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Gary L. Freed, MD, MPH; Teresa Kauf, PhD; Victoria A. Freeman, RN, DrPH; Donald E. Pathman, MD, MPH; Thomas R. Konrad, PhD

Arch Pediatr Adolesc Med. 1998;152:285-289.

Objective  To explore the effect of concern about vaccine-associated malpractice litigation on provider immunization practices and attitudes.

Design  A cross-sectional mail survey.

Participants  One thousand one hundred sixty-five pediatricians and 1849 family physicians.

Main Outcome Measures  Physicians' perceptions of the legal and financial risks of providing immunizations and of the liability protection afforded by state programs and their current immunization practices.

Results  The response rate was 72% for pediatricians and 63% for family physicians. Overall, less than 30% of the respondents believed that federal and state programs protect them against vaccine-related lawsuits, with pediatricians more likely to believe so (32% vs 21%, P<.001). Pediatricians were also more likely than family physicians to believe that the diphtheria, tetanus, and pertussis vaccine could be administered safely to children with a family history of seizures, a minor respiratory tract illness, or a previous local reaction to the vaccine. Liability issues were not significantly associated with any of the outcome variables, except that those physicians who believed that the whole-cell diphtheria, tetanus, and pertussis vaccine increased their risk for lawsuits were less likely to indicate that the diphtheria, tetanus, and pertussis vaccine was safe for children with a family history of seizures (P<.001).

Conclusions  Liability-related variables were not independently associated with most immunization behaviors examined. This raises the question as to whether physicians cite liability as a reason for not immunizing children with acute and chronic illnesses, when their concerns are actually otherwise. These data suggest that educational efforts focused on liability issues alone will have little effect on inappropriate delaying of immunization for these children. Rather, education is needed regarding inappropriate contraindications themselves.

From the Division of Community Pediatrics (Dr Freed), the Cecil G. Sheps Center for Health Services Research (Drs Freed, Freeman, Pathman, and Konrad), the School of Pharmacy (Dr Kauf), and the Department of Family Medicine (Dr Pathman), University of North Carolina at Chapel Hill.

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