Doctors sound alarm over COVID-19 vaccine exemptions: ‘We have ethics’

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Dr. Nili Kaplan-Myrth has spent countless hours trying to convince hesitant patients to get vaccinated against COVID-19.

The Ottawa-based family doctor told Global News she’s encountered patients who don’t want to get vaccinated because they’re scared. Some have asked for an exemption – but that’s something Kaplan-Myrth won’t do.

“A patient asked if they could be exempted, and there was no medical reason; they just didn’t feel comfortable having the vaccine,” she said.

“I said, ‘No that is not a valid reason to be exempted.’ … it’s very restricted who can be exempted – in fact it’s so exceedingly rare that you have to wonder how any of the people who are getting these exemptions are given the exemption.”

Read more: Two Ontario doctors barred from issuing medical exemptions for COVID vaccine, masks, testing

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Kaplan-Myrth is one of several health-care professionals expressing shock after the College of Physicians and Surgeons of Ontario barred two doctors last week from providing COVID-19 vaccine, mask and testing exemptions.

As well, a third Ontario doctor also had their exemption abilities restricted late last month.

The provincial regulator issued the interim orders under provisions of the Regulated Health Professions Act, which allows them to impose restrictions on a member’s licence if it believes their conduct “exposes or is likely to expose patients to harm or injury.”

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A spokesperson for the college told Global News it expects physicians to provide exemptions based on valid medical reasons.

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“Deliberately providing patients with exemption documentation that does not meet Ministry criteria or providing exemptions to circumvent vaccination mandates could constitute serious misconduct,” they said.

“We take these matters very seriously and, wherever we become aware of allegations, we would take all appropriate steps to investigate.”

Read more: ‘Fraud is a crime’: B.C. doctor pens open letter to people asking for vaccine exemption notes

In light of this, Global News contacted every province and territory’s medical regulator to see if any other region has received complaints regarding doctors providing exemptions.

Global News received replies from every jurisdiction with the exception of Prince Edward Island and the Northwest Territories. Some regions couldn’t provide the information, either citing privacy laws or that the information wasn’t available.

Regulators in Nova Scotia, New Brunswick, Saskatchewan, Yukon and British Columbia haven’t received any formal complaints.

However, in B.C., regulators there told Global News that it has heard through “informal avenues that illegitimate COVID-19 vaccine exemption and deferral letters may be circulating in the community.”

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The College of Physicians and Surgeons of BC said it hasn’t seen any evidence of those letters, but published a public service announcement for those who may be required to determine the legitimacy of a vaccine exemption letter.

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“If people are writing exemptions … they’re writing those exemptions either because they feel like they have to appease their patients, or they haven’t learned how to say no to their patients,” Kaplan-Myrth said.

“But we have to say no to patients all the time.”

Read more: Number of COVID-19 vaccine exemptions being given out seems ‘high,’ Ontario medical officer says

Earlier this month, Ontario Chief Medical Officer of Health Dr. Kieran Moore said the number of vaccine exemptions being given out in the province seems “high.”

He said there are two main reasons for a medical exemption: a severe allergic reaction to a vaccine ingredient, and a risk of inflammation to the heart caused by the shot.

When those two risks are considered, there should be an exemption rate of approximately one to five per 100,000, Moore said.

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“We’ve tried to educate physicians, nurse practitioners who fill out these forms to ensure that they are aware of the two major medical exemptions for these vaccines,” he said.

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“I’ve heard, let’s say through hockey leagues and/or through employers, of a one to two per cent medical exemption rate. To me, that does seem high and we have to have physicians and nurse practitioners better aware of what the true medical exemptions are.”

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Kaplan-Myrth added that misinformation is driving fears among the hesitant.

“It’s really hard to get a person past that extreme fear, but still that is not a reason that you give them an exemption,” she said.

Dr. David Esho, a family doctor in Toronto, told Global News he has been able to convince some patients to get vaccinated, but that it’s a work-in-progress for others.

“I think some of them don’t really understand what the criteria are, and that’s where my job as a physician is to educate them around what are the actual reasons for vaccine exemptions or mask exemptions,” he said.

“I think it’s important that as family physicians, as physicians in general, that we always practice with the best evidence-based medicine.”

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Dr. Steven Bellemare, director of strategic engagement and advocacy with the Canadian Medical Protective Association, told Global News doctors need to use “clinical judgment” when assessing their patients’ needs.

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“It really is important that physicians understand that they have to follow their college’s guidelines,” he said. “And if they are going to be providing exemptions, they do it in the context of proper clinical assessment and an established doctor-patient relationship.”

When asked about complaints regarding illegitimate exemptions being given, a spokesperson for the Federation of Medical Regulatory Authorities of Canada told Global News that medical regulatory authorities (MRA) must follow due process “and, by legislation, cannot make public comments while these processes are unfolding.”

“There may in fact be several cases across the country where physicians have been brought to the attention of the MRA for the concern you outline, but due process must be allowed to unfold as it should.”

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For Kaplan-Myrth, she hopes that other physicians continue to be there for their patients.

“My message to any colleague who is doing the public a disservice by providing falsified exemptions is that they have no business practicing medicine,” she said.

“We have standards, we have ethics, we have codes of conduct and we have a responsibility to ensure the health and safety of our population.”

— With files from Ryan Rocca and The Canadian Press


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