Blog note: this article references a Humboldt County Grand Jury report.
California makes schools submit vaccination rates every year so the public can see how protected they are from infectious diseases — but those schools face no real consequences if they don't comply, the Record Searchlight has learned.
Especially with measles outbreaks proliferating in the state, the lack of accountability for those schools is “extremely problematic,” said State Sen. Richard Pan, a pediatrician in the Sacramento area who authored SB 277, which banned philosophical objections to vaccines for kids going to school in California.
As of last Wednesday, measles had sickened 44 people across California in 2019, the California Department of Public Health's most recent data show. The state illnesses come as the Centers for Disease Control and Prevention had recorded 760-plus cases nationwide, breaking a record for the illness since health officials declared it eradicated in 2000.
“It’s like a wildfire … if you don’t put it out right away, it doesn’t stop,” Pan said when contacted about the lack of accountability. “So, I mean, this is not the time for the (state) to be backing off. This is the time for them to be getting even stricter with people.”
Among the findings of a Record Searchlight investigation into immunization reporting:
- Last school year, California quietly stopped enforcing what little consequences there were for the schools that don't make their vaccination rates public.
- That potential accountability — through audits that could trigger reduction of per-student funding — had only been in place for two years and also only applied to public schools dependent on state money. The state confirmed it no longer conducts the audits, which were in place from 2015 to 2017.
- Most of the schools that didn't report immunization rates in recent years were private, meaning they had no state funding to lose even if an audit found they were out of compliance. California Department of Public Health data show that in 2017-18, 99.2% of public kindergartens reported their immunization rates, while only 90.7% of private schools with kindergartens did.
Schools have to submit immunization rates for kindergarten and seventh-grade classes every year because kids are legally required to have certain shots to enter those grades. All told, data show there were over 200 schools each for kindergarten and seventh grade last school year that didn't report their numbers — and apparently didn't face any consequences from the state for it. A sampling of schools listed as delinquent in Shasta County yielded two that were no longer in operation, though.
It's not clear how many schools appear on both lists, but any that offer both kindergarten and seventh grade likely would.
“Knowing which schools are problem spots is extremely important — for policymakers and for outbreak-watch.”
Dorit Reiss, professor at San Francisco’s UC Hastings College of the Law
In many communities all schools still reported numbers. But in others — particularly smaller counties — the gaps in reporting add up.
In Calaveras County, only five out of eight schools with seventh grades reported their numbers last school year, while 11 out of 15 with kindergartens did. In Madera County, 30 of 39 schools with seventh grades reported.
Since health experts say a community needs about 95 percent of its population to be vaccinated to stave off measles — one of the shots required for kids to start school — they say it's an issue when schools don't face any risk if they fail to prove they've met that threshold.
“Knowing which schools are problem spots is extremely important — for policymakers and for outbreak-watch,” said Dorit Reiss, a professor at San Francisco’s UC Hastings College of the Law who also writes on vaccine laws. “There’s a whole set of problems with that.”
State 'does not impose consequences'
It's the first sentence on the second page of the California Department of Public Health's lengthy report on kindergarten vaccination rates for the 2017-18 school year.
"Each autumn all schools with kindergartners in California are required to report student compliance with California School Immunization Laws," the report reads.
Similar text is also just below a parent-friendly “How Is Your School Doing?” map on the agency’s purple-themed “shotsforschool.org” website — and in the California Code of Regulations.
Here's what happened before if schools ignored that rule: When the California Department of Public Health got its annual immunization rates from schools and child-care facilities, it would tip off the California Department of Education to any that didn't submit their numbers. That triggered a state board, the Education Audit Appeals Panel, to do an audit on the school's immunization rates.
If a school got audited for not reporting and had also claimed attendance dollars for kids who weren't up to date on required shots after a certain point, it could have lost that money. Private schools also have to submit numbers, but they don't get attendance money from the state like public schools do.
“The problem is, by not reporting numbers, we don't know exactly what they're doing.”
State Senator Richard Pan, Democrat - Sacramento, Yolo
Only 46 kindergartens and 32 seventh grades on the delinquent list were at public schools subject to funding loss. But now, even the limited threat of consequences is gone.
A spokeswoman for the California Department of Education confirmed that audits stopped in the 2017-18 school year because they yielded "a low number of audit findings."
“Currently, the CDE does not impose consequences on (districts) that do not report vaccination rates,” Information Officer Cynthia Butler said in an email.
It wasn't clear how many of those audits happened and what they found. Butler didn't respond to follow-up messages seeking that and other information.
In her original message, Butler deferred to state public health for information on any other consequences delinquent schools face. But that agency just confirmed its process of informing the department of education, and said it also puts those schools' non-compliant status on maps for the public.
“Schools that do not report on the immunization status of their students are reported by CDPH to the California Department of Education,” an email from the agency reads. “Additionally, local health departments may visit the schools to improve compliance with immunization requirements.”
A public health spokesperson also confirmed that “2019 audits do not include” the review of immunization rates from non-reporting schools.
It appears both agencies signed off on the change. Minutes from the audit panel's June 2017 agenda say the board approved removing immunization audits because "The Departments of Education and Public Health found that compliance levels were such that further testing at this time is not needed."
Tim Morgan, staff attorney for the audit panel, said the state controller's office gets stakeholder input on what school areas need to be audited. One thing that's "always a potential concern" in those talks: whether it's worth the cost to keep auditing something, Morgan said.
"The problem is, by not reporting numbers, we don't know exactly what they're doing," Pan said.
Counties try to fill in
In some areas, Reiss said she's seen issues with vaccination rates dissolve with a little outside help. But, "if you don't know the problem, you can't do that."
The non-enforcement issue came up in a recent Humboldt County grand jury report on immunizations. It mentions a "lack of enforcement for non-compliance and failure to ensure that school reports were completed accurately, on time, and submitted to the California Department of Public Health."
"Schools also did not face any penalties for failing to ensure accurate and timely follow-through," the report reads.
The report goes on to recommend the county get involved with enforcement, because "parents have difficulty obtaining information about that individual school's vaccination rates" without any.
Denise Aguilar holds her son, Esai, 4, while she and others gathered to oppose a proposed measure to have public health officials grant medical exemptions for vaccination instead of leaving the power to physicians, at the Capitol, Tuesday, March 26, 2019, in Sacramento, Calif. The authors of the bill, state Sen. Richard Pan, D-Sacramento, and Assemblywoman Lorena Gonzalez, D-San Diego, say the legislation is needed to crack down on a few unscrupulous doctors who are helping parents avoid vaccinating their children. Opponents say the measure is unnecessary because current law has already increased the vaccination rate. (Photo: AP Photo/Rich Pedroncelli)
Tom Kaut is the administrator of Montessori Children's House of Shady Oaks, which offers both pre-school and kindergarten in Redding. It shows up as delinquent in a search of the shotsforschool.org website for 2017-18.
Kaut reported immunization rates last fall and in November 2017, he said, but it's possible he missed a deadline. The school also changed ownership that year, so Kaut said he thinks that could have caused a snafu in getting numbers submitted.
Kaut said he got a different reactions from the agencies that handle child care and kindergarten.
For the pre-K facility, Kaut said he got a reminder to turn in his numbers from a branch of the California Department of Social Services because it regulates those centers. While he didn't remember the employee saying so in plain words, Kaut said he got the impression the facility's license would have been in jeopardy if he didn't get the numbers in.
When it came to the kindergarten, Kaut said he didn't remember hearing much from the state.
"We wouldn’t have any consequences for the kindergarten, that I’m aware of," he said.
Local agencies in Shasta County are "kind of the teeth" of the requirement that schools submit their numbers, Kaut said. But he acknowledged other counties might not get involved as much.
"Locally, I do believe they're very good about it," he said. "It may not be the day after you fail to report, but they do get around to you."
But as much as they might try to encourage schools to report, counties don't have an enforcement role, either.
In Shasta County, Community Education Specialist Tim Mapes said the public health department looks at local schools' numbers before sending them on to the state, and the agency also helps bring schools up to speed on reporting requirements. In some cases, the county might even visit a school to help them comply, Mapes said.
"Any corrective actions, that type of thing, would come down the line" from the state he said.
While Mapes said Shasta County tries to be "more proactive" about helping schools get in compliance with reporting rules, he, too, acknowledged that other counties might not have the resources to do that as much.
And even if every school turns out to have a high immunization rate, vaccine advocates say the state needs to make sure they're turning in numbers to find that out in the first place.
"We've already strengthened our vaccine laws. If we don’t know the rates," Reiss said, "it’s hard to track enforcement, and it makes it harder to assume it’s actually working."
Other Redding-area schools that didn't turn in their numbers for 2017-18, per the California Department of Public Health, are:
- Grace Presbyterian School
- Columbia-East Valley K-6 Community Day School (that school didn't have any enrollment last year and is only on the books for technical reasons, the district's superintendent said)
- Stanley Academy (the department of education's database said that school closed in May of 2018)
- Victory School (a home school)
- Quail Creek Academy
- North State Christian Academy
A duty to protect?
Overall vaccine numbers are up in California, but Pan said it's important to stay vigilant about reporting compliance. That's because there are still pockets of the state where "virtual echo chambers" on the Internet have created a risky trend away from vaccination, he said.
"There's actually a culture built around it," Pan said, "and that's what social media has done."
Revisiting the wildfire analogy, Pan said he hears people who oppose vaccines complain about their rights the same way some say they shouldn't have to clear trees around their homes to ward off fires.
"But what happens when someone doesn't do that, right? It's not just their house that gets burned down," he said. "And that's what this is about."
While Pan's bill aimed to stop vaccine opt-outs, some health experts fear parents are finding loopholes — like medical exemptions that aren't really needed — to get their unvaccinated kids into school anyway. Pan has a new bill moving through the legislature, SB 276, that would tighten the rules of SB 277 so that fewer people could potentially get around the law that way.
At the same time, Reiss said schools that don't face any consequences for not submitting their numbers also could be getting away with admitting too many "conditional entrants." That's the category for students who aren't totally up to date on shots, but who can still go to class if their schools decide it's OK — the idea being kids with temporary medical issues or who are between rounds of shots aren't punished.
Schools that let in too many kids who weren't up to date on shots — more than 25 percent of a grade level, per the state — also risked losing attendance dollars for those kids when the immunization audits were still happening.
But even if every school reported, there already were other limitations to the public's access to vaccination data.
Classes with fewer than 20 total students still have to submit their numbers, but the state said it doesn't publish their names for confidentiality reasons. Still, it factors those numbers into counties’ overall rates.
Pan said he sees the need for that rule, since it's "very important" to protects student privacy. But he said the agencies involved also have a duty to protect kids' health.
"There's other laws we have in place to protect student safety, and they are obligated to enforce those," he said. "You're not going to enforce the existing laws? That would be extremely problematic."
May 13, 2019
Redding Record Searchlight
By Alayna Shulman
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