A bill is working its way through the Iowa legislature that would require medical examiners to include information on the medical examiners form used to fill out the death certificate about recent vaccinations given to any child under age three who dies of any cause. The bill, SF 2302, passed the Iowa Senate’s Human Resources committee on February 18 by a 8-5 party-line vote with Republicans voting in favor and will proceed to the full Senate for approval within the upcoming weeks.1
Bill’s Sponsor: “It’s Only About Facts”
Sen. Dennis Guth, the bill’s sponsor, was approached by a medical examiner who said that the death certificate for a child three years old and younger included eight questions about the last thing the child ate, and only one question about vaccination, which was whether the child was up-to-date on recommended vaccines at the time of death. The medical examiner felt it would be important to know a little more about the vaccination history of a child who died. “I thought it was a reasonable idea, and it’s something that’s not pro or anti vaccination, it’s only about understanding what’s going on. It’s only about facts.” Iowa has about 40 sudden unexplained infant deaths each year.2
Health and Medical Groups Oppose Disclosure
In the Senate subcommittee meeting, the bill was met with opposition from public health officials and Iowa’s medical trade associations. Amy McCoy, with the Iowa Department of Public Health, stated they are “undecided” on the matter but cited concerns about accessing vaccination records due to HIPPA, the federal law protecting patient privacy.
Dennis Tibben, representing the Iowa Medical Society and the Iowa Chapter of the American Academy of Pediatrics, stated their concern was the potential to slow down child death investigations. “We have several county medical examiners amongst our membership who have voiced concerns about the practical implications of accessing medical records.”
Lina Tucker Reinders of Iowa Public Health Association spoke against the bill.:
We owe it to our children to maintain Iowa’s strong culture of vaccinations. We are concerned that the package of vaccine-related bills that have been introduced this session will not together increase Iowa’s vaccination rates or serve to protect children from vaccine-preventable diseases, to the contrary. We’re concerned that they will introduce doubt to parents who have well-placed trust in their medical providers and the public health community.
Deborah Thompson, a volunteer with the Iowa Public Health Association was worried about what would be done with the information collected. “We put this information on, and then what? Which set of researchers pick it up and then what happens to it then? How is it used to wield in defense or for a particular set of arguments?”
Section 164.512(g)(1) of HIPPA law allows for disclosure of medical records to be shared with “medical examiners or coroners to assist them in identifying the decedent, determining the cause of death, or to carry out their other authorized duties.”3 Deputy state medical examiner Jonathan Thompson, MD, said collecting the information would add only an hour of extra work.
The Department of Public Health already has a child death review team, which investigates any death of someone under 18 that is not a natural death. This review includes past medical history and sometimes includes vaccination history. While information on death certificates are publicly available, the vaccination information would only appear on the medical examiner’s form, not the death certificate, and, would not be made public.
Parents Support Collecting Information After Children Die
Brei Johnson, president of Informed Choice Iowa, argued in support of SF 2302. “Everybody should work really hard to unturn every stone to get those parents the answers that they deserve, whether it’s a police officer, whether it’s a medical professional, whoever,” she said. “
We should be getting those parents the answers they deserve. To turn over every single rock—but not to leave this one turned over—I start asking a lot of questions why. Why wouldn’t we turn that rock over and give those parents that answer and be able to check that box without clear thought or without a doubt that no, your baby did not die from that vaccine? Or, maybe, start looking and creating statistics here in Iowa that might show it is.
Shanda Burke, a concerned citizen and certified medical assistant said, “If you want people and patients and parents to be sure of their choices, have the study. Show the information. This is gathering information. I don’t see why that would lead to vaccination hesitancy. We shouldn’t be placing vaccination rate above a good policy. This is a good policy to gather information to determine whether or not there is a correlation, and if there is not, we’ll accept that. If there is, we need to figure out what to do.”