tion and the measles outbreak that began at Disneyland theme parks in Califor- nia in late 2014 pushed the clinic to take action. ARC pediatrician Kimberly Avila Edwards, MD, says the clinic’s pediatrics
leaders thoroughly weighed the risks and benefits for patients in deciding on the new policy. “There was a lot of very thoughtful discussions that went into it,” Dr. Avila
Edwards said. “And just seeing the increases in non-vaccinators … I don’t know how we [couldn’t] have made that decision.”
POLICY PARTICULARS ARC’s new policy aims to protect the clinic’s most vulnerable patients, such as infants who aren’t fully vaccinated, seniors, those who have compromised im- mune systems, and pregnant women. “Only a small fraction of our patients are not in full compliance with the CDC
vaccine schedule,” Dr. Ziari said. “However, we know that it takes just one case to become a safety concern.” Physicians who tell patients to seek care elsewhere must ensure they’re not
violating Texas Medical Board (TMB) rules and abandoning patients. TMB rules list “termination of patient care without providing reasonable notice to the pa- tient” as a violation of the Texas Medical Practice Act. The board’s rules don’t explicitly define reasonable notice, but TMB spokesperson Jarrett Schneider says the board generally accepts 30 days as a reasonable time window. TMB takes physician abandonment seriously. If the board determines a phy-
sician abandoned a patient, the doctor could face penalties ranging from a re- medial plan with a $500 fine to sanctions that could include continuing medical education requirements and an administrative penalty. In some cases of patient abandonment, depending on the facts, the board could revoke a physician’s medical license. (See “Firing Patients,” May 2012 Texas Medicine, pages 37–40, or visit
www.texmed.org/FiringPatients.) Dr. Ziari said patients who are already in the ARC system would have vary-
ing timetables to adhere to the catch-up schedule to continue treatment at ARC. “It depends on how old the child is and how old he or she is when entering
the catch-up schedule because there are rules about how vaccines are given, the intervals, and who gets which vaccines, depending on how old the child is,” Dr. Ziari said. “So each physician will decide, looking at their CDC catch-up sched- ule and how old that child is.” Although ARC recommends the flu vaccine, it is not required.
MEDICINE RALLIES AROUND ARC When ARC announced its new vaccination requirement, it had the support of the Texas Medical Association and the Texas Pediatric Society (TPS). Austin gastroenterologist Pradeep Kumar, MD, president of the Travis Coun-
ty Medical Society (TCMS), spoke at the news conference to offer ARC support on behalf of TMA and TCMS. Dr. Kumar says a policy like ARC’s aims to eliminate the risks of having an
unvaccinated child in the waiting room with other pediatric patients. He says the effectiveness of illness prevention rests not in 100-percent vaccine effective- ness but in the concept of “herd immunity.” That is, even though vaccines aren’t
“We’re trying to protect those patients who [aren’t] vaccinated from being infected with a vaccine- preventable illness.”
+
CDC’s recommended immunizations and catch-up schedules:
www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html
September 2015 TEXAS MEDICINE 25
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