It couldn’t have happened to a nicer guy than Dr. Robert Sears, better known as Dr. Bob Sears, the antivaccine pediatrician who first made a name for himself with his book recommending an evidence-free “alternative” vaccination schedule.
You remember “Dr. Bob,” don’t you? I haven’t written about him in a while because he hasn’t been in the news much and he hasn’t been sending out antivaccine dogwhistles that disguise antivaccine views as “freedom” and “parental rights.” When last I considered “Dr. Bob” in any level of detail, he was defending himself against an action taken by the Medical Board of California for “gross negligence” in writing a non-evidence-based letter in support of a two year old’s medical exemption from California’s vaccine mandate. Not surprisingly, antivaccine activists rallied around him, painting him as a victim of persecution. Don’t they always? Of course, it is important to note at this point that, during the run-up to and after the passage of SB 277, the California law that eliminated non-medical exemptions to school vaccine mandates, Sears led the way in monetizing strategies for antivaccine parents to avoid the mandates. Indeed, a reader showed me evidence that Dr. Bob was selling letters in support of nonmedical exemptions online without ever actually having seen the patient.
Like this one:
And this one:
In any case, the Medical Board of California’s action commenced nearly two years ago, and yesterday we learned that a decision has been rendered. Basically, a consent agreement has been negotiated, and it’s pretty onerous for poor, poor Dr. Bob. Before we get to the terms of the agreement, let’s review the charges, which I described in detail here but will just summarize here.
First, from the original complaint:
On April 3, 2014, two-year-old J.G. presented to Respondent for the first time. He was seen by Respondent for what medical records describe as a “two year.” The visit of this date includes a summary of the patient’s history with a brief description of J.G.’s prior vaccination reaction, as described by the patient’s mother. Her description included, “shut down stools and urine” for 24 hours with 2 month vaccines and limp “like a ragdoll” lasting 24 hours and not himself for up to a week after 3 month vaccines.
Respondent wrote a letter dated April 13, 2014 excusing patient J.G. from all future vaccinations. The letter indicates that the patient’s kidneys and intestines shut down after prior vaccinations and that at three months the patient suffered what appears to be a severe encephalitis reaction for 24 hours starting approximately ten minutes after his vaccines, with lethargy.
The letter dated April 13, 2014 was not maintained in patient J.G.’s medical chart in Respondent’s office.
There’s more, including other visits to Dr. Bob. Dr. Bob also saw the child in June 2014 for headache with a history of being hit on the head with a hammer by Dad two weeks prior to visit. According to the Board, there was also a mention of a split lip prior to the hammer incident. However, the physicial examination indicated “no residual marks now.” The Board also noted that no additional physical examination, including the all-important neurological examination (in cases of head trauma), was performed and no assessment with plans recorded. I used to do trauma, including pediatric trauma, and I know that this is a grossly inadequate evaluation for what might be a concussion, based on symptoms and timing, after having been hit in the head with a blunt object. Child protective services was involved, as well. Dr. Bob then saw J.G. a few times for various medical issues. One of those issues was how he dealt with the child’s head injury. The other issue that drew the attention of the board was this:
The standard of care requires that a physician evaluating a patient for a possible reaction to vaccines obtain a detailed history of the vaccines previously received as well as the reaction/reactions that occurred. Based on that information, the physician should provide evidence-based recommendations for future immunizations.
Respondent was grossly negligent and departed from the standard of care in that he did not obtain the basic information necessary for decision making proior to determining to exclude the possibility of future vaccines, leaving both patient J.G, the patient’s mother, and his future contacts at risk for preventable and communicable diseases.
Based on Dr. Bob’s granting of the medical exemption to vaccinations for J.G. and his failure to do a neurological examination of the child when he presented with persistent headaches after head trauma, the Board listed the first cause for disciplining Dr. Bob as gross negligence. The second cause for discipline was repeated negligent acts, given that there were two instances of gross negligence included in the complaint. The third cause for discipline was failure to maintain adequate and accurate medical records.
Fast forward from 2016 to 2018. First, we learn from the decision that Dr. Bob has waived his right to contest the charges against him, accept probation, and to be bound by the Board’s probationary terms.
It is hereby ordered that Physician’s and Surgeon’s Certificate No. A60936 issued to Respondent Robert Williams Sears, M.D. is revoked. The revocation is stayed and the Respondent is placed on probation for thirty-five (35) months on the following terms and conditions.
This is big. Basically, Dr. Sears’ license is already revoked, and the only way he can keep that revocation from taking effect after his term of probation is to do everything the board requires to the board’s satisfaction. But what is the board going to require of Dr. Bob? Here’s one thing:
1. EDUCATION COURSE. Within 60 calendard days of the effective date of this Decision, and on an annual basis thereafter, Respondent shall submit to the Board or its designee for its prior approval educational program(s) or course(3) which shall not be less than 40 hours per year, for each year of probation. The educational program(s) or course(s) shall be aimed at correcting any areas of deficient practice or knowledge and shall be Category I certified. The educational program(s) or course(s) shall be at Repsondent’s expense and shall be in addition to the Continuing Medical Education (CME) requirements for renewal of licensure.
I wonder what classes Dr. Bob will be required to take? Vaccine courses? Definitely? Courses in basic pediatric trauma? Absolutely. Courses on vaccine-preventable infectious diseases? Without a doubt. He will need all of these.
2. PROFESSIONALISM PROGRAM (ETHICS COURSE). Within 60 calendar days of the effective date of this Decision, Respondent shall enroll in a professionalism program that meets the requirements of Title 16, Celifornia Code of Regulations (CCR) section 1358.1. Respondent shall participate in and successfully complete that program.
Yes, Dr. Bob could surely use some help in the area of professionalism and ethics. The problem, of course, is that he almost certainly knows what is ethical. He simply chooses not to do it. He chose to sell bogus nonmedical exemptions to school vaccine mandates. He chose to publish a book with an “alternative” vaccine schedule with no scientific basis. He chose to flirt with the antivaccine movement and become a hero.
And he definitely needs monitoring:
3. MONITORING – PRACTICE. Within 30 calendar days of the effective dates of this Decision, Respondent shall submit to the Board or its designee for prior approval as practice monitor(s) the name and qualifications of one or more licensed physicians and surgeons whose licenses are valid and in good standing, and who are preferably American Board of Medical Specialties (ABMS) certified. A monitor shall have no prior or current business or personal relationship with Respondent, or other relationship that could reasonably be expected to compromise the ability of the monitor to render fair and unbiased reports to the Board, including but not limited to any form of bartering, shall be in Respondent’s field of practice, and must agree to serve as Respondent’s mentor. Respondent shall pay all monitoring costs.
Monitoring physician(s) must submit quarterly reports to the Board that including an “evaluation of the Respondent’s performance, indicating whether Respondent’s practices are within the standards of practice of medicine and whether Respondent is practicing medicine safely, billing appropriately, or both.” There are a number of other stipulations. For instance, Dr. Bob can’t supervise physician’s assistants or nurse practitioners while on probation, must report activities, if he leaves the state for more than 30 days, if he ceases practice for more than 30 days, and a number of other things, including:
Failure to fully comply with any term or condition of probation is a violation of probation. If Respondent violates probation in any respect, the Board, after giving Respondent notices and the opportunity to be heard, may revoke probation and carry out the disciplinary order that was stayed.
Of course, Dr. Bot must pay all costs associated with probation monitoring as designated by the Board. The order was signed on May 1.
This is pretty serious business. Dr. Bob, perhaps for the first time since he finished his pediatrics residency, must practice to the proper standard of care and will be supervised to make sure that he does. Assuming the Board is smart enough not to let Dr. Bob pick a monitor with “integrative medicine” proclivities or antivaccine proclivities himself (no Dr. Jay Gordon, please!). Thankfully, Dr. Bob won’t be able to pick his father or brother as monitors because they are family and thus have a conflict of interest. Dr. Bob will have no wiggle room. He’ll have to administer vaccines on time and on schedule for his patients. He’ll have to try to persuade parents who don’t want to vaccinate that they should. He’s really, really not going to like that.
I bet that his patients aren’t going to like it very much either. Indeed, I can’t help but wonder if his practice can survive. After all, Dr. Bob’s entire practice model is based on catering to the vaccine-averse and the antivaccine parents living near San Diego and other parts of southern California. How many of them are going to keep taking their children to see him now that he’s going to be forced to adhere to the CDC schedule of recommended vaccines? He can no longer delay, space out, or omit vaccines, and, assuming the board doesn’t let Dr. Bob pick a monitor who’s also an antivaxer or who also caters to the vaccine averse, there won’t be any easy way for him to practice the way he used to practice and get away with it.
I find the prospect of that…very satisfying.
On the other hand, there is another possibility that is less satisfying: Dr. Bob will pick an integrative medicine or functional medicine quack (and there are many in southern California) who’s squishy on vaccine mandates; the board won’t object; and he’ll practice as before, only less blatantly antivax. He’ll scale back or suspend his public appearances speaking out against SB 277 for three years but keep publishing his book. When it’s all over, he’ll be free and clear to go back to the way he was before. It could happen if the Board veto any monitor that Dr. Bob picks who isn’t clearly pro-vaccine. I never could figure out why most state laws allow the disciplined physician to pick his own monitor, subject to Board approval, rather than having the Board pick the monitor, allowing the doctor to object only if there is a clear conflict of interest or interpersonal conflict, but that’s the way it is. Getting to pick his own monitor could be the loophole through which Dr. Bob slithers out to escape. Here’s hoping the Medical Board of California is savvy enough not to let Dr. Bob get away with that, but there’s no guarantee that it is.