Risk Strategies for Managing Parents of Pediatric Patients Who Refuse or Delay Vaccines
Laura M. Cascella, MA, CPHRM
Despite best efforts at education and the use of various communication strategies, pediatricians and other pediatric providers will continue to encounter parents who refuse some or all vaccinations for their children or who do not want to follow the recommended immunization schedule.
When these situations occur, the following guidance can help pediatric providers promote ongoing communication and collaboration with parents and reduce potential liability risks:
- Document in the patient’s health record all conversations about the risks and benefits of vaccinations as well as the provision of Vaccine Information Statements and other educational materials.
- Consider using an informed refusal form to document each time parents refuse a vaccination for their child. See the American Academy of Pediatrics’ (AAP’s) sample Refusal to Vaccinate form.
- Continue discussions about the importance of vaccinations, safety considerations, and parental concerns at subsequent patient visits. Provide strong, consistent recommendations during each conversation.
- Educate parents about the signs and symptoms of vaccine-preventable diseases and the steps they should take if their child becomes sick.
- Inform parents about their responsibilities to their child and others if they refuse or delay vaccinations (e.g., informing healthcare personnel, childcare providers, and schools about the child’s vaccine status). Consider using the Centers for Disease Control and Prevention’s educational handout, If You Choose Not to Vaccinate Your Child, Understand the Risks and Responsibilities.
- Discuss any extra precautions that parents need to take before bringing their child to the pediatric practice or another healthcare facility (e.g., notifying staff in advance).
- Put a flag or electronic alert on the records of patients whose parents have refused or delayed vaccinations. Alerts can serve as an indication to have a follow-up discussion about vaccinations, and they can offer the provider a reminder about the patient’s vaccine status if he/she presents with an illness.
Some pediatric providers may ultimately decide to dismiss patients whose parents refuse or delay some or all vaccinations. Pediatricians and professional organizations continue to debate the benefits versus potential adverse outcomes of this approach.
Although AAP recognizes patient dismissal as an acceptable option, it recommends that pediatric providers not make this decision without serious and diligent deliberation. Further, the AAP states “the same legal and ethical constraints exist to dismissal for any permissible reason, including failure to vaccinate. Dismissal must be conducted in a manner consistent with applicable state laws prohibiting abandonment of patients.”1
For more guidance related to dismissing patients, see MedPro’s Terminating a Provider–Patient Relationship guideline.
Endnote
1 Edwards, K. M., & Hackell, J. M. (2016). Countering vaccine hesitancy. Pediatrics, 138(3), e20162146. doi: 10.1542/peds.2016-2146
MedPro 
