Dr Bob Sears license on probation for invalid vaccine exemptions – again

On 27 June 2018, Dr Robert (Bob) Sears, an anti-vaccine pediatrician, agreed to a stipulation with the California Medical Board that put his license to practice on probation and subjected him to a set of non-trivial conditions.

The revocation of the medical license of Dr Bob Sears was stayed by the Medical Board – it will not become operative unless he violates the conditions – but given the specific allegations in the complaint and the fact that this was his first disciplinary action, an immediate full revocation was not likely. The sanction is non-trivial, and a clear warning against future misconduct. 

Dr bob sears

About Dr Bob Sears

Dr Bob Sears has been promoting problematic information about vaccines, and active in anti-vaccine circles, for years. While his Vaccine Book pretended to offer a middle of the road approach to vaccines, it was grossly inaccurate in several ways and stoked parents fears from vaccines.

His Autism Book was even worse: it embraced the debunked notion that vaccines cause autism pretty openly, among other things recommended that children with autism not receive additional vaccines (p. 336), and limiting or delaying vaccines for their siblings (pp 336-337), and actively recommended an alternative schedule as a way to prevent autism (pp. 337-338) – all things with no scientific basis, and against the evidence. He also recommended non-science based and potentially dangerous treatments for autism like chelation (pp. 274-275) and Hyperbaric oxygen therapy (HBOT) (pp. 280-287), both not recommended and unfounded.  

In recent years Dr. Sears has gone more openly anti-vaccine, making statements during measles outbreaks downplaying the risks and discouraging people from vaccinating. And moreAfter SB277 he openly encouraged, may be enabled, and probably provided unwarranted medical exemptions.

However, his anti-vaccine activities are not what the disciplinary action was about.  

Not really Dr. Bob Sears. Probably a pro-vaccine doctor. Photo by Online Marketing on Unsplash

Dr Bob Sears case  

On 20 September 2016, the Executive Director of the Medical Board of California, represented by the office of the California Attorney General, then headed by Kamala Harris, brought a complaint against Dr. Sears (pdf).

The complaint referred to his treatment of a child known as J.G., treated by Dr. Sears from the age of two on, during 2014-2015. The allegations included negligent treatment of the child and poor record keeping. There were three parts to the allegation:

Part 1

Writing an unjustified permanent medical exemption for J.G..

What appears to have happened is that J.G.’s mother claimed that her son experienced reactions after his vaccines, and without obtaining the child’s prior records, Dr. Sears translated them into more severe reactions than described and gave an exemption based on that. The first claim was that he “shut down stools and urine” for 24 hours after his two months vaccines – which translated in Dr. Sears’ letter to “kidneys and intestines shut down”. As a doctor interviewed by medical journalist Tara Haelle explained, 

“… a doctor would not write “kidneys and intestines shut down,” unless perhaps it was explicitly intended to avoid technical terms for a lay audience; he would write “renal failure and ileus.”

“But he can’t write renal failure because he doesn’t have any proof or evidence that the kid has renal failure,” Snyder said. “If your intestines really shut down, to have ileus and renal failure, that’s shock.”

The second claim by the mother was that after his three months vaccines the child went “limp like a rag doll”. Again, without obtaining medical records or checking, apparently, that translated in Dr. Sears’ letter into “severe encephalitis”. Once again, Dr. Snyder interviewed by Tara Haelle addressed this:

“Snyder also noted that it’s not uncommon for parents to come in saying their child didn’t “act like themselves” or were “limp like a ragdoll” or “limp like a noodle,” but that expression is often not literal when parents use it, and it certainly does not typically mean that the child has encephalitis. It does warrant further questioning to understand what the parent means, he said, but it would hardly be a reason for exempting a child completely from all vaccines, ever again. If the mother meant something more serious than the typical figure of speech, due diligence would require a comprehensive investigation.”

In other words, Dr. Sears appeared to have written a letter exempting the child from all future vaccines, a letter that at best was not well-founded, without any real investigation into the fact. 

It’s important to note that this exemption letter preceded SB277. The child could have taken a personal belief exemption at the time. It was still ill-founded. 

 

Dr Bob Sears
Photo by pina messina on Unsplash

 Part 2

Not examining J.G. when he came in with a headache after a report of being hit with a hammer by dad two weeks earlier.

As explained by Orac, regarding this:

…no additional physical examination, including the all-important neurological examination (in cases of head trauma), was performed and no assessment with plans recorded. I used to do trauma, including pediatric trauma, and I know that this is a grossly inadequate evaluation for what might be a concussion, based on symptoms and timing, after having been hit in the head with a blunt object.

Part 3

Not keeping proper records on this (which is a separate head of discipline under California law).

The stipulation against Dr Bob Sears

As mentioned, on 27 June 2018, Dr Bob Sears signed a “Stipulated Settlement and Disciplinary Order” agreeing to certain disciplinary sanctions. The opening paragraph on page three says: 

IT IS HEREBY ORDERED THAT Physician and Surgeon’s Certificate No. A60936 issued to Robert William Sears, M.D., is revoked. The revocation is stayed and Respondent is placed on probation for 35 months on the following terms and conditions.

In other words, Dr. Sears’ license is on probation, subject to conditions. According to a colleague who specializes in health law, this kind of resolution – a conditional revocation, subjecting an erring doctor to conditions that limit his or her ability to abuse discretion again – is a pretty typical form of resolution for medical boards. 

The money question here is what are the conditions – and they are pretty tough (as pointed out by Orac in the article mentioned at the top).

  1. Dr. Sears will take a board-approved educational course of 40 hours per probation year aimed at correcting “any areas of deficient practice and knowledge…”. 
  2. Dr. Sears will take a professionalism (or ethics) course approved by the Board. If he took one after 2014 but before the stipulation, it can count if the Board approves it. 
  3. Dr. Sears will propose a designated monitor. The monitor has to be “..one or more licensed physicians and surgeons whose licenses are valid and in good standing, and who are preferably American Board of Medical Specialties (ABMS) certified.” This has to be someone with “no prior or current business or personal relationship with Respondent,” at least ruling out some of Dr. Sears anti-vaccine colleagues. The monitor will have access to Dr. Sears’ records and premises, and will, well, monitor Dr. Sears. Obviously, the identity of the monitor matters a lot. The monitor will report to the board quarterly about Dr. Sears’ practice and whether they’re within the standards of practice. As an alternative, Dr. Sears can participate in a “professional enhancement program” with reports and character review.  
  4. Dr. Sears will notify any hospital he has privileges in. 
  5. Dr. Sears may not supervise physician assistants or advanced practice nurses while on probation. 
  6. Dr. Sears will report to the Board quarterly if he complied.
  7. Dr. Sears needs to inform the Board of any travel outside California that will last more than 30 days.

This is a pretty strong set of conditions. The limits on supervision, and the notification requirements, and especially the monitoring, are not trivial. Of course, much depends on who the monitor will be, and how it will work in practice. But for the next 3 years, Dr Bob Sears should be under pretty close supervision. Chances are he would either walk very cautiously or slip and lose his license, at least for a time.

This is a stipulation. It’s not a precedent, but it does offer a standard and a reflection on the Board’s mood. It is a warning shot to doctors providing fake medical exemptions from vaccines. By hobbling an influential anti-vaccine doctor, it also protects children from preventable diseases less directly. 

On 29 June 2018, Dr Bob Sears posted on his Facebook page about the situation. Unsurprisingly, the post blamed the case against him on a conspiracy initiated by “a legislator.” He also mentioned that there are several other cases against him in the works. We do not know what will happen, but it is worth following.
 
 
 

Update– Issuing more invalid vaccine exemptions

According to an article in Forbes by Tara Haelle, a respected science journalist, Dr Sears is at again. He is facing another review and examination by the Medical Board of California, less than a year after he was put on probation, as discussed above. Ironically, he was one of the anti-vaccine individuals who testified against vaccines before a California Assembly committee hearing that was reviewing SB276 last week. 

As California Senator and pediatrician, Richard Pan, MD,  said:

I find it astonishing that a person who is on probation with the medical board is going to be the main spokesperson to say the bill is bad, the person the bill is designed to protect against.

According to Haelle, a complaint was brought by Kimberly Kirchmeyer, executive director of the Medical Board of California, which alleges that Sears signed vaccine medical exemptions for two siblings. Those children did not have medically-recognized contraindications for any vaccines, based on their medical records.

This may violate the conditions of his probation. 

Haelle wrote:

Sears recorded the children’s family medical history as “autoimmune disorders, lupus, psoriasis (in Dad), inflammatory bowel disease, irritable bowel disease, irritable bowel syndrome (in Dad), gluten sensitivity severe in Mom and Aunt, suspect CD [celiac disease] in aunt, neurodevelopmental disorders, ADD/ADHD (in Dad), psychiatric disorders, schizophrenia (Dad), bipolar, and depression.”

The boy’s exam included “psoriatic plaques on scalp, back of neck and ears,” and the girl’s exam was normal, though Sears documented no vital signs for her (blood pressure and temperature). Both children were diagnosed with “viral infection, unspecified” and “feeding difficulties” despite the purpose of the appointments being solely recorded as “vaccine exemption” visits.

Sears determined that the boy “qualified for medical exemption from vaccines for family history of autoimmune disorders (Dad and others), inflammatory bowel disease (Dad), neurodevelopmental disorders (Dad), psychiatric disorders (Dad), and the child’s own autoimmune disorder.” Sears determined the girl qualified “based on review of her past medical history, family history, and current state of health.” He filed letters for both children “exempting [them] from all vaccines for the rest of [their] childhood.”

None of the conditions or family history, as noted in the children’s records, meet the criteria for contraindications to any CDC-recommended childhood vaccines, according to the CDC

In other words, Sears is trying to claim that non-vaccine related family history of the parents exempted the children from vaccinations. No, that’s not legitimate.

Sears also tried to connect a diagnosis of psoriasis, in one child, as a reason to exempt them from vaccinations. Again, that is a nonsensical justification for a vaccine medical exemption. The complaint against Sears states:

childhood long medical vaccine exemption… based on diagnosis of psoriasis, without immunosuppressive medication, is a simple departure from standard of care.

Vincent Iannelli, MD, wrote a powerful critical analysis on his Vaxopedia blog regarding the claim of psoriasis as a contraindication for vaccination. Essentially, there is nothing there, and it is a fake reason to claim a medical exemption. Not only does Dr. Iannelli recognize this, but I also recognize it, and so does the Medical Board of California.

As Dr. Ianelli writes:

The bottom line is that experts that treat people with psoriasis recommend that they be fully vaccinated.

“Psoriasis is a treatable, chronic dermatosis. The very low absolute risk of new-onset or relapsed psoriasis following influenza vaccination should not change its universal recommendation, particularly for patients with psoriasis on immunosuppressive therapy. We present this case to highlight clinical manifestations of this rare association.”

Shi et al on Widespread psoriasis flare following influenza vaccination

It should be clear that neither psoriasis nor a family history of psoriasis should be a reason to get a medical exemption for vaccines.

Sears was also accused of not maintaining proper records for the two patients that are part of this complaint. One of the options that the Medical Board may use is to revoke his medical license.

We’ll update this article as these new complaints move through the review system of the Medical Board.

Notes

This article was originally published in June 2018. As a result of  Sears more recent anti-vaccine activities, it has been updated to include that. 

This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law. 

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also a member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.



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Dorit Rubinstein Reiss
This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy and the law. 

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.