In summary

A new California law that took effect this year further restricted questionable medical exemptions and cracked down on doctors who granted them outside of accepted medical guidelines.

For years, Dr. Tara Zandvliet was known as the go-to doctor for so-called “medical exemptions” for parents unwilling to give their children the immunizations required to attend school in California. The San Diego pediatrician said she wrote about 1,000 vaccine exemptions between 2016 and 2019, according to the California medical board.

Now the state agency overseeing physicians has banned Zandvliet from writing any more of those controversial exemptions and placed her on three years of probation for gross negligence and unprofessional conduct. 

Screenshot of Dr. Tara Zandvliet testifying before the Senate health committee in opposition to a SB 792, a bill that would require employees of daycare facilities to be immunized against influenza, pertussis and measles, on April 15, 2015. Zandvliet has been sanctioned by the Medical Board of California for her exemptions given to children for vaccinations required for school. Image via Senate Media Archive

And under a California law that took effect Jan. 1, every one of those 1,000 exemptions are now invalidated. Parents likely will either have to vaccinate their children before they return to school in person, get a conditional acceptance from the school, or homeschool their children unless they can find a doctor who will grant a legitimate medical exemption.

Medical vaccine exemptions are intended to be exceedingly rare and mostly temporary. Doctors typically only grant them for children who are undergoing chemotherapy, have allergies to specific vaccine ingredients or who live with certain immune disorders. 

By contrast, Zandvliet wrote exemptions based on children’s allergies and other reasons not supported by clinical guidelines, the medical board charged. 

Public health experts say these questionable exemptions – now mostly banned by tough new legislation – led to an alarming rise in measles and other childhood diseases. The medical board twice sanctioned another physician in Orange County, including this year, for improperly giving vaccine medical exemptions. The board continues to investigate others. 

Neither Zandvliet nor her attorney responded to a CalMatters request for comment on Friday.

“I appreciate that the medical board has moved forward with this (oversight) to keep our kids safe at school.”

california sen. richard pan

California is one of the few states that no longer allows parents to claim religious or philosophical exemptions from standard childhood immunizations required to attend private or public school. After lawmakers banned that practice after the large 2015 measles outbreak originating at Disneyland, some families sought out doctors who would write them still-allowed medical exemptions. 

Medical exemptions rose dramatically as parents tried to make an end run around the ban. State lawmakers subsequently passed new legislation, SB 276, that further restricted medical exemptions and cracked down on doctors who granted them outside of accepted medical guidelines. 

“We wanted to be sure with SB 276 that the Medical Board of California had the tools it needed to pursue physicians who abused their authority to write medical exemptions which were not consistent with the standard of care,” said California Sen. Richard Pan (D-Sacramento), who authored the bill. “I appreciate that the medical board has moved forward with this (oversight) to keep our kids safe at school.”

Pan, a pediatrician, emphasized that it’s important for parents to keep their children’s immunizations up to date even in the midst of a pandemic. Childhood vaccinations have dropped 40 percent from the previous April, according to the California Department of Public Health.

“Just because COVID is here doesn’t mean measles or pertussis have gone away. These diseases haven’t disappeared,” he said. “Doctors are working to make sure kids are safe when they come for their immunizations – talk to your doctor if you have concerns about steps they’ve taken to protect children.”

CalMatters COVID-19 coverage, translation and distribution is supported by generous grants from the Penner Family Foundation, Blue Shield of California Foundation, the California Wellness Foundation and the California Health Care Foundation.

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Barbara Feder Ostrov

Barbara Feder Ostrov, Contributing Writer for CalMatters, has reported on medicine and health policy for more than 15 years. She most recently covered California and national health issues for Kaiser Health...