The Tennessee legislature is poised to pass legislation that would stop the Department of Children’s Services from giving any vaccine to a child in custody without written permission of a parent or guardian — a measure that could have “unintended consequences” such as an inability to act swiftly in an outbreak of meningitis at a juvenile facility, public health professionals said.
The measure, House Bill 1380 and Senate Bill 1111, by Rep. John Ragan, R-Oak Ridge, and Sen. Janice Bowling, R-Tullahoma, would effectively end Tennessee’s so-called “Mature Minor” doctrine giving physicians discretion to give older teens vaccines without explicit parental permission and putting in check the state’s child welfare agency’s control over the health care decisions for children in its care. As applied to Children’s Services, the bill would end the agency’s ability to provide vaccines to children of all ages.
The prospect has alarmed some pediatricians who say the measure’s requirement of written parental consent for vaccinations provided to teens is contrary to standard practice and an “unwelcome government intrusion” into the doctor-patient relationship.
Ragan said the bill would restore parental rights in their children’s health care decisions.
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The bill follows GOP backlash at the height of the pandemic, when the state’s former vaccine chief, Dr. Michelle Fiscus, sent a memo to health care providers outlining the Mature Minor doctrine. The memo infuriated Republican leaders and eventually led to Fiscus’ firing.
The state Senate on Monday voted in favor of the bill; it has yet to reach the floor of the House. A spokesperson for Children’s Services did not respond to questions Monday about the agency’s position on the bill.
Children may come into state custody behind on their childhood vaccinations as a result of parental neglect, or need vaccines to be enrolled in a school or to be placed in foster homes with other children.
In those instances, routine immunizations for chicken pox, measles or other diseases are critical, advocates for children in state care said. Currently, Children’s Services is responsible for obtaining all necessary health care for children who come into its custody, including vaccines.
Brian Haile, CEO of Neighborhood Health, which provides health care at clinics serving low-income patients in Middle Tennessee, said his organization doesn’t take a position on whether the Mature Minor doctrine is a good thing.
“The truth is teenagers aren’t lining up to get vaccines of any type,” with the exception of routine flu shots, he said.
“What we’re really worried about is the foster care kids and the kids in the juvenile justice system,” Haile said. “Where there’s a potential meningitis outbreak, time is of the essence, and at least as we understand this, those kids could not be vaccinated.”
In some instances, parents may have abandoned children; in others, they may resist complying with Children’s Services requests for their permission, a result of the neglect that may have led to their children being taken into custody. Parents may also resist providing permission as a result of the mistrust they develop with Children’s Services after their children are taken away. And in the case of disease outbreaks in group settings, Haile said swift medical intervention is critical.
The proposed new law would allow the department to petition a judge for permission to vaccinate a child, but — in addition to their efforts to get signed, written vaccine permission — a legal petition for a vaccine would add yet another administrative burden to caseworkers who are already overburdened, child advocates said.
Pediatricians said the policy would upend standard practice for their patients — those in state custody and those who are not.
“Treating older minors without parental consent has been a standard part of medical practice at least since the 1980s Tennessee court decision that supported older minors having capacity to make their own medical decisions,” said Nashville-area pediatrician Dr. Vidya Bansal.
The bill has received limited public debate since its introduction into the legislature. Pediatricians say they have not had the opportunity to make public comments.
“As physicians, we have tried to make public comments advocating for vaccinations, and we have been denied this opportunity,” said Dr. Amy Gordon Bono, a primary care physician. “We continue to see this legislative body silence voices who speak politically inconvenient truth.”
Read more at TennesseeLookout.com.