California Democrats are taking a new approach to crack down on anti-vaxxers: by going after the doctors selling them phony exemptions.

The proposed legislation, Senate Bill 276, would require any doctor who writes five or more exemptions in a year to undergo review by the health department. And if those exemptions aren’t found to be “true, accurate, and complete,” according to the text of the bill, the doctors could be charged with perjury, which could put their medical licenses at risk.

Introduced by Democratic state senator and doctor Richard Pan, the bill passed the Assembly’s Committee on Health Thursday 9-2 and now goes to the appropriations committee next week.

“California charging doctors with perjury for writing fraudulent exemptions is unique," said Dorit Reiss, a law professor at UC Hastings and an expert on vaccination law. "No other state is going after phony doctors other than California, but this is partly because most states have other options — like religious or personal belief exemptions — or already have reviews of medical exemptions in place.”

Leading up to Thursday’s hearing, Pan received death threats. Opponents of the bill also showed up wearing shirts with a blood-splattered image of Pan’s face. Others likened his efforts to put unlawful doctors behind bars to the Nuremberg trials.

If signed into law, the bill will cost California $50.5 million for the next five years. Gov. Newsom expressed skepticism earlier in June and worried that government bureaucrats would inhibit doctor-patient relationships. But after some recent amendments, Newsom said Tuesday that he would sign the bill.

More than 1,000 cases of measles across 28 states have been reported so far this year, the highest number since 1992. In addition to California, sizable outbreaks of the highly contagious, yet preventable, disease have been reported in Washington, New York, and Pennsylvania.

To address New York’s measles outbreak — largely among Brooklyn’s Otrhodox Jewish community, who claim religious exemption from vaccination — Gov. Andrew Cuomo signed a ban on vaccination exemptions based on religious beliefs in early June. And experts say fraudulent exemptions provided by medical professionals could soon start happening in the state.

$180 for an exemption

California made it illegal to obtain exemptions for nonmedical purposes, like religious, personal, or philosophical beliefs, in 2015, after more than 100 people near Disneyland contracted measles.

But the state is only one of a handful to outlaw exemptions except those for medical reasons, and parents are paying doctors and surgeons for ways around the ban. The rates of medical exemptions in California rose by 250% from 2015 to 2017, partly due to parents “doctor shopping,” according to a 2018 study from the American Academy of Pediatrics.

One San Diego doctor, who’s responsible for one-third of all medical exemptions in the state, charges $180 per appointment. Parents have even started sharing lists of doctors with reputations of issuing medical exemptions for money on Facebook.

“What they’re doing is they are putting children in harm's way for their personal and financial gain,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and co-director of the Texas Children’s Hospital Center for Vaccine Development.

Under California’s proposed law, doctor’s approval of medical exemptions would have to conform to criteria outlined by the Center for Disease Control, the federal Advisory Committee on Immunization Practices, or American Academy of Pediatrics.