Student Well-Being

Mask Exemptions: Which Students Really Need Them and How Are Parents Getting Them?

By Lisa Gutierrez, Sarah Ritter, and Eric Adler, The Kansas City Star — August 16, 2021 11 min read
Photo showing a group of elementary school classmates wearing protective face masks in the classroom while desks are socially distanced due to new COVID-19 regulations.
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Parents in Kansas City who don’t want their children to wear masks in school despite mandates are swapping names of local physicians and nurse practitioners they claim will sign medical exemptions for families.

Some local pediatricians report they’re getting more requests for exemptions lately and confirm that some doctors and nurses are “willing” to write mask exemptions, sometimes without any medical reason.

Overland Park pediatrician Dr. Natasha Burgert called it “maddening.”

“This is not surprising,” said Burgert. “There will always be physicians who unethically risk the safety of their patients and their community ...

“These clinicians and parents will be directly responsible for allowing delta to spread in schools. And, this callous disregard for others is why the pandemic will continue in KC.”

In May, Johnson County pediatrician Christine White wrote on Facebook that she had secured a mask exemption for one of her school-age children from Dr. Doug Brooks in Olathe.

White is running for the Blue Valley school board on a platform that calls for letting parents choose whether their children mask up.

This week Blue Valley became the last major district in Johnson County to mandate masks for all grade levels, like almost every other school district in the Kansas City metro.

“I got my 16-year-old a mask exemption today,” White wrote in a post that was shared with The Star and appears to have been deleted. “I’ll hang on to it for the start of the 2021-2022 school year — in case we still need it. I’m hopeful we won’t need to put it to use.

“I want to thank Doug Brooks, MD and Curtis Beall, DNP for having the bravery and decency to help children attend school this year (and next year if needed) mask free. Masks should be optional for children come fall of 2021. Both inside and out.”

A receptionist at the office of Brooks and Beall, a nurse practitioner, said Wednesday she could not comment because this information is private.

Johnson County Pediatrics, where White works, also declined to comment. But it posted on Facebook this week that it will not give mask exemptions unless they are medically necessary, a “very rare” occurrence.

Three other local doctors and nurse practitioners who, parents on social media claim, are willing to provide the exemptions did not return repeated requests from The Star for comment.

But an employee who answered the phone at one Shawnee family care group said she didn’t know why the doctor’s name was circulating on social media because the doctor is “not providing medical exemptions for children.”

“We have actually, in our office, seen mask exemptions for our patients who we know do not need mask exemptions,” said Dr. Susan Ratliff with Pediatric Partners in Johnson County.

“They’re our patient, so we know their medical conditions. And they come to us with a mask exemption from one of these places in town.”

Ratliff said she has not seen an exemption signed by a pediatrician. Two of the names circulating on Facebook are of local nurse practitioners.

“As physicians, we took an oath to do no harm. That is part of the Hippocratic Oath,” said Ratliff. “And when people are giving these mask exemptions, in my opinion, they are completely going against the oath that they took.”

This is not surprising. There will always be physicians who unethically risk the safety of their patients and their community ... These clinicians and parents will be directly responsible for allowing delta to spread in schools.

At the same time, some local pediatric groups are telling patients they will not write exemptions outside of what would be medically necessary — and those exemptions are rare.

Masks are a hot-button topic for educators and parents as kids head back to school. Parents who oppose them, such as in Blue Valley, are continuing their protests.

As of Wednesday, almost every school district in the Kansas City area said they would require masks for all students and staff for pre-kindergarten through 12th grade.

Some exceptions: Raymore-Peculiar in Missouri and Turner in Kansas merely recommend masks. Platte County and Kearney have yet to announce their protocols. And, in Johnson County, Gardner-Edgerton and Spring Hill require masks only through middle school, following the county’s mandate.

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend universal masking indoors for grades K-12.

The CDC’s guidelines are based on “new evidence” about the highly contagious delta variant.

The pediatrics group recommends masks “because a significant portion of the student population is not yet eligible for vaccines, and masking is proven to reduce transmission of the virus and to protect those who are not vaccinated.” Children under 12 are not yet eligible for the COVID vaccine.

Exemptions are rare

Parents across the country are looking for workarounds to mandates, and medical exemptions appear to be one way.

Some local parents already have them in hand. One parent took her child to an Overland Park pediatrics office for a recent appointment with no mask, but an exemption letter from another physician’s office. It did not go over well with the staff, a physician in the office told the Star.

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In Bibb County, Alabama, parents angry about the school mask mandate this week said they were going to fill out medical exemption forms that were being passed among the protesters.

Guidance from the pediatrics academy and the CDC allows very few medical reasons a child cannot wear a face mask.

The academy encourages its 67,000 members to tell parents that masks can be worn safely by nearly all children 2 and older, “including the vast majority of children with underlying health conditions, with rare exception.”

Doctors who are asked to approve a medical exemption are advised to first consider: Can these children remove the mask by themselves?

“If a child is unable to put on and take off their mask by themself, then they shouldn’t be masked, which covers a lot of things like developmental disabilities or severe physical disabilities,” said Dr. Angela Myers, division director of infectious diseases at Children’s Mercy.

“Another exemption would be a child with severe autism who just cannot tolerate something on their face, which causes a lot of stress or problems, because having a mask there is only good if you leave it there.

“If you’re constantly taking it off, putting it on, taking it off, or touching it all the time then you’ve lost the ability of the mask to provide much protection.”

If a medical exemption is justified for those reasons, the pediatrics academy says the child’s medical providers might “consider advising the parent/guardian to explore virtual learning opportunities with their school district prior to or in lieu of providing a medical exemption.”

School Mask Mandates at a Glance

This information is no longer being updated. The last data update was on May 23, 2022.

  • MASK MANDATE BAN IN EFFECT


    1. Florida

    On Sept. 22, Florida's surgeon general instituted a rule that gives parents and legal guardians "sole discretion" over masking in schools. On Nov. 5, a judge sided with the state health department in a legal challenge to rule. On Nov. 18, Gov. DeSantis signed a bill that allows parents to sue school districts that require masks.

    2. Georgia

    On March 29, Gov. Kemp signed the “Unmask Georgia Students Act” which allows parents to exempt their child from a school mask requirement. The law went into effect immediately.

    3. Iowa

    On Sept. 13, 2021, a federal judge ordered Iowa to halt enforcement of its law banning mask mandates in schools. On Jan. 25, 2022, a federal appeals panel narrowed that injunction. Iowa’s attorney general announced the state is not enforcing the ban while awaiting further action from the court. On May 16, 2022 a U.S. Court of Appeals lifted the injunction.

    4. Oklahoma

    On Sept. 1, an Oklahoma judge temporarily blocked the state law banning school mask mandates, but students or their parents can still opt out of school mask mandates if they choose.

    5. Utah

    In Utah, local health departments can issue 30-day school mask mandates with approval from the state or county government, according to the state’s top education official.

    6. Virginia

    On Jan. 15, Gov. Youngkin issued an executive order allowing parents to opt their child out of any school mask mandate. It effectively rescinded the state's school mask requirement that had been in place since August. That executive order was later halted by a judge. On Feb. 14, the Virginia legislature passed a measure that bans school mask mandates. That bill was signed by the governor on Feb. 16 and went into effect on March 1.

    MASK MANDATE BAN BLOCKED, SUSPENDED, OR NOT BEING ENFORCED


    1. Arizona

    On Sept. 27, a judge in Arizona blocked the state laws banning mask mandates that were set to take effect on Sept. 29. On Nov. 2, the Arizona Supreme Court upheld that ruling. On April 25, Gov. Ducey signed HB2616, which prevents schools from requiring a student to wear a mask without first getting parental consent. The ban, which replaces the one blocked by the courts, will go into effect 90 days after the legislature adjourns.

    2. Arkansas

    An Arkansas judge ruled on Dec. 29, that a law signed by the governor in April that prohibited local officials, including school boards, from setting mask mandates was unconstitutional. School districts have been able to set their own mask requirements since August when the judge put the law on hold.

    3. South Carolina

    On Sept. 28, a federal judge suspended South Carolina from enforcing the rule that banned school districts from requiring masks for students.

    4. Tennessee
    5. Texas

    On March 17, an appeals court upheld an injunction that blocked Gov. Abbott's executive order banning mask mandates in schools, finding it is unlawful and exceeding the governor's authority. This is not the first time the state's ban has been halted by a judge.

    MASK REQUIREMENT IN EFFECT


    1. Hawaii

    Although Hawaii's state-wide indoor mask mandate ended on March 25, indoor masking will still be required in public schools at least through the summer.

    PREVIOUSLY HAD MASK REQUIREMENT


    1. California

    On Feb. 28, the governors of California, Oregon, and Washington issued a joint announcement that mask requirements would end in their states effective March 12.

    2. Connecticut

    On Feb. 7, Gov. Lamont announced that the school mask rule would expire Feb. 28. He signed a bill on Feb. 15 that made the expiration date official.

    3. Delaware

    On Feb. 7, Gov. Carney amended his emergency order to allow his state-level school mask requirement to expire March 31. On Feb. 28, he announced that masks would no longer be required effective at 6:00 p.m. on Tuesday, March 1.

    4. District of Columbia

    On March 8, the department of health released updated guidelines that recommend universal masking only when community COVID-19 levels are high.

    5. Illinois

    On Feb. 5, a judge issued a temporary restraining order on the governor's statewide mask requirement. On Feb. 25, the state supreme court vacated that order. On the same day, the governor announced he would lift the requirement on Feb. 28.

    6. Kentucky

    Kentucky's school mask mandate ended in September, when the state legislature voted to limit the governor’s emergency powers.

    7. Louisiana

    According to a State of Emergency proclamation issued Nov. 23, which was extended on Jan. 19, students were required to wear masks in schools, but districts could opt out of the mandate if they adopted an isolation and quarantine policy consistent with the state's department of health protocols. On Feb. 16, Gov. Bel Edwards extended the order without requiring masking in schools.

    8. Maryland

    On Jan. 5, the mask mandate was extended for 180 days, but allowed school districts to opt out if certain vaccination rates were met. On Feb. 22, the state board of education voted to rescind the mandate. On Feb. 25, a state legislative committee gave final approval to lift the mandate effective March 1.

    9. Massachusetts

    On Sept. 27, the state began allowing schools to apply for a waiver from the face covering rules for vaccinated individuals if certain vaccination rates were met. On Feb. 9, officials announced the statewide mask requirement for K-12 schools would be lifted on February 28.

    10. Nevada

    On Feb. 10, Gov. Sisolak announced the immediate suspension of the school mask requirement. The previous mask requirement had only applied to counties with populations of 100,000 people or more.

    11. New Jersey

    On Feb. 7, Gov. Murphy announced plans to end his state’s school-mask requirement on March 7.

    12. New Mexico

    On Feb. 17, Gov. Grisham announced the end of the mask requirement, effective immediately.

    13. New York

    On Jan. 24, a judge struck down the state's mask mandate. A day later, an appeals judge restored the mandate. On Feb. 27, Gov. Hochul announced the mandate would be lifted on March 2.

    14. Oregon

    On Feb. 7, health officials said the state would drop its school mask requirement no later than March 31. On Feb. 24, the Oregon Health Authority announced the requirement would lift on March 19. However, on Feb. 28, the governors of California, Oregon, and Washington issued a joint announcement that mask requirements would end in their states effective March 12.

    15. Pennsylvania

    A statewide mask mandate for Pennsylvania schoolchildren was thrown out by the state Supreme Court on December 10.

    16. Rhode Island

    On Feb. 9, Gov McKee announced the school mask mandate would only remain in effect until March 4. On Feb. 15, he signed an executive order specifying that the order would take effect at 5 p.m. on March 4.

    17. Virginia

    On Jan. 15, Gov. Youngkin issued an executive order allowing parents to opt their child out of any school mask mandate. It effectively rescinded the state's school mask requirement that had been in place since August. That executive order was later halted by a judge. On Feb. 14, the Virginia legislature passed a measure that bans school mask mandates. That bill was signed by the governor on Feb. 16 and went into effect on March 1.

    18. Washington

    On Feb. 17, Gov. Inslee announced the state's school mask requirement will end effective March 21. However, on Feb. 28, the governors of California, Oregon, and Washington issued a joint announcement that mask requirements would end in their states effective March 12.

  • NOTES
    In January 2022, the Missouri attorney general, Eric Schmitt, sued some school districts that required masks, citing a November ruling by a county judge that said local health orders tied to COVID-19 were illegal. (The ruling was interpreted differently by different districts.) The state’s treasurer announced he would also crack down on schools with mask mandates. In mid-March, Schmitt began dropping lawsuits against school districts that no longer required masks. On May 19, 2022 Schmitt announced new lawsuits against several districts that had reinstated mask requirements.
    On Feb. 23, 2022, New Hampshire’s governor announced the state was no longer recommending universal indoor masking and therefore schools have to end mask mandates, arguing they violate state education department rules. Soon after, the department advised districts that the mandates “are inconsistent with” their rules. There’s disagreement over whether districts still have the authority to require masks, but at least one district changed its policy in response. A bill that would have banned mask mandates was vetoed by Gov. Sununu in May 2022.
    Updated 5/23/2022 | Sources: Local media reports, Education Week reporting | Learn more here

What if a face mask would hinder a child who needs help communicating? That does not justify a medical exemption, the academy says. Instead, the medical provider should encourage the parents and school to consider face masks with a clear plastic insert, which have proven helpful for “many children” on the autism spectrum, with intellectual disabilities or mental health disorders, the pediatrics group says.

There are no other physiologic conditions — including cardiac and pulmonary — “that would automatically warrant a medical exemption to the use of a cloth face mask in school,” the academy says.

Some parents who oppose masks say their children just don’t like wearing them.

“I have two thoughts on that. Number one, kids actually tolerate it quite well. And adults can also tolerate it quite well. And it’s all in your attitude, it’s all in your perspective,” said Myers.

“We have health care providers, police, EMTs and paramedics who are wearing masks all day every day when they’re around the public. It’s something that we can all do, and it’s actually not that hard.

“Even kids can get used to wearing masks in school all day. If you don’t make a big deal about it, it’s less likely the kid’s going to make a big deal about it.”

But also, there are a lot of things kids don’t want to do but adults have them do for their health, Myers said.

“Sometimes my kids don’t want to eat vegetables, but yet, they need to eat some vegetables for dinner every night,” she said. “Sometimes they don’t want to brush their teeth. But yet, we know that kids need to brush their teeth every day, twice a day.”

Why they don’t want masks

Ratliff said some parental concerns about children wearing masks stem from misinformation.

“We definitely have parents who ... don’t have bad intentions,” she said. “They get misinformation that their child should not wear a mask so they want an exemption for whatever reason — anxiety, or asthma, that’s a common one.

“People think that if their child has asthma they shouldn’t wear a mask, where that’s actually not true. All of the asthma organizations will recommend that to decrease their chance of getting COVID, (children) should wear a mask if they have asthma.”

She said educating parents wins over some. “But, we also have parents who are against masks for whatever reason, and they ask for mask exemptions that they’re pretty adamant about,” she said.

At the meeting Monday where the Blue Valley school board expanded the mask mandate to all grades, school leaders said they had received nearly 1,400 emails about COVID protocols for the new year. They called it a deeply emotional topic.

Parents who objected that night or on other occasions say they want the freedom to make that decision for their families.

“We’re just parents who love our children and want the best education available for them free from medical mandates by an increasingly totalitarian government,” said Owen Frederick, father of two grade-schoolers in the district, who also accused the district of teaching “Marxist racism.”

Brooke Loo, who identified herself as a physician’s assistant for the past 14 years, called the district’s mask mandate “absolutely ludicrous when ... children have 100 percent survivability rate.” In fact, children have died from COVID-19 since the pandemic began.

“The bottom line is you don’t have a say in my child’s medical decision,” Loo said. “None of you do.”

One Johnson County mother who sought information about how to get a mask exemption on Facebook, and did not want to be identified fearing backlash, said parents and doctors are afraid to talk.

“I am sure you will not hear from a single doctor that is trying to help us parents, or any other parents in my situation,” she said.

“Once they talk, they get threatened or silenced, so they want to continue to be able to help.”

But one mother, whose children are patients of Brooks, contacted The Star to defend him.

“Whether or not he is giving out exemptions for masks, he has helped my family so much as a doctor, I trust him 100 percent,” said Stephanie Relly of Grandview, whose family has been treated by Brooks for about a decade.

Relly home-schools her children, so they are not affected by school mask mandates. She, nonetheless, thinks children should not be forced to wear masks whether their reasons fit within the guidelines or not.

“I’m 100 percent for mask exemptions,” she said, “if children are struggling to breathe.” She also thinks there are reasons that may not be covered by current medical guidelines.

Pediatricians double down on masks

Medical professionals who will sign or dole out exemptions are themselves the exception.

“Honestly, it’s just sad,” said Ratliff, who has three children in Blue Valley schools. “The mask recommendations are there for the well-being of all the kids and all the teachers. And ultimately to keep the kids in school.

“A 14-day quarantine just based on the fact that they were exposed to COVID — that is enough in my opinion to keep kids masked. You have an entire class out because of an exposure — how are kids going to learn? They don’t have the choice of virtual learning this year.”

Most pediatric groups in Kansas City urge parents to keep their children safe with masks.

Even some mask exemption forms themselves appear to discourage the exemption itself.

The form used by the Lawrence school district, where everyone 2 and older must wear masks when indoors on school district property, has a message to health care providers.

“Lawrence Public Schools asks that primary care providers, and medical professionals in Kansas, work to support and promote masking for adults and children,” it says. “Furthermore, please advise youth and their parents on how to increase comfort while wearing masks.”

This week, Johnson County Pediatrics, where White works, posted a notice on Facebook that said the doctors in the office, “without exception,” agree with masking guidelines from the pediatrics academy and CDC, and the need for those 12 and older to get vaccinated for COVID-19.

“Johnson County Pediatrics will not offer mask exemptions unless physical, developmental or behavioral conditions make wearing a mask unsafe,” the group posted on Monday.

The doctors noted that medical exemptions are “very rare” and that in most cases, if a child can’t wear a mask safely for medical reasons, “that child should not attend school in person.”

Some of those rare exemptions, they wrote, include developmental delays, severe autism and limited physical mobility.

“We are doing all we can to promote vaccines and masks,” said Dr. Kristen Stuppy at Pediatric Partners in Overland Park, who posts frequently about both on social media.

The Pediatric Partners website acknowledges the “public discord” over masks, but supports their use.

“If you worry based on some theories floating around that the masks are in some way dangerous, simply stop to think about how long they have been safely used by many people, including physicians, carpenters, and children with immune deficiencies for years,” the website says.

“Masks are not dangerous if they are worn correctly, which includes keeping them over the nose and mouth with a proper fit that limits the need for readjustments. They should be replaced or cleaned if they are soiled and at least daily.”

Copyright (c) 2021, The Kansas City Star. Distributed by Tribune Content Agency.

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