DiversityNursing Blog

Judge Upholds Policy Barring Unvaccinated Students During Illnesses

Posted by Erica Bettencourt

Mon, Jun 23, 2014 @ 12:41 PM

By 

stock footage order in the court a judge says the words and strikes the gavel on the wooden base several times

In a case weighing the government’s ability to require vaccination against the individual right to refuse it, a federal judge has upheld a New York City policy that bars unimmunized children from public school when another student has a vaccine-preventable disease.

Citing a 109-year-old Supreme Court ruling that gives states broad power in public health matters, Judge William F. Kuntz II of Federal District Court in Brooklyn ruled against three families who claimed that their right to free exercise of religion was violated when their children were kept from school, sometimes for a month at a time, because of the city’s immunization policies.

The Supreme Court, Judge Kuntz wrote in his ruling, has “strongly suggested that religious objectors are not constitutionally exempt from vaccinations.”

The lawyer for the plaintiffs, Patricia Finn, said she plans to appeal the decision, announced this month. On Thursday, Ms. Finn asked the district court to rehear the case.

Amid concerns by public health officials that some diseases are experiencing a resurgence in areas with low vaccination rates, the decision reinforces efforts by the city to balance a strict vaccine mandate with limited exemptions for objectors. Pockets of vaccination refusal persist in the city, despite high levels of vaccination overall.

State law requires children to receive vaccinations before attending school, unless a parent can show religious reservations or a doctor can attest that vaccines will harm the child. Under state law, parents claiming religious exemptions do not have to prove their faith opposes vaccines, but they must provide a written explanation of a “genuine and sincere” religious objection, which school officials can accept or reject.

Some states also let parents claim a philosophical exemption, though New York does not. Some parents refuse to have their children vaccinated because of a belief that vaccines can cause autism, though no link has ever been proved.

Two of the families in the lawsuit who had received religious exemptions challenged the city’s policy on barring their children, saying it amounted to a violation of their First Amendment right to religious freedom and their 14th Amendment right to equal protection under the law, among other claims. Their children had been kept from school when other students had chickenpox, their suit said.

The third plaintiff, Dina Check, sued on somewhat different grounds, saying that the city had improperly denied her 7-year-old daughter a religious exemption. She said the city rejected her religious exemption after it had denied her a medical exemption, sowing doubts among administrators about the authenticity of her religious opposition. But Ms. Check said the request for a medical exemption had been mistakenly submitted by a school nurse without her consent.

After the school barred her daughter, Ms. Check home-schooled her and then moved her to a private school that accepted her daughter without the vaccinations. State vaccination requirements cover public and private schools, but in New York City, private schools have more autonomy in handling exemptions.

Ms. Check said she rejected vaccination after her daughter was “intoxicated” by a few shots during infancy, which she said caused an onslaught of food and milk allergies, rashes and infections. Combined with a religious revelation she had during the difficult pregnancy, she said, the experience turned her away from medicine. Now she uses holistic treatments.

“Disease is pestilence,” Ms. Check said, “and pestilence is from the devil. The devil is germs and disease, which is cancer and any of those things that can take you down. But if you trust in the Lord, these things cannot come near you.”

In turning down all three families, Judge Kuntz cited a 1905 Supreme Court ruling that upheld a $5 fine for a Massachusetts man who disobeyed an order to be vaccinated during a smallpox outbreak, a case that helped establish the government’s right to require immunizations as a matter of public health.

Ms. Finn, the families’ lawyer, said that case should not be relevant. “There’s no way that court anticipated that children would be subjected” to the vaccines they must get today, she said.

In New York, the statewide mean religious exemption rate rose over the last decade, from .23 percent in 2000 to .45 percent in 2011, a 2013 study in the medical journal Pediatrics said.

New York City schools granted 3,535 religious exemptions in 2012-13, according to data from the state’s Health Department. Though city schools, public and private, have an overall immunization rate around 97 percent, according to the department, 37 private schools were below 70 percent. Health experts believe that above a certain immunization rate, outbreaks are limited because a disease cannot spread to enough people during its incubation period to sustain itself, a phenomenon known as “herd immunity.” For measles, which is highly contagious, that rate is believed to be 95 percent, according to Daniel Salmon, deputy director at the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health.

Though widespread vaccinations have practically eliminated diseases like measles and mumps from the United States, flare-ups have occurred. The 477 measles cases reported this year represent the worst year-to-date count since 1994, according to the Centers for Disease Control and Prevention.

Among the 25 people who contracted measles in New York City between February and April this year, two were school-age children unvaccinated because of parental refusal. When one of the children, who was being home-schooled, contracted the measles, city health officials barred that child’s sibling, who had a religious exemption, from attending school. The sibling eventually contracted measles as well. Health officials credited the decision to keep the second child out of school with stopping the spread of disease in that community.

Ohio, which granted more than three times as many religious and philosophical exemptions to kindergarten students last year as it did in 2000, is struggling to contain a measles outbreak that has recently spread to 339 Amish people who were largely unvaccinated, the state health department said.

Mr. Salmon said it can be difficult for states to balance an obligation to mandate vaccination with some leniency for families who have strong objections. Rules that force parents to articulate their beliefs and require public officials to educate them about the risks of exemption are states’ best defense against the spread of disease, he said.

Still, especially because parents who refuse vaccination tend to cluster geographically, it takes only a few unvaccinated children to start an outbreak, he said. At that point, even vaccinated children are at risk.

“Diseases have a way of finding our vulnerabilities,” Mr. Salmon said, “the kinks in our armor.”

We want to know what you think. Agree or disagree?

Source: nytimes.com

Topics: health, children, law, immunization, schools, judge, NY

What are the National CLAS Standards?

Posted by Alycia Sullivan

Mon, Apr 14, 2014 @ 11:50 AM

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care(the National CLAS Standards) are intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services. Adoption of these Standards will help advance better health and health care in the United States.

The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice (The Blueprint) is an implementation guide to help you advance and sustain culturally and linguistically appropriate services within your organization. The Blueprint dedicates one chapter to each of the 15 Standards, with a review of the Standard's purpose, components, and strategies for implementation. In addition, each chapter provides a list of resources that offer additional information and guidance on that Standard.

Health Equity & Culturally and Linguistically Appropriate Services (CLAS): How Are They Connected?

Health inequities in our nation are well documented, and the provision of culturally and linguistically appropriate services (CLAS) is one strategy to help eliminate health inequities. By tailoring services to an individual's culture and language preference, health professionals can help bring about positive health outcomes for diverse populations. The provision of health care services that are respectful of and responsive to the health beliefs, practices and needs of diverse patients can help close the gap in health care outcomes. The pursuit of health equity must remain at the forefront of our efforts; we must always remember that dignity and quality of care are rights of all and not the privileges of a few.

What is the history of the National CLAS Standards?

In 2000, the Office of Minority Health published the first National Standards for Culturally and Linguistically Appropriate Services in Health Care (National CLAS Standards), which provided a framework for all health care organizations to best serve the nation’s increasingly diverse communities. In fall of 2010, the Office of Minority Health launched the National CLAS Standards Enhancement Initiative in order to revise the Standards to reflect the past decade’s advancements, expand their scope, and improve their clarity to ensure understanding and implementation. With the enhancement initiative, the National CLAS Standards will continue into the next decade as the cornerstone for advancing health equity through culturally and linguistically appropriate services.

Legislating CLAS

State agencies have embraced the importance of cultural and linguistic competency in the decade since the initial publication of the National CLAS Standards. A number of states have proposed or passed legislation pertaining to cultural competency training for one or more segments of their state’s health professionals. At least six states have moved to mandate some form of cultural and linguistic competency for either all or a component of its health care workforce. Access the Legislating CLAS map.

Source: Think Cultural Health

Topics: culture, law, CLAS, standards, health equity

Obama Signs New Military Sexual Violence Provisions Into Law

Posted by Alycia Sullivan

Thu, Jan 10, 2013 @ 02:02 PM

SWANlogoAfter much anticipation across the nation, President Obama signed the 2013 National Defense Authorization Act (NDAA) into law. In the end, it included 19 amendments to significantly reform Department of Defense sexual assault and sexual harassment policies. This landmark bill has the largest number of sexual violence provisions ever signed into law, and represents the culmination of more than 18 months worth of relentless advocacy work by the Service Women’s Action Network (SWAN). We want to thank the many veterans and service members who shared their voices to demand policy change this year, including Ayana Harrell, Nicole McCoy, Cindy McNally, Ruth Moore, Laura Sellinger and so many others.

The NDAA is an enormous bill that specifies the budget and expenditures of the Department of Defense (DOD). It also contains sections that deal with military issues ranging from the total number of troops to retiree benefits, and everything in between. It is one of the primary vehicles used by Congress to provide oversight and mandate change within the military. Every year, SWAN partners with key members of Congress to provide bipartisan legislative recommendations to both the House and Senate to improve the welfare of service women and women veterans.

This year, SWAN was able to help introduce into the bill a record number of provisions based on our policy agenda, chief among them to improve the way the military handles sexual assault and sexual harassment in the ranks. Other provisions were also included that improve health care for service women and military families. Specifically, the law now provides for:

  • Prohibiting the military from recruiting anyone convicted of a sex offense
  • Mandatory separation of convicted sex offenders
  • Insurance coverage for abortions in cases of rape or incest for service women and military family members
  • Retention of restricted report documentation for 50 years if so desired by the victim
  • The creation of “Special Victims Units” to improve investigation, prosecution and victim support in connection with child abuse, domestic violence and sexual assault cases
  • Allowing victims to return to active duty after separation to help prosecute sex offenders
  • The creation of an independent review panel comprised of civilian and military members that will closely examine the way that the DOD investigates, prosecutes, and adjudicates sexual assaults
  • Required sexual assault prevention training in pre-command and command courses for officers
  • Improved data collection and reporting by the military on sexual assault and sexual harassment cases
  • Annual command climate assessment surveys to track individual attitudes toward sexual assault and sexual harassment
  • A review of unrestricted sexual assault reports and the nature of any subsequent separations of victims who made those reports
  • Notification to service members of the options available for the correction of military records due to any retaliatory personnel action after making a report of sexual assault or sexual harassment
  • Requirement for DOD to establish a policy for comprehensive sexual harassment prevention and response
  • Language that will allow better oversight and tracking of DOD’s implementation of sexual assault provisions from prior Defense Authorizations in order to ensure they are being enforced properly

Legislating reform of DOD policies can be a difficult, complicated and sometimes painfully slow process, and is only one of several tools SWAN uses to make institutional change happen. Ensuring those policies are properly implemented by the services and fairly practiced in individual units “where the rubber meets the road” is a continuous process for us. Calls from active duty troops and veterans on our Helpline continue to inform and guide our work. We are grateful to be able to provide help to service members and veterans in need. We are also thankful for our incredible coalition of military, veterans and civil rights organizations, the members of Congress who have partnered with us, and each one of you who have supported us this year. In order to eradicate sexual assault and sexual harassment we must continue to work together to transform military culture. The passage of the 2013 NDAA is another critical step in moving the military one step closer to change.

As we move forward with this year’s policy and legislative agenda, and prepare for our second annual Summit on Military Sexual Violence, SWAN will continue to hold our civilian and military leadership accountable for the welfare of our nation’s service members and veterans. We will continue to fight for changes in the execution of military justice for victims of sexual assault, service members’ access to civil courts, and comprehensive reform of VA policy regarding “Military Sexual Trauma” compensation claims. With your support, we look forward to continued success as we begin work on the 2014 NDAA.

* This article is from Service Women’s Action Network

Topics: military, sexual violence, law, SWAN, Department of Defense

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