A small but growing number of doctors in the Rochester area are joining doctors across the country who have decided to dismiss patients who refuse to have their infants vaccinated.
The process has become known as "firing parents," and it's a controversial practice because the American Academy of Pediatrics advises against it. But pediatricians have seen a rise in the number of parents refusing vaccines for their children, and some have decided to send a stern message.
"This was not even on the radar ten or twenty years ago," says Dr. Michael Pichichero of Legacy Pediatrics in Rochester. "We almost never had parents challenging the validity of vaccines. But now I'd say one in twenty families are challenging vaccines, with many of those parents outright refusing them for their kids."
Dr. Pichichero does not fire parents who take this route, but his colleague, Dr. Janet Casey, does. Dr. Casey has not wanted to comment publicly on the practice, but Dr. Pichichero says he empathizes with her.
"This is not easy," Dr. Pichichero says. "For me, I'd rather stay in contact with parents who refuse vaccines, because I want to continue to give them good information and monitor the health of their children. And fortunately, I'm often able to change their minds."
Dr. Pichichero estimates that when confronted with families who question vaccines, he's able to convince 80 percent of parents to have their children vaccinated. "It comes down to the fact that they've been getting bad information. When they hear of the risks of not having babies vaccinated, they want to do what's best for their child."
For parents who persist in declining vaccines, Dr. Pichichero requires them to sign a statement acknowledging the risk that comes with the decision. "That is often where they draw the line," Dr. Pichichero says. "They don't want to sign that document. That's when the danger becomes real. I've seen a baby literally cough to death from whooping cough. It's not hypothetical."
So why does Dr. Casey, for example, handle this issue differently? Dr. Pichichero says doctors who fire parents are primarily concerned about exposure to other children.
"The big issue is the waiting room," he explains. "When you choose not to have your child vaccinated, you're potentially exposing other children. Yes, other kids are often vaccinated. But there are families that will come in to our office before they've had the chance to have their newborns vaccinated. When they're in the waiting room, we don't want them to be vulnerable because other parents have not made good decisions." Dr. Pichichero added that vaccines aren't perfectly effective, meaning even vaccinated children could be at risk.
A recent study found that 30% of 133 pediatricians in the state of Connecticut have recently fired parents for refusing vaccines, and a separate survey of 909 midwestern doctors found that 21% did the same. A decade ago, only 6% of pediatricians routinely took the same approach, according to the American Academy of Pediatrics.
The Wall Street Journal reported on this issue earlier this year.
13 WHAM News has heard from parents of other practices who were "fired" for refusing vaccines, but those doctors were similarly reluctant to speak publicly about the issue. Some parents are offended by the idea that they might be dismissed.
We met Krysten Glor in Canandaigua, the mother of two healthy boys, ages 4 and 2. She disputes Dr. Pichichero's comment that "parents can be influenced by celebrities and celebrity doctors who have made factually dubious comments about vaccines."
"This is not about celebrities," Glor told us. "I'm concerned enough to do my own research." She says the heavy metals, along with other components in vaccines, are a problem. "The monkey and the mouse and the different cells that are in there, it just doesn't feel right to me. Formaldehyde, those things don't feel right to put into my kid."
Dr. Pichichero says that's an example of an uneducated position. "There is no evidence that aluminum in vaccines, for example, does any long-term harm," he says. "We're not asking parents to put their children in danger. We're asking them to take a step that protects their kids."
Glor, who says other parents have referred to her as a "quacky mom," has no plans to change her mind. "It seems easier to nurse a child through an illness rather than have them get something more severe due to a vaccine," she says. If her pediatrician dismissed her family based on this stance, Glor would find another practice.
But at Legacy Pediatrics, many parents have expressed gratitude for the firm stance of Dr. Casey. They appreciate the idea that their kids are not placed at risk when they pay a visit. "When parents are dismissed, we've seen some real surprise," Dr. Pichichero says. "It might shock them into really considering their actions."
Other parents who oppose vaccines point to the profit model of the American medical system, with one parent urging 13 WHAM News to "ask doctors how much money they're making by pushing vaccines." Dr. Pichichero says it's a misconception that pediatricians have a financial incentive to get children vaccinated.
"In large HMO organizations like the Kaiser Permanente system in California, doctors do get report cards about the percentage of fully vaccinated individuals, and if they don't achieve a high enough level, it would be a negative on thier private practice capabilities. Here in Rochester, there are no health care plans that incentivize doctors to give vaccines." He adds, "We make almost no money when we give vaccines. We buy the vaccine and we are only allowed to charge the insurance company what we paid for it, and then we are given a very nominal charge -- like eight or nine dollars -- to store the vaccine, give the vaccine, get the needle and syringe, record everything that happens. It's not a money maker for us, but it is our obligation."
Ultimately, Dr. Pichichero expects the discussion to continue regarding vaccines. "We wish we didn't have to have this debate," he says. "I think the phrase 'firing parents' is too harsh. My colleagues who take this step are trying to help families and children. Dr. Janet Casey is serving as an advocate for the children who come to this office and spend time in the waiting room. I know that my colleagues in this position want parents to think very hard about these decisions. I respect that. And I suppose I wouldn't be surprised to see more doctors go in that direction."