Frequently Asked Questions about Immunization & NC Law

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Frequently Asked Questions about Immunization & NC Law

Frequently Asked Questions about

Immunization & NC Law

Jill Moore, JD, MPH

UNC School of Government

September 2007


Roadmap

“Show me the law that says that”

Illustrations of some frequently asked

questions

More detail in handouts


NC Law: Immunization Required

Every child present in NC must be

immunized against specific diseases.

Required immunizations and schedule

for getting them set forth in state

regulations.

Parents/guardians responsible for

making sure child is immunized.


NC Law: Exemptions

Two types of exemptions allowed:

medical and religious.

No philosophical or personal exemption

No philosophical or personal exemption

in NC.


NC Law: Immunizations & School

If a child is unimmunized and not eligible

for a medical or religious exemption,

child may be excluded from school or

day care.


NC Law: Requirements for Day Care or

School Entry

Parent/guardian must present certificate

of immunization or documentation of

exemption.

If certificate not presented or incomplete,

school principal or day care operator

gives parent notice of deficiency.

Parent has 30 days to obtain

immunization or child is excluded from

day care or school.


NC Law: Quarantine

If there is an outbreak of a vaccinepreventable

disease, unimmunized

children may be quarantined during the

outbreak.

This applies to children who have been

exempted from the immunization

requirements, as well as non-exempt

unimmunized children.


NC Law: Enforcement

of Immunization Requirements

In theory, could enforce immunization

requirements same as any other public

health law (charge with misdemeanor,

obtain court order).

In practice, issue of compliance with

immunization requirements usually

addressed when child enters day care or

school.


Case Facts



Homeschooled

child not immunized

Parent’s testimony:

1. Prior bad reaction

to immunization

2. Desire not to

immunize a factor

in choosing

homeschooling


Questions Raised



Must parents who

homeschool their

children comply

with NC’s

immunization

requirements?

Might child be

medically exempt

from requirements?


Are homeschooled children exempt from

the requirements?

No. NC’s immunization requirements

apply to “every child present in this

state.”

Home schools must keep immunization

records.

If child qualifies for a medical or religious

exemption, home school must document

the exemption.


Which children qualify for a medical

exemption?

Child is exempted when an immunization

is medically contraindicated.

A physician must certify the medical

contraindication.

The contraindication must be recognized

by the Advisory Committee on

Immunization Practices (ACIP).


Which children qualify for a religious

exemption?

Child is exempted when the bona fide

religious beliefs of the child’s parent or

guardian are contrary to the

immunization requirements.

Parent claims exemption by writing a

statement of religious objection for each

child for whom exemption claimed.


Does NC recognize a philosophical

objection to immunization?

Common philosophical or personal

objections:

Concern that risk of immunization outweighs

benefits.

Different views of science of immunization.

Don’t agree with governmental mandate.

No philosophical or personal exemption

in NC.


Case facts

Parent/guardian

tells health care

provider not to

give child one or

more required

immunizations.


Questions presented

Since immunizations

are required by law,

does a HCP need

consent to immunize

a child?

What should a health

care provider do

when a parent or

guardian refuses an

immunization that is

required by law?


Is “consent” necessary?

Not informed consent in the way we

usually think of that term. This is a legal

requirement.

But HCP does need at least tacit

permission to proceed.


What Not to Do

HCP should not

attempt to

immunize the

child over the

parent’s objection.

HCP should not

restrain the child

or parent.


What should HCP do if a parent refuses

required immunization?

Explain:

Immunization’s purpose, risks &

benefits

NC law requiring immunization

Medical consequences of refusal

Legal consequences of refusal

Child may be denied school enrollment

Child may be quarantined in outbreak


Should NC HCPs use AAP’s “Refusal to

Vaccinate” form?

This is up to the HCP, but both HCP &

parent should understand:

The parent’s signature on the form does

NOT exempt the child from NC’s

immunization requirements.

Even if the child qualifies for an

exemption under NC law, the AAP form

is NOT proper documentation of the

exemption.


Case Facts

Grandmother

presents child for

immunization.

Says child’s

Says child’s

mother and father

asked her to get

the child’s shots.


Question Presented

Who may

authorize a health

care provider to

immunize a child?


Who may present a child for

immunization?

Parent, guardian, person standing in loco

parentis

Any other adult (18 or older) who signs a

statement that he/she has been

authorized by parent/ guardian/ person in

loco parentis to obtain the immunization

DSS if it has custody of child

Minor himself in some circumstances


When may a HCP immunize a child presented

by someone who is not the parent?

Person presenting child for immunization

must be an adult (18 years or older).

Person must sign a statement that he or

Person must sign a statement that he or

she has been authorized by the child’s

parent/guardian/PILP to obtain the

immunization.


Case facts

Teenager

presents herself

for immunization –

no accompanying

adult.

Immunizations in

question: HPV

and hepatitis B


Question presented

Can a minor (< 18

years of age)

authorize her own

immunization, or

must a parent,

guardian or other

adult authorize it?


When can a minor authorize her own

treatment?

NC law: A HCP may accept a minor’s

consent for “medical health services for

the prevention, diagnosis, and treatment

of” four conditions:

Venereal disease and reportable

communicable diseases

Pregnancy

Abuse of controlled substances

Emotional disturbance


May a minor consent to

immunization for hepatitis B?

Yes. The immunization is a “medical

health service” for the prevention of a

reportable communicable disease.


May a minor consent to

immunization for HPV?

Yes. The immunization is a “medical

health service” for the prevention of a

disease that North Carolina public health

officials have determined is a “venereal

disease” for purposes of this law.


Which minors can consent under this

law?

To consent to treatment, a person needs both:

Legal capacity to consent

Decisional capacity (AKA competence) to consent

Ordinarily minors don’t have the legal capacity

Ordinarily minors don’t have the legal capacity

to consent to their own medical treatment,

even if they have decisional capacity. This law

gives minors legal capacity to consent, but a

HCP should not accept the minor’s consent

unless the minor also has decisional capacity.


Easy cases


Where is the line crossed?


Case Facts

Parent has a pastdue

account with a

health care

provider.

HCP refuses to

provide

immunization

record until account

is paid.


Question presented

If there’s an

unpaid account,

can HCP refuse to

provide an

immunization

certificate or

information?


Can HCP refuse to provide immunization

info because account is unpaid?

No. Parent has right under HIPAA to

review and obtain a copy of child’s

information – unpaid account is not

ground for denying this right.

Other entities have a right under state

law to demand immunization information,

and CHP must provide it: health

department, schools, day cares, some

others.


Other Questions?

Jill Moore

919-966-4442

moore@sog.unc.edu

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