St. Clair advisory board asks state to clarify whether physician 'appropriateness' exemptions must use state waiver form

The St. Clair County Health Department Advisory Board voted to direct Health Officer Liz King, with advice from legal counsel, to ask the Michigan Department of Health and Human Services to formalize its interpretation of whether physician-issued "appropriateness" exemptions for school immunization requirements are equivalent to state waivers that must be recorded on the state form. The motion passed on a recorded roll-call vote 6–0.

Medical Director Dr. Kevin Nevin told the board that a state letter sent to the department — included in the meeting packet — treats physician exemptions as the same as waivers and therefore subject to the state's form requirement. He said he had provided a sealed copy of a confidential exemption letter for a local family (referred to in the meeting as Mr. Eberly’s case) to the school and that the state's response was now causing legal uncertainty about whether the county’s clinical exemption process is lawful.

"This will very likely prove to be exhibit A in the inevitable lawsuit that will be filed against the state under the Michigan Administrative Procedures Act for the arbitrary and capricious interpretation of the regulations by the state," Dr. Nevin said during the presentation.

Dr. Nevin outlined three possible paths: ask the state for a declaratory ruling that formally states what the regulation covers; file a Freedom of Information Act request for the new form the state says clinicians must use; or prepare for litigation if the state persists in what he described as an "arbitrary" interpretation. He recommended the board seek a declaratory ruling before taking other steps.

Board members discussed jurisdictional questions (the family’s school-of-choice relationship with a district in another county was raised) and litigation risk. Several members said the county has an obligation to assist a resident who asked for department support. At roll call, the members recorded the motion as passing 6–0. The motion, read aloud by the chair, was described in the meeting minutes as "a letter from Liz with advice from legal to request clarification from the state in the form of a declaratory ruling as to the question of physician issue of appropriateness."

Next steps: The board authorized the health officer to prepare and send the request to the state with input from county counsel. The board recorded that it will await legal advice and that litigation remains a possible outcome if the state declines to clarify or continues to press the new interpretation.

Provenance: Meeting discussion introducing the state letter and exemption question begins in the meeting materials and public remarks at SEG 001 and the motion, vote, and outcome are recorded in SEG 576–SEG 597.

Ending: The board recorded the motion, instructed staff to seek legal input, and the health officer will transmit the request to the state for a declaratory ruling.