When Cathlene Echan walked into her pediatrician's office two weeks after giving birth, she was nervous about discussing her recent decision not to vaccinate her second baby.
But Echan, of Orange County, Calif., did not expect to be asked to leave.
"The doctor said it was too much of a liability to have us as patients," said Echan, a 28-year-old stay at home mom. Echan's oldest child, Josiah, now 5, had just been diagnosed with autism around the same time her second son Torren, now 2, was born.
Echan said she did research and read articles online about autism, she talked with other parents and then came to the pediatrician's office with doubts about vaccines.
"I hadn't come to a conclusion at that point when I saw the doctor, but I was so nervous because they're brothers, and I thought there could be a predisposition for it," said Echan. "As a mom, I can't knowingly do something to my second child when I believe it played a role in causing my older child's neurological disorder.
"She was very nice at first, but when I asked her to give him [Torren] a checkup, she said, 'you need to leave,'" said Echan.
Echan's situation is a growing problem for parents and pediatricians alike. Despite adamant statements from the American Academy of Pediatrics and the U.S. Centers of Disease Control that vaccines have no link to autism, an anti-vaccination movement is growing online, from parent to parent, and through activist celebrities, such as actress Jenny McCarthy.
Now, more and more doctors are feeling compelled to say "no" back to these parents. The issue was raised Wednesday at the annual American Academy of Pediatrics meeting in Washington, D.C.
Dr. Gary Marshall, a presenter at the meeting, said there are some cases when it's ethical and legal to refuse to continue to see, or treat, a child.
"In the middle of treatment, you can't just say, I'm done," Marshall, of the University of Louisville School of Medicine, said during a session that addressed parental concerns about vaccinations and how pediatricians can respond.
"But if it becomes obvious that you and the family will never see eye-to-eye on a specific issue, there's no reason not to 'fire' them, providing you follow the steps necessary to avoid charges of abandonment," Marshall explained in the meeting. "Those include providing written notice that you will no longer treat their children and giving them a set time frame -- at least 30 days -- to find another physician."
Dr. Mary Fallat, chair of the Committee of Bioethics of the American Academy of Pediatrics, said doctors should try hard to work with parents, if they refuse to vaccinate, by providing information and trying to come to an agreement about a vaccination schedule.
"If that doesn't work, and the pediatrician feels really strongly that they cannot care for the child -- which is not the norm -- then they need to find another pediatrician who can take care of that child," said Fallat.
In some cases, Fallat said, doctors may feel an ethical concern about families who don't vaccinate their children.
"Ethically, that is a real concern on the part of the pediatrician because there are some diseases that are really disabling," she said. "If a pediatrician says, 'OK, I agree, it's OK for you not to immunize your children' and they do come down with some of these diseases then… it makes the doctor feel like he's partly to blame."