Another Physician in California Is Charged With Selling Medically Unnecessary Vaccine Exemptions

Not too long ago, we wrote about Robert “Bob” Sears, MD, a physician in California who got in trouble with the Medical Board of California for issuing unnecessary exemptions to vaccination. After Senate Bill 277 was signed into law in 2015, many families who had personal beliefs against vaccination apparently turned to some physicians to sign medical exemption forms without much of a true medical need for that exemption. In some cases, money was exchanged in cash, without getting the insurance companies involved. (California has near universal insurance coverage for children, including undocumented children.)

In San Diego, Tara Zandvliet, MD, has been charged with “gross and repeated negligence, as well as failure to properly maintain records for writing the exemption.” According to the charging documents, and a Voice of San Diego investigation:

“The charges against Zandvliet are identical to those Sears faced in the case that landed him on probation. One other physician, Dr. Kenneth Stoller, is also facing gross negligence charges for vaccine exemptions.

In the charging document, Zandvliet admits she has likely written 1,000 vaccine exemptions since 2015, when a state law went into effect banning personal belief exemptions to vaccines.

Zandvliet charges $180 for an office visit related to a vaccine exemption. Not counting exemptions she may have declined to write, she has made roughly $180,000 in the vaccine exemption business.

A new law, partially inspired by VOSD’s investigation, would subject doctors like her to more scrutiny. Starting in 2021, public health officials will have the power to review and overrule any exemption written by a physician who wrote more than five exemptions in a calendar year.

After Zandvliet emailed Mr. A – whose name is withheld in the document to protect patient privacy, according to the charging document – he managed to find four accounts of family members with autoimmune conditions. But he only provided medical documentation for one. In the other three cases, he simply provided Zandvliet with letters from family members.

Zandvliet’s own website suggests she will not write an exemption based on such thin documentation. “Useful but rarely sufficient are emails or letters from family members about their diseases,” the website reads.

The three letters cite psoriasis and asthma as the primary conditions. After questioned by Voice in March about the reasons she uses to issue an exemption, Zandvliet removed psoriasis and asthma (as well as eczema) from her website as qualifying conditions in family history that might lead her to write an exemption.

At the time she said: “I have found that a few of the diseases on my list seem to invite misinterpretation more than others, and so I have deleted them.”

Zandvliet did not respond to a request for comment about the new charges.”

A new law passed this year in California, Senate Bill 276, gives the medical board and the state and local departments of health more authority over reviewing medical exemptions. According to the Los Angeles Times:

“The eventual compromise — as much about policy as optics — seemed to work for both sides. Instead of the state Public Health Department reviewing all medical exemptions, officials would focus their scrutiny on schools with immunization rates below 95% and exemptions written by doctors who issue five or more waivers in a calendar year.

The threshold would allow the state to ensure that schools with low immunization rates did not pose a danger to the public. Physicians say people are best protected from measles outbreaks if at least 95% of a community is vaccinated.

A source involved in the negotiations said the threshold for doctors writing exemptions was less scientific. Most doctors write one or two medical exemptions a year, so five seemed like a good number, the source said.

And in an effort to satisfy the concerns of parents, an appeals process would be created for children whose medical exemptions are revoked by the state.

The changes also added some new teeth to SB 276 by ensuring that the Medical Board of California had access to a child’s medical records for investigations into complaints against doctors. The state public health department would also be able to prohibit a physician from writing new medical exemptions while he or she is under investigation by the medical board.”

With over 180 exemptions given, at $1,000 each, Dr. Zandvliet will surely have every subsequent exemption closely examined. Of course, we must note that these are just allegations by the medical board and are yet to be adjudicated. She is also not charged with a criminal violation, just an administrative one. Nevertheless, the consequences could be dire for her ability to practice medicine if she is found to have committed the violations in the charging document. Other physicians found “selling” vaccine exemptions should take pause.

Author: René F. Najera, DrPH

I am the editor of the History of Vaccines site, an online project by the College of Physicians of Philadelphia. All opinions expressed on these blog posts are not necessarily those of the College or any of my employers. Check out my professional profile on LinkedIn: https://www.linkedin.com/in/renenajera Feel free to follow me on Twitter: @EpiRen

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