults to be immunized. However, effective September 1, 2016, Senate Bill 792 will prohibit individuals from being employed or volunteering at a day care center or a family day care home if they have not been immunized against influenza, pertussis, and measles.

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