Doctors may "fire" parents who refuse to vaccinate their children

From ABC News and MedPage Today:

When Cathlene Echan walked into her pediatrician's office two weeks after giving birth, she was nervous about discussing her recent decision not to vaccinate her second baby. (The Echan family is pictured.)

But Echan, of Orange County, Calif., did not expect to be asked to leave.

"The doctor said it was too much of a liability to have us as patients," said Echan, a 28-year-old stay at home mom. Echan's oldest child, Josiah, now 5, had just been diagnosed with autism around the same time her second son Torren, now 2, was born.

Echan said she did research and read articles online about autism, she talked with other parents and then came to the pediatrician's office with doubts about vaccines.

"I hadn't come to a conclusion at that point when I saw the doctor, but I was so nervous because they're brothers, and I thought there could be a predisposition for it," said Echan. "As a mom, I can't knowingly do something to my second child when I believe it played a role in causing my older child's neurological disorder.

"She was very nice at first, but when I asked her to give him [Torren] a checkup, she said, 'you need to leave,'" said Echan.

Echan's situation is a growing problem for parents and pediatricians alike. Despite adamant statements from the American Academy of Pediatrics and the U.S. Centers of Disease Control that vaccines have no link to autism, an anti-vaccination movement is growing online, from parent to parent, and through activist celebrities, such as actress Jenny McCarthy.

Now, more and more doctors are feeling compelled to say "no" back to these parents. The issue was raised Wednesday at the annual American Academy of Pediatrics meeting in Washington, D.C.

Dr. Gary Marshall, a presenter at the meeting, said there are some cases when it's ethical and legal to refuse to continue to see, or treat, a child.

"In the middle of treatment, you can't just say, I'm done," Marshall, of the University of Louisville School of Medicine, said during a session that addressed parental concerns about vaccinations and how pediatricians can respond.

"But if it becomes obvious that you and the family will never see eye-to-eye on a specific issue, there's no reason not to 'fire' them, providing you follow the steps necessary to avoid charges of abandonment," Marshall explained in the meeting. "Those include providing written notice that you will no longer treat their children and giving them a set time frame -- at least 30 days -- to find another physician."

Dr. Mary Fallat, chair of the Committee of Bioethics of the American Academy of Pediatrics, said doctors should try hard to work with parents, if they refuse to vaccinate, by providing information and trying to come to an agreement about a vaccination schedule.

"If that doesn't work, and the pediatrician feels really strongly that they cannot care for the child -- which is not the norm -- then they need to find another pediatrician who can take care of that child," said Fallat.

In some cases, Fallat said, doctors may feel an ethical concern about families who don't vaccinate their children.

"Ethically, that is a real concern on the part of the pediatrician because there are some diseases that are really disabling," she said. "If a pediatrician says, 'OK, I agree, it's OK for you not to immunize your children' and they do come down with some of these diseases then& it makes the doctor feel like he's partly to blame."

Yet, while in theory, doctors should find another physician who will treat an unvaccinated child, in the real world, it can put families in a difficult spot.

After Echan left her first pediatrician, she said she could not find another doctor who would take her family, once she told them she was unwilling to vaccinate her children.

"I don't know what happened to my older one, I just know that he has autism and he wasn't born with it," said Echan. "So I don't know what to do then, I'm scared."

Dr. Steven Abelowitz, director of the Coastal Kids clinic where Echan was first turned away, says the process of dealing with parents who don't want to be vaccinated is evolving.

Abelowitz didn't see Echan, nor could he speak to what happened that day. However, he said he does try to work with families who fear there's a link between vaccines and autism.

"Four or five years ago, it really was a rare instance that someone wouldn't want to do vaccines," said Abelowitz, who is an adjunct professor at the University of California Los Angeles and University of Southern California.

"Now we deal with vaccine concerns 10-20 times a day," he said.

Abelowitz says his office tries to provide as much information as possible on the risks and benefits of vaccines, and Coastal Kids even works with families to spread out the vaccination schedule over a longer period of time.

"The big, big change came after Jenny McCarthy came on TV," said Abelowitz. "Knowing now how many people fear it, we really want to try to work with parents."

However, Abelowitz said he does have concerns about keeping unvaccinated children in a practice, especially if the children aren't vaccinated against whooping cough, or pertussis, which can be fatal in young children and is still found in the United States.

Abelowitz also says he worries about babies coming into his office having contact with older children whose parents have refused to allow vaccinations.

"We also have to be responsible to the kids in the waiting room ... my biggest fear is [for] these young babies who are under the age of 2 months who are not vaccinated."

In the end, Echan took her children to see a naturopath -- a person who studied holistic medicine but does not have a legal license to practice medicine in most states.

"I love doctors; I'm not opposed to doctors. I just haven't needed them yet," said Echan. "I know that there are pediatricians out there who will take children who aren't vaccinated."