A 'reactive' approach:
ELLENSBURG, Wash. – As public and private workers across the state bypass workplace COVID-19 vaccination mandates with medical exemptions signed by a doctor, the state of Washington fails to identify doctors who issue an excessive number of those vaccine waivers without legitimate medical reasons, a KING 5 investigation found.
There are documented cases of doctors in Washington and across the country who financially profited from people looking to circumvent COVID-19 vaccine or childhood immunization requirements. But the state doesn’t compile data on which or how many of its medical professionals are signing exemptions.
Even at Washington state agencies, where more than 1,300 people requested medical exemptions in response to Gov. Jay Inslee’s Oct. 18 COVID vaccine mandate, human resources officials are not required to track or monitor providers with suspicious practices when processing exemption requests.
Instead, like many other states, Washington relies on the state Department of Health (DOH) and its medical boards and commissions to review and investigate COVID-related complaints against medical professionals. It’s a process that, experts say, makes it difficult to catch doctors misusing the exemption process because the patients receiving the forms are in “cahoots” with the doctors and unlikely to file a complaint.
“The thing about medical boards is they are reactive…They don’t do preventative regulation,” said Ross Silverman, professor of health services administration and policy at Temple University’s College of Public Health in Philadelphia, Pennsylvania. “It’s relying on the system to kind of catch up with the violators.”
For months, one Ellensburg osteopathic physician featured in a November KING 5 investigation went undetected by some employers and public health officials as she repeatedly wrote COVID vaccine and mask exemption forms for patients across Washington state without conducting a medical exam or asking any medical questions, in some cases.
Reporters found the provider, Dr. Anna Elperin, potentially raked in tens of thousands of dollars a month from exemptions she sold to patients – including to four undercover journalists, who paid a total of $750 for the exemption forms. The forms claimed they had medical conditions that precluded them from getting the COVID vaccine and wearing masks. The journalists say they don’t have any such medical conditions.
The medical exemption process is supposed to be reserved for a small percentage of people who have one of few legitimate medical conditions that may prevent coronavirus vaccination. In Washington state, public employees who wished to avoid the mandate also had the option to seek a vaccine exemption on religious grounds – a route that proved to be significantly more popular among thousands of unvaccinated state workers. But medical ethicists explain that exemptions signed by doctors are more likely to receive approval from employers without receiving much scrutiny.
“It’s very difficult for a non-health care provider to question the judgement of a signed, essentially sworn statement (from a doctor) that their clinical judgment is telling them that this person has a risk,” Silverman said. “It’s very hard to overcome that unless you happen to have a health professional doing the review of those applications.”
In the Ellensburg area, at least 25 public employees – including university students and staff, K-12 educators and an emergency response professional – received vaccine or mask exemptions signed by Elperin, according to public records KING 5 obtained while spot-checking a handful of public agencies and institutions in Kittitas County.
There were also hundreds of other patients who drove hours from faraway cities – like Bellingham, Seattle and Spokane – to receive Elperin’s exemptions, according to three of her former employees.
Public records show one Washington State Department of Labor and Industries (L&I) employee, based out of the agency’s Moses Lake division, received COVID vaccine and mask exemption forms signed by Elperin in October – one week before the state’s vaccine mandate deadline.
L&I reported it did not approve the employee’s exemption request. But it’s not clear how many private and public employers across the state did accept Elperin's forms or how many COVID vaccines and mask exemptions she signed.
“It’s so insidious – the way that some health care professionals have really tried to monetize and grift people who have real legitimate vaccine concerns and hesitancy,” said Dr. Kolina Koltai, a nationally recognized Seattle-based researcher who studies the anti-vaccination movement on social media. “It’s an abuse of the system. It’s almost unforgivable.”
When confronted in November about the medical exemptions she issued to four undercover journalists, Elperin unequivocally denied that she was running an “exemption mill.”
The doctor said she had “no idea” if she wrote exemptions for the journalists without asking them medical questions or conducting medical exams because she would have to “go back and carefully review the chart.”
Weeks after KING 5’s first report, reporters contacted Elperin via email on Dec. 15 to give her a chance to share information for this story and another opportunity to respond to the allegations against her. She replied a day later, writing:
"You are continuing to be a disgrace to the profession of an investigative journalism. You should be ashamed of calling yourself an AMERICAN. May I get you a one way ticket out of this country? I will pay for a one-way ticket out of this country … to…. Perhaps, VENEZUALA, (sic) CHINA, or RUSSIA? Anyone who would like to sponsor AMERICA HATERS TO LEAVE ?!?!
Hit Me up. Lets (sic) start a GOFUNDME"
Koltai, the researcher who works at University of Washington’s Center for an Informed Public, said Elperin’s case reveals the state of Washington needs to do more to proactively find doctors who may not be following good clinical practice when writing exemptions.
“How many doctors are there? Even if you have 20 doctors in the state and they’re signing (unjustified exemptions), they can do real harm to the health of Washington,” she said. “It indicates that we do need to start putting more scrutiny on it so that we can put faith back into the system.”
One doctor disciplined since pandemic start:
In addition to repeatedly signing and selling vaccine and mask exemptions, reporters found Elperin openly defied Washington state's mask mandate. The doctor has also made baseless statements about COVID that are unsupported with scientific evidence, and she has minimized the seriousness of the pandemic in social media posts, at public events and in an interview with reporters.
“This is a scamdemic. This has little to do with public health at this point. It has more to do with government control,” Elperin said during a Nov. 12 KING 5 interview.
Koltai, whose research mostly focuses on COVID misinformation spread online, said misinformation spread by local doctors, like Elperin, poses an even greater threat to the public because of the clout they carry as trusted medical professionals.
“It’s almost immeasurable – the power that comes from listening to a local doctor – because imagine, this is someone in your community. It’s someone not far off. It makes it seem more tangible,” Koltai said. “I think doctors like Dr. Elperin are a very vocal minority ... but I think what happens is that when a doctor does get to come out and say (COVID) is a scam, their voices get elevated, particularly online.”
Since the start of the pandemic, the Washington State Department of Health (DOH) has received at least 158 COVID-related complaints against 104 medical doctors, osteopathic physicians and physician assistants, according to a KING 5 analysis of DOH data obtained in early November through a public records request.
Katie Pope, a DOH spokesperson, said the complaints include allegations of medical providers violating mask requirements, social distancing and being unvaccinated; allegations of falsifying vaccination records or granting exemptions with minimal medical basis; and allegations of promoting questionable methods to treat COVID-19.
She said the department doesn’t know how many Washington medical providers have been accused of falsifying COVID-19 vaccine records or granting exemptions without basis because DOH's tracking system doesn't separately categorize those type of complaints.
Despite a strong public stance by the Washington Medical Commission (WMC) pledging action against doctors who “erode the public trust” with COVID misinformation, KING 5 found one medical professional has been disciplined for COVID-related allegations – nearly two years into the pandemic.
In October, the state medical board suspended Scott Miller, a Washougal physician's assistant, over allegations that he prescribed ivermectin to treat COVID and “fell below the standard of care” because there’s no reliable clinical evidence that shows the drug is effective in preventing or treating coronavirus.
Spokespeople at the DOH and the WMC – the state medical board that handles the disciplinary process for medical doctors and physician assistants – declined interview requests to explain the lack of action.
“DOH believes that providers violating COVID-19 requirements are the exception and not the rule, and we are committed to partnering with boards and commissions to address COVID-19 violations using established processes and timelines outlined in the law,” Pope wrote in a statement. “Every allegation we receive is investigated and reviewed on its own merits and appropriate action will be taken.”
As of Nov. 9, there were at least 32 medical providers, including Elperin, under investigation in Washington state for COVID-related allegations. The open investigations involved two osteopathic physicians, four physician assistants and 26 medical doctors. Most of those investigations have remained open for two to four months, according to a KING 5 analysis of DOH records.
The state health department has reviewed at least 12 mostly COVID-related complaints against Elperin since July 2020. Agency records show DOH closed 10 of them without action.
Of the 104 medical professionals who were accused of COVID-related violations, Elperin received the second highest number of complaints. Miller, the suspended physician assistant, received 15 COVID-related complaints – more than any other medical professional on the list.
As a doctor of osteopathic medicine, Elperin is licensed by the Board of Osteopathic Medicine and Surgery. Her medical license remains active, as of Dec. 16.
Citing the ongoing disciplinary process, DOH, which manages the state’s osteopathic board, declined to discuss the specific allegations against Elperin or the nature of the state’s investigations into two complaints about her.
"No statement of charges have been filed in these cases yet and the Board is still considering legal options," Pope wrote in a Nov. 18 statement. "It’s not appropriate for DOH to speak about the allegations at this time."
A WMC spokesperson said the commission is monitoring Elperin’s case, even though it doesn’t have any oversight of osteopathic physicians.
“The WMC is aware of the osteopathic physician in your investigation last month,” wrote Stephanie Mason, public information officer, in a statement. “While (doctors of osteopathic medicine) are not regulated by the WMC, we are paying close attention to this example.”
Other states have processes to catch exemption abuse:
As vaccination mandates across the country become increasingly common, medical ethicists and legal experts, including Professor Silverman, say most states aren’t yet equipped to catch potential COVID vaccine exemption abusers.
But in at least two states – California and West Virginia – processes to identify the misuse of school immunization exemptions could show Washington a framework for detecting medical providers writing unjustified COVID vaccine waivers.
A California law, passed in 2019, requires the state’s physicians who write medical exemptions for school vaccines to report details about each exemption – including medical documentation that supports it – to a state database. The California Public Health Department is required by law to review the school vaccine exemptions when a doctor writes five or more medical exemptions in a calendar year.
“We see these types of regulatory systems work for childhood vaccines,” Silverman said.
California State Sen. Richard Pan (D-Sacramento) is the lawmaker responsible for creating the state’s system of tracking exemptions.
In 2015, he first authored legislation banning non-medical exemptions in California. He then spearheaded the 2019 law after he said he observed that medical exemptions significantly increased in California once families were no longer allowed to submit personal belief exemptions to avoid school vaccination requirements.
“Frankly, after we passed the 2015 law abolishing non-medical exemptions, I think some of the doctors who discourage vaccinations found a marketing opportunity, and they were literally advertising that they would sell exemptions for as much as $300, $500 a piece,” Pan said. “It was an opportunity to make a profit off their anti-vaccine followers. I think it’s shameful that they tried to take advantage of them that way.”
A spokesperson for the California Public Health Department said the public health officials have referred at least 15 physicians to the state medical board this year, based on a review of the providers’ exemptions.
“It does create the capacity to detect these physicians,” Pan said. “The other thing that it did is also discourage many of them from essentially selling medical exemptions because they knew their license was at risk. … We’re seeing fewer ads for medical exemptions.”
In West Virginia, where non-medical exemptions for school vaccination requirements are also banned, physicians don’t have the authority to issue medical exemptions alone.
The providers are required to request medical exemptions from a state immunization officer, who reviews the doctor’s medical proof that a patient requires a school vaccine exemption. The state officer then makes a determination on whether or not to approve it.
California and West Virginia’s current processes only apply to school vaccination exemptions – not to exemptions for the COVID-19 vaccine.
“Most places don’t have those kinds of structures in place for COVID-19 vaccinations,” Silverman said. “I think they should be prepared for this.”
Where Washington stands on vaccine exemption oversight:
Gov. Jay Inslee, who ordered COVID vaccine and mask mandates in Washington state, isn’t calling for more scrutiny of the medical providers issuing exemptions.
“We think the policies in place now for identifying fraud are appropriate under the circumstances, which are to get as many people as vaccinated as possible in an emergency situation,” wrote Mike Faulk, press secretary for Inslee, in a statement. “This initiative came together quickly to give people an appropriate amount of time to get fully vaccinated, and the overwhelming majority complied.”
State officials asked Washington agencies to submit aggregate exemption data on the number of accommodations requested, pending and granted. The Washington State Office of Financial Management (OFM) collects the data and reports it bi-weekly.
Faulk said he’s aware that some public agencies, including DOH, chose to track names of providers who wrote COVID exemptions for their employees, even though it wasn’t a requirement under Inslee’s mandate.
Washington State Rep. Monica Stonier (D-Vancouver), who serves on the House of Representatives’ Health Care & Wellness Committee, said it’s concerning to her that Washington state officials have no idea how many medical professionals are writing an excessive number of exemptions for the COVID-19 vaccine.
“We need to pay closer attention,” she said, adding that there needs to be a way for the state to audit medical professionals – absent a complaint – to make sure people are receiving quality care from their medical professionals. ”We may have a gap in the system.”
Currently, there's no disciplining authority in Washington state that has the power to proactively audit health care providers.
Stonier, who co-authored a bill that banned non-medical exemptions for the measles, mumps, rubella vaccine in 2019, said learning about Elperin’s case has inspired her to brainstorm potential changes that would improve the system.
“It’s hard to see a case like this in your own state…I’m looking forward to discussion with my colleagues in the health care committees in the legislature to see what we might take up,” she said. “I would agree that we need better data, and I believe that we should have had a clearinghouse that would help surface this sooner.”