Doctors Swallow Bitter Pill

The Medical Board, whose job it is to keep patients safe from dangerous doctors, should be notified when a doctor with addiction issues fails a drug test, right?

Senators Hill, Block and Jackson extracted that commitment from the California Medical Association and Senator Galgiani yesterday, at a hearing into Galgiani's bill, SB 1177, that would create a drug and alcohol abuse program for doctors at the California Medical Board.

Confidentiality and unaccountability have been the hallmark of CMA bills on this issue since 2008.

What they failed to resolve is a second question – also asked by Senator Block at yesterday’s hearing: “Are patients of impaired physicians given notice of impairment?”

The answer is still no.

It should be a no-brainer that doctors caught abusing substances while in a rehab program shouldn’t be able to keep that secret from patients they're treating. But the bill thus far doesn’t require patient notification when their doctor fails a drug or alcohol test or doesn’t meet the other terms of a drug treatment plan.

It was just last week that the same group of Senators voted 7-0 (with two not voting) to require doctors to inform their patients when they are on probation. Patients should have the right to know if their doctor was sanctioned for negligence that killed a patient. They should also have the right to know if their doctor just failed a drug test. 

2008 is the year the Medical Board shut down its “diversion” program that allowed substance abusing doctors to choose a treatment program and avoid discipline for drug and alcohol abuse. The program’s intractable problems placed patients at risk of being harmed by drunk or high doctors.

The diversion program created a revolving door for drunk and high physicians who went in and out of treatment, avoiding discipline while their patients were unaware of their ongoing problem. It failed five out of five audits. It failed to monitor substance-abusing doctors and let them off the hook for failing to comply with rehabilitation terms.  Once doctors “graduated” the program, follow-up to ensure doctors’ continued sobriety was haphazard, if it happened at all.

It led to horrific patient harm, like what happened to Tina Minasian, who is disfigured and in pain years after being mutilated by an Orange County surgeon who she learned too late had been in and out of the diversion program.

It would be unconscionable for the legislature to re-create that program and repeat the mistakes of the past.

Full disclosure to the Board and patients when doctors fail to comply with drug and alcohol treatment would avoid such tragic outcomes for patients.

Something else we didn’t expect to hear yesterday: The top lobbyist for the California Medical Association admitting publicly that rates of addiction by physicians are consistent with rates of addiction by the general public.

That’s a reversal of the CMA’s position during the Prop 46 campaign, when they refused to accept a Medical Board estimate that was based on addiction in the general population. The Board said 15 to 18 percent of physicians will have a substance abuse problem during their lifetime, and 1 to 2 percent will have an abuse problem at any given time.

The truth is that the Medical Board doesn’t need to run a doctor substance abuse program. Doctors who want to seek treatment can already do so in the private market. The mission of the California Medical Board is to protect patient safety – not protect doctors who want to keep their drug use secret.

But the CMA wants a feather in its cap. So, if the legislature is going to re-create a program at the Board and give it the government’s stamp of approval, it should also demonstrably improve patient safety. Full disclosure to patients and the Medical Board of a doctor’s failure to follow a treatment program would be that proof.

The Senate Business and Professions committee got halfway there yesterday.

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