A coalition of California physicians and business leaders are striving to defeat a proposed law that would force doctors to be drug tested after adverse events or risk losing their license.
Proposition 46 requires that doctors submit to drug and alcohol testing at random and within 12 hours after an adverse event has been identified. Positive results or failure to appear for testing would result in a medical board investigation and a license suspension until findings are complete, according to the proposed initiative. Californians vote on the ballot item on Nov. 4.
Dr. Theodore M. Mazer
If passed, the proposed law would unreasonably penalize doctors unable to meet testing rules and lead to excessive suspensions, said Dr. Theodore M. Mazer, a San Diego-based otolaryngologist in private practice and past president of the San Diego County Medical Society.
“It’s poorly worded and poorly thought out, and it was simply put there to deceive the voters into thinking they were doing something for patient safety,” Dr. Mazer said in an interview. “It will actually result in questions about privacy invasion for doctors and could take doctors who are doing nothing wrong out of practice temporarily with suspended licenses because they couldn’t report in a timely fashion.”
The drug-testing provision is one of three components of Prop. 46, a ballot initiative backed by the state’s trial bar and consumer interest group, Consumer Watchdog. Another provision of the proposal would raise California’s $250,000 medical malpractice cap on noneconomic damages to $1.1 million. A third measure would require physicians to check a statewide database before prescribing Schedule II and Schedule III drugs. The drug-testing provision would apply only to doctors who practice in hospitals or who have hospital privileges.
A spokesman with Consumer Attorneys of California referred questions to Consumer Watchdog. At this article’s deadline, messages left with Consumer Watchdog had not been returned. In a statement, the organization said Prop. 46’s drug and alcohol testing procedures are in line with other industries charged with protecting people’s lives.
“Millions of Californians in safety-sensitive positions are already drug tested at work, such as police officers, firefighters, construction workers, and truck and bus drivers,” the statement said. “Currently, doctors are not tested, although they practice medicine on tens of thousands of California patients every year.”
Dr. Richard Thorp
California physicians have long faced attacks to the state’s medical malpractice award limit, but the drug-testing proposal is new, said Dr. Richard Thorp, who is president of the California Medical Association. If approved, California would become the first state to mandate such testing of doctors. The proposed law could encourage other states to follow in California’s footsteps, opponents said.
“California’s first in a lot of things,” Dr. Mazer said. “This is not a smart first to be.”
The drug-testing provision raises more questions than answers and would likely cause more harm than good, noted Dr. Yul D. Ejnes in a Sept. 30 Annals of Internal Medicine article. The initiative does not specify the time frame in which a medical board must complete its investigation of a doctor’s positive drug result. Additionally, the proposal targets all physicians with admitting privileges, regardless of access to controlled substances, specialty, or impairment risk.
“Randomly testing physicians without some form of risk stratification will likely result in many false-positive results,” said Dr. Ejnes, an internist in private practice in Cranston, R.I., who is immediate past chair of the American College of Physicians Board of Regents. “Prop. 46 addresses verification of positive results, but, as we see in clinical practice, that process only adds to the intrusiveness, expense, and stress that should not have occurred in the first place.”
Dr. Thorp added that the database measure of the proposal, as it’s written, would be detrimental to doctors and patients. The state’s drug monitoring database, called the Controlled Substance Utilization Review and Evaluation System (CURES), currently lacks funding and staff to fully operate the system, he said. Glitches and accessibility problems led to a 2013 law that raised licensing fees for health providers to better fund the database. Physicians are required to register with the system by 2016, according to the law.
“It’s a huge database,” Dr. Thorp said in an interview. “It takes time to get that moving. To mandate this for every doctor and pharmacist is just a recipe for disaster.”
The database and drug-testing components of the initiative were merely included to sway voters into striking down the malpractice cap, said Dr. Richard E. Anderson, chair and CEO of the Doctors Company, a national liability insurer. The company is among the coalition of health care and business leaders against the proposed law.