Monroe Pediatrics takes a stand and will no longer care for non-vaccinated patients

Monroe Pediatrics is joining a growing number of pediatric practices nationwide which will no longer care for patients if their parents or guardians decline to vaccinate their children according to the recommendations of the Centers for Disease Control.
Practice officials said the decision was a difficult one, but they have decided “the risk is too great,” according to a July 16 initial email to parents.
Elsewhere locally, Washingtonville Pediatrics has the same policy.
“Over the years, while we disagree, we have reluctantly supported families who have chosen to delay vaccination,” the email said. “We are now concerned that the number of children unvaccinated and under-vaccinated in our community is a serious risk. The personal risk of not vaccinating is now expanding beyond the individual and into our community and office.”
'We're not just talking about measles'
The recent and unprecedented regional outbreak of measles - primarily in nearby Rockland County - was the impetus for the decision, although Dr. Jamee Goldstein, one of the six physicians in the practice, stressed: “We’re not just talking about measles.”
Goldstein said since she joined the practice, there’s been a slight increase in the numbers of families who decline or defer vaccinations against communicable diseases. Those vaccinations are now required for entry into public school due to recently passed New York State legislation.
Interestingly, New York State has excluded flu, hepatitis A, HPV and rotovirus vaccinations from its school entry requirement. Because of that, Monroe Pediatrics also exempts them from its list of now required vaccinations to remain in the practice.
“We have people who have declined or postponed vaccinations for a variety of reasons,” she said. “This current measles outbreak is the straw that broke the camel’s back. It’s caused us to make a decision about under vaccinated patients. This is aligned with New York State and its recently passed vaccination legislation.”
Goldstein estimated approximately five percent or less of the 9,000 patients in its practice would be impacted if parents/guardians chose to not vaccinate their children. The practice’s patient base extends beyond the greater Monroe area.
“The vast majority of children in our practice are vaccinated on time or on a delayed schedule,” she added.
Goldstein stressed the practice will continue to care for patients who are medically unable to receive vaccines and believes this policy will better protect them as well as newborns who must reach an initial age before a vaccination schedule can begin.
Outbreaks
“In my 45 years (of living in the Monroe area), I’ve dealt with outbreaks of Hepatitis A and the mumps,” she said. “There was a measles outbreak the year of my junior prom, and it wasn’t necessarily in the religious community. I had to get a third vaccination in order to go to my junior prom. That was required by the school in the 1980s. Ten years ago, it was a mumps outbreak. Pertussis, it’s ongoing. We see it and then it goes away for a couple of years. I do know families who have been affected by these diseases, including in my own immediate family - polio and varicella, as examples, prior to vaccine. It can be extremely serious.”
Goldstein said the requirement also means patients must finish their primary series of vaccinations.
“We are requiring them to finish the series and then do the booster doses,” she said. “Everyone who is not vaccinated will get a letter and a deadline to start the process. We’re taking this a step further and saying patients actually have to finish the vaccinations. Remember, you can’t wait until your child goes to kindergarten to begin vaccinations. They won’t be allowed in.”
Choices remain
Goldstein also felt some parents do not understand the new state law.
“The state is saying if you want a public education for your child, you have to have your child vaccinated,” she said. “But parents still have choices. They can home school their children. They can move somewhere where there is an allowance for parental choice or due to religious beliefs. But in school, you don’t know who is sitting next to your child in school. Or, who may be on chemotherapy or is otherwise compromised? Or, what if the teacher has an immune issue? Or, if the janitor has a pulmonary problem? You don’t know your neighbor’s health history. The whole idea behind herd immunity is that we can protect the people who don’t or can’t protect themselves.”
Percentages of the population needing to be vaccinated to achieve herd immunity vary by disease. For example, according to the CDC, to achieve herd immunity for measles, at least 90 to 95 percent of the population needs to be vaccinated.
A less contagious disease like polio would need 80 to 85 percent of the population to be vaccinated for herd immunity to work.
“The pediatricians who started the practice believed you should not hold a child responsible for their parents’ decisions and they should have good health care available to them,” Goldstein said. “We always tried to allow parents to do what they want, but now there are too many illnesses in the community and too many fragile children we have to protect. We feel all children deserve good care, but we have to protect our community. We’re happy to have the conversation and educate, but we have to think about the greater good.”