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What happens when a school district has questions about a physician’s opinion that immunizing a child would present a greater risk to the child’s health than the risk of contracting a vaccine-preventable disease?

Is a school district permitted to “look behind” and question the medical reasoning of the child’s physician?

The answer is yes. Under state Department of Health (DOH) regulations, a principal or person in charge of a school is permitted to “require additional information supporting the exemption.”

The Commissioner of Education recently addressed this issue in Appeal of E.C. (Decision No. 17,638, May 8, 2019).

In that case, the student had a family history of a blood-clotting disorder, and her physician provided an opinion that she should not be vaccinated for measles, mumps and rubella (the “MMR” vaccine).

The physician cited (i) the girl’s adverse reaction to the varicella vaccination and (ii) the fact that her sibling developed the blood-clotting disorder shortly after having received the MMR vaccination.

The school district consulted with DOH, and on advice from a medical expert in that agency, denied the request for a medical exemption.

Subsequently, the student’s parent provided additional information for consideration by the district. The district again asked the DOH expert, who in turn sought input from the U.S. Centers from Disease Control and the Johns Hopkins University Bloomberg School of Public Health. A written report was prepared, which, after citing to relevant scientific studies and literature, concluded that there was no evidence that “this student’s family history of [the blood-clotting disorder was] associated with an increased risk of [the blood-clotting disorder] after MMR vaccine beyond that in the general population.”

The school district denied the student a medical exemption for a second time, and the student’s parent appealed to the commissioner of education. (Decisions regarding an application for medical exemption to immunization requirements by a principal or person in charge of a school are final and cannot be appealed to a board of education. They can, however, be appealed to the commissioner of education.)

The commissioner upheld the school district’s denial of the exemption. The commissioner stated that “[w]hile I am empathetic to petitioner and [the student’s] circumstances and understand petitioner’s concerns, petitioner has failed to show that respondent’s determination here was arbitrary or capricious.”

In other words, the record contained evidence supporting the district’s determination.

The E.C. decision was issued shortly before the Public Health Law was amended to eliminate religious exemptions, and is one of the more recent and important decisions from the commissioner related to medical exemptions from the immunization requirements. While most medical exemption requests are likely to be far less technical than the one reviewed in E.C., all school districts should be aware of this decision.

Principals should understand that, based on both the law and the E.C. decision, it is is necessary to carefully review a family’s request and the supporting information from the physician. It is permissible to request additional substantiation for the request, and ensure that there is sufficiently detailed information provided by the physician, such that the district may render an informed decision on the merits of the request for an exemption.

– Heather Cole, Ferrara Fiorenza P.C


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