Open Letter to Hawaii's Health Directors Regarding Their Genocidal Practice of Tuberculosis Skin Testing Low Risk Children for School Access

Tuberculosis skin testing of low risk school children in violation of national public health standards and CDC advisories is ongoing exclusively in Hawaii. This legal notice to state public health officials details their offenses.

December 16, 2002

Mrs. Loretta Fuddy, M.P.H., A.C.S.W.
Acting Director
Hawaii Department of Health
1250 Punchbowl St.
Honolulu, Hawaii 96813
(808) 586-4400 - Fax (808) 586-4444

RE: The Manifestation of Divine Will
Dear Mrs. Fuddy:
We have been retained by The Manifestation of Divine Will (TMoDW) to seek redress of concerns on the part of its Hawaiian resident members that the Hawaii Department of Health, and the Hawaii Tuberculosis Control Program, has failed to ensure that the public is adequately informed of their right to exemption from the medical treatments said to be required (i.e., Tuberculosis skin testing, and chest x-rays), imposed by State Laws §671-3 Informed consent; board of medical examiners standards (HRS) and §302A-(1154) Immunizations upon entering school; tuberculosis clearance; (1156) Exemptions; and (11570) Exemptions from immunization; no recognized; epidemic conditions. 

Who are The Manifestation of Divine Will Members?
TMoDW is an international religious group of Judeo-Christian members.  Some of TMoDW’s membership is comprised of people whose children have suffered a broad spectrum of vaccine reactions, permanent neurological disabilities, and some even death from vaccine reactions.  Other members have done a lot of reading and research and have concluded that vaccines, tuberculosis skin tests, and radiological tests, present a threat to their children’s health. They have, therefore, chosen not to give their children any vaccines.  Still others, perhaps the majority of TMoDW members, are people who follow strict Levitical laws for diet and hygiene, and rely solely on nature-based therapies such as herbal medicine, homeopathy, and chiropractics. These members have become very concerned with the ever increasing quantities of vaccines that are being added to the infant and young child schedules.  They have been researching and gathering information about the long term health risks and immune system impairment associated with vaccine ingredients, vaccine contaminants, or vaccine injuries, and have decided to discontinue vaccinating their children.  These people have concluded, in light of lacking risk/benefit scientific studies, that the risks posed by vaccines outweigh their potential benefits.

Likewise, TMoDW members have researched tuberculosis skin testing and, likewise, concluded that this procedure bears such similarities to vaccination, immunologically, that it too should be avoided. This belief is based upon the knowledge that when a tuberculosis skin test is administered, antigens from Mycobacterium tuberculosis are introduced into the skin, and seep beneath the skin, to enter the bloodstream. In this way it prompts an immune response. However, in addition to M. tuberculosis proteins, other chemicals and extraneous particles, including foreign RNA and DNA, may be administered. In this way, tuberculosis testing is effected in precisely the same way (i.e., physiologically and immunologically), and presents similar, albeit far less, risks as common forms of vaccination. This is perhaps the best rationale for grouping “tuberculosis clearance” together with “immunization” for school entrance, as it is in Hawaii state law §302A-(1154), discussed below.

The TMoDW also has a growing membership of health care providers, both physicians and alternative medicine practitioners, who support its mandate to provide parents and legal guardians with full disclosure of the risks associated with any medical treatments, including vaccination and tuberculosis testing, before the decision to accept these treatments is made.  
TB Skin Testing and Immunization Versus Religious Laws
Hawaii statute §302A-1154 entitled: “Immunization upon entering school; tuberculosis clearance” addresses as a single legal entity both “immunization” and “tuberculosis clearance.” Although it might be argued that “immunization” and tuberculosis skin testing are two distinct medical treatments, both involve similar physical and immunological processes that are abhorrent to fundamental religious laws and convictions regarding blood purity and genetic integrity.

Specifically, when a tuberculin test is administered, antigens from Mycobacterium tuberculosis are introduced into the skin, with some seeping beneath the skin, to enter the bloodstream in an effort to trigger an immune response to this specific antigen. However, in addition to M. tuberculosis proteins, other extraneous particles including foreign RNA and DNA may be administered during the test. Also, the Mantoux® skin testing product contains petrochemical stabilizers and sterilizers, as with all vaccines. These include two certified chemical toxins and suspected carcinogens—phenol and polyoxyethylenesorbitan monooleate (otherwise known as Tween 80 or polysorbate 80). In this way, tuberculosis skin testing is effected in precisely the same way (i.e., physiologically and immunologically) as “immunization,” and presents similar, though arguably less, risks. Given these facts, both vaccination/”immunization” practices along with tuberculosis skin testing, violates religious laws pertaining to the sanctity of the blood and requirement to abstain from any medical treatment that might compromise blood and genetic purities. Specifically, these blood purity laws are found in Lamentations 4:13-15; Ezekiel 3:18-19;5:17; 14:19; Luke 13:1-5 and others) and genetic laws (Leviticus 19:19).

Legally Available Exemptions to Mandatory Immunization
The following state laws pertain to this action: State Law §671-3 Informed consent; board of medical examiners standards (HRS) and §302A-(1154) Immunizations upon entering school; tuberculosis clearance; (1156) Exemptions; and (1157) Exemptions from immunization; not recognized; epidemic conditions. These impact parents’ and guardians’ legal rights to exempt their children from otherwise mandatory vaccinations, except under “epidemic conditions.” Regarding the law §302A-1157, when there is “a danger of an epidemic from any of the communicable diseases for which immunization is required [under sections §302A-(1154) to §302A-(1163)],  then exemptions are “not recognized.” However, since there is no acceptable vaccine for tuberculosis at the present time (i.e., vaccination with Bacillus Balmette-Guerin [BCG] is not usually recommended in the U.S. because of the low rate of infection here and because the BCG vaccine has questionable effectiveness), and, therefore, no immunization requirement for tuberculosis vaccination, these exemptions are required by state officials to be given to parties who make such requests:

Legal Requirements for Informed Consent to Medical Treatment (Including Vaccination, Chest X-ray, and Tuberculosis Skin Testing)
By law, parents and legal guardians of children are entitled to full disclosure of the availability of these exemptions, and other alternatives to vaccination, tuberculosis skin testing, and chest x-rays, as an integral component of the process of securing their informed consent.

Hawaii State Law §671-3 Informed consent; board of medical examiners standards provides:
. . . Standards established by the board of medical examiners include provisions which are designed to reasonably inform a patient, or a patient's guardian, of:
(1) The condition being treated;
(2) The nature and character of the proposed treatment or surgical procedure;
(3) The anticipated results;
(4) The recognized possible alternative forms of treatment; and
(5) The recognized serious possible risks, complications, and anticipated benefits involved in the treatment or surgical procedure, and in the recognized possible alternative forms of treatment, including nontreatment,
then the standards shall be admissible as evidence of the standard of care required of the health care providers. 

The purposes of this law include facilitating treatment, admission to care facilities, and personal assistance services for persons lacking the capacity to make decisions about such matters; and to promote communication and understanding between health practitioners and their patients or clients.

Tuberculosis Skin Testing as a Medical Treatment
Reflect on the medical scientific standard for tuberculosis skin testing as issued by the U.S. Centers for Disease Control and Prevention in June, 2000. It further discourages this medical treatment for members of TMoDW in Hawaii. It states:
Decision to Tuberculin Test Is [a] Decision to Treat

Targeted tuberculin testing programs should be designed for one purpose: to identify persons at high risk for TB who would benefit by treatment of LTBI. Following that principle, targeted tuberculin testing programs should be conducted among groups at risk for recent infection with M. tuberculosis and those who, regardless of duration of infection, are at increased risk for progression to active TB. With the exception of initial testing of persons at low risk whose future activity will place them at increased risk of exposure (e.g., employment in a setting where TB transmission may occur), screening of low-risk persons is discouraged because it diverts resources from activities of higher priority. In addition, a substantial proportion of tuberculin-test-positive persons from low-risk populations may have false-positive skin tests. (Emphasis added. Source: ATS/CDC Statement Committee on Latent Tuberculosis Infection Membership List. Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection. June 2000, p. 18. Available from http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4906a1.htm)”

The above standard for TB testing recognizes, therefore, this act as “a decision to treat.” Thus, it falls within the scope of medical practices for which full informed consent, and all the contingencies required therein, must be met under the aforementioned laws.

It should be noted that the members of TMoDW currently seeking entrance to Hawaiian schools, have never been at high risk for TB infection, and are clinically healthy in every way.

Moreover, not only does this medical/scientific standard clearly state that “screening of low risk persons is discouraged,” it establishes the parameters for declaring “epidemic tuberculosis,” versus “endemic” disease levels, and even discourages mandated uniform testing in low rate “epidemic” populations as follows:

The general U.S. population currently (June, 2000) has an estimated M. Tuberculosis infection rate of 5—10%, and children entering school in many areas of the country have a 0.1—1% prevalence of infection. Even if the test has a specificity approaching 99%, testing of persons in such low-prevalence groups would result in most positive tests being false-positive tests.( CDC Ibid., pg. 12)

Comparing Hawaii’s 2002 tuberculosis case rate of 12.5/100,000 with its Pacific Ocean neighboring state, that also has high immigration, reveals that Hawaii’s “epidemic” is not such that extraordinary measures of mandated TB skin testing is indicated nor even suggested under standard established public health policies. None of the following more severe “tuberculosis epidemics” in California have “required” the extraordinary measures for tuberculosis skin testing practiced by the Hawaii Tuberculosis Control Program (HTCP).  Ranking California counties by three-year average crude case rates, the tuberculosis case rate in Alameda County (17.4/100,000) is the 4th highest rate in the State of California.  Berkeley’s three-year case rate is 15/100,000 which ranks Berkeley 7th in the State, just behind Los Angeles County (16.7/100,000).  Berkeley public health officials “strive to meet California state case rate of 13.4/100,000.”  Yet, according to California state law Safety Codes 121476 and 121505, despite these higher tuberculosis case rates than Hawaii’s 12.5/100,000, no required tuberculosis skin testing program exists for school children, and parents are given free choice in the matter of philosophical, besides medical and religious exemptions. (Sources: http://www.ci.berkeley.ca.us/publichealth/statusreport/Tuberculosis.html and http://www.leginfo.ca.gov/cgi-bin/waisgate?WAISdocID=89122913864+1+0+0&WAISaction=retrieve)

As reported by Dr. Jesse Wing, Director of the HTCP, to Dr. Leonard Horowitz, a public health expert and managing member of TMoDW, 80% of current cases of tuberculosis in Hawaii derive from foreign born immigrants to the Hawaiian Islands. In Dr. Horowitz’s case, his low risk children, the subjects of this discrimination and illegality, are all American born members of TMoDW. They will be unable to attend school in January 2002, according to Dr. Wing’s written notice, unless they are TB skin tested or x-rayed.  All of this:

False and Misleading Claims Directing Public Acceptance of TB Skin Testing and Related Implications Regarding Human Experimentation
Pursuant to its pro-vaccination policy and the leadership it has assumed as reflected in circulating Hawaii Tuberculosis Control Program publications, including information sheets, pamphlets to inform parents and legal guardians of vaccination requirements for their children, and related Internet proclamations. Often, these are reproduced by individual health units, school boards, principals of schools, physicians and healthcare providers throughout the state. They are also used by those other organizations and individuals as the basis for supplemental educational material, including the dissemination of information about vaccination requirements through the media.

Further evidencing the Hawaii Department of Health Tuberculosis Control Program breach of Law §671-3 Informed consent; board of medical examiners standards, false and misleading claims have been made in their published  “educational” literature. Regarding the tuberculin skin test, officials of the program claim, “A small amount of harmless fluid will be put just under the skin on your arm.” (See: http://www.state.hi.us/health/resource/comm_dis/tb/faq.htm) For at least two reasons, this statement is false, misleading, and even fraudulent, as it seeks to persuade/manipulate compliance behavior in a targeted person or population.

Firstly, the tuberculosis skin test is not supposed to be injected “under the skin,” but “intradermally” (i.e., within the skin). Subdermal injections of Tuberculin Purified Protein Derivative (Mantoux)–Tubersol produced by Connaught laboratories is considered extremely risky. Secondly, as stated above, this product contains phenol and Tween 80 (polyoxyethylene sorbitan monooleate), both well established chemical toxins and suspected carcinogens, along with other potentially harmful substances. These additional ingredients include foreign proteins that may trigger allergies and even autoimmune reactions in some persons. Accordingly, the company’s literature provides the following warnings and potential side effects of tuberculosis skin testing: 

Allergy to any component of Tuberculin Purified Protein Derivative (Mantoux) Tubersol or an allergic or anaphylactic reaction to a previous test of [the same product]: . . . should not be administered to known tuberculin positive reactors because of the severity of reactions (e.g., vesiculation, ulceration, or necrosis) that may occur at the test site in highly sensitive persons; to patients with severe blistering tuberculin reactions in the past; to patients with extensive burns or excema or to persons with documented active TB or documented treatment (active or passive) in the past. . . Vesiculation, ulceration or necrosis may appear at the test site in highly sensitive persons may also occur. Strongly positive reactions may result in scarring at the test site. Immediate erythematous or other reactions may occur at the injection site. The reason(s) for these occurrences are presently unknown. There have been rare systemic allergic reactions reported that were manifested by immediate skin rash or generalized rash within 24 hours. Two of the reported cases had concurrent symptoms of upper respiratory stridor. These reactions were treated with epinephrine and steroids and resolved. No cause and effect was able to be established with a specific component of skin test. (See:http://www.vaccinationnews.com/DailyNews/July2002/TBTest27.htm)

Between 10—20% of the world population suffers from chronic eczema, cited above as contraindicating tuberculosis skin testing. Approximately 5% of the U.S. population maintains multiple chemical sensitivities. Obviously, this reflects a significant percentage of people for whom the tuberculosis skin test would not be a “harmless fluid” as generically alleged by HTCP literature.

Black’s Law Dictionary defines “fraud” as “2. A misrepresentation made recklessly without belief in its truth to induce another person to act.” Given this, and the preceding scientific  and commercial facts, the behavior of HTCP officials who authorized the circulation of this material, is arguably, if not definitively, fraudulent and liable for civil, and possibly criminal, tort proceedings.

Related Cases:

In the case of Jones v. State, Dept. of Health in Wyoming (March 9, 2001) it was determined that the Department of Health “exceeded its statutory authority” by refusing to grant a middle school student a requested exemption from a vaccination. In LePage v. State of Wyoming (March 13, 2001), the Supreme Court of Wyoming again determined that the Department of Health exceeded its statutory authority in denying a request for religious exemption from school immunization requirements. The court determined that it was “mandatory” to administer the exemption requested due to the presence of the word shall in the statute that required this action. This word is similarly present in the Hawaii exemption statute: §302A-1156 that states, “no certificate or other evidence of immunization shall be required for entry into school” for parents requesting a religious exemption. The court wrote: “The choice of the word “shall” intimates an absence of discretion by the Department of Health and is sufficiently definitive of the mandatory rule intended by the legislature.” In this case (LePage v. Wyoming) the Supreme Court also determined that the Dept. of Health’s action violated constitutional liberties and the “free exercise of religion.” The judges wrote:

Furthermore, construing the statute as the Department of Health suggests raises questions concerning the extent to which the government should be involved in the religious lives of its citizens. Should an individual be forced to present evidence of higher religious beliefs to be scrutinized by a governmental employee? If parents have not consistently expressed those religious beliefs over time, should they be denied an exemption? Can parents have beliefs that are both philosophical and religious without disqualifying their exemptive request? Should the government require a certain level of sincerity as a benchmark before an exemption can be granted? If the legislature chose to address these types of questions with further leglislation, such legislation would call into question the constitutional prohibition against governmental interference with the free exercise of religion . . .

In another related case, People v. Adams (1990 Cal.App.3d 1431, 265 Cal.Rptr. 568; California Court of Appeals No. C003631), the court reinforced and earlier determination that “‘A person of adult years and in sound mind has the right, in the exercise of control over his own body, to determine whether or not to submit to lawful medical treatment.’ (Cobbs v. Grant (1972) 8 Cal.3d 229, 242 [104 Cal.Rptr 505, 502 P.2d 1].) It follows that such a patient has the right to refuse any medical treatment, even that which may save or prolong life. . . . The fundamental right to refuse medical treatment is guaranteed by the right of privacy set fourth in article I, section 1 of the California Constitution. . . . [Furthermore,] the right to reject life-sustaining procedures is such a fundamental constitutional right and matter of public policy that it outweighs a defendant’s right to confront his accuser, just as it prevails over other significant competing interests . . . The right involves privacy and one’s personal dignity.”

This court also concluded that “While it may be convenient to insist on [medical treatment for the public’s benefit], it is quite another matter to do so at the patient’s sole expense and against his competent will, thus inflicting . . . physical torture on his body [and emotional torture on his mind] . . . Such a course of conduct invades the patient’s constitutional right of privacy, removes his freedom of choice and invades his right to self-determine.” (Satz v. Perlmutter (Fla.Dist.Ct.App. 1978) 362 So.2d 160, 164, affd. 379 So.2d 359.)

Remedy Sought

To redress its very serious concern that the Hawaii Tuberculosis Control Program is failing in its duty to adequately inform parents and legal guardians of the risks posed by routine tuberculosis skin testing, and the implied availability by statute of exemptions to this and otherwise mandatory vaccination requirements, TMoDW seeks:

In this regard, we urge Hawaii legislators and public health policy makers to critically reflect on, and adopt, current California statutes in this regard.  Their Safety Code concerning certification of tuberculosis-free status of school children is far more appropriate, and “public friendly,” even for a state in which tuberculosis case rates are significantly higher than the Hawaiian Islands. In addition, given the scientific and medical considerations, and “standard of care” parameters for public health practice detailed above, the state of California’s law provides for philosophical, besides medical and religious, exemptions to tuberculosis testing. This law states:

121505.  The certificate shall not be required for a person who is

subject to an order made pursuant to subdivision (a) of Section

121485, if the parent, guardian, or other adult who has assumed

responsibility for his or her care and custody in case of a minor, or

the person seeking admission, if an emancipated minor, provides to

the governing authority an affidavit stating that the examination

required to obtain the certificate is contrary to his or her beliefs.

  If at any time there should be probable cause to believe that the

person is afflicted with active tuberculosis, he or she may be

excluded from the school or other institution listed in Section

121485 until the governing board is satisfied that he or she is not

so afflicted.

The MoDW would be pleased to engage in further discussion with you regarding its concerns and proposed redress of those concerns as set out above.  We look forward to hearing from you promptly in that regard.  

Yours very truly,          
Robert Critchlow, J.D.