Democrats in Sacramento are basking in a national spotlight as reporters and pundits pick apart high-profile votes on transportation, cap and trade and immigration and speculate if, and how, they will turn a legislative supermajority into concrete action to resist Trump administration policies. Yet the industries that traditionally rule the roost in the statehouse are not sitting this session out.
One of those lobbies – the California Medical Association – has a lot on the line next two weeks. With three votes lawmakers could strike a killing blow to patient safety in California by eliminating most remaining doctor oversight and opening the floodgates to illegal opioid prescriptions. Or, politicians could require that dangerous doctors be fully investigated and that patients be notified when their doctor’s actions place patients at risk. Will Sacramento stand up for patients or protect dangerous doctors when the spotlight is focused elsewhere?
Bad doctors are often unaccountable when patients are harmed. Regulators at the Medical Board of California close most complaints about a doctor’s treatment without significant investigation. The Board has an 88% disapproval rating with the public for complaint-handling.
There is however one area where the Board has improved physician oversight: Opioid prescribing.
Opioid overdoses are the leading cause of accidental death in the country and the CDC has found that most of those drugs are obtained from doctors. To address this overdose epidemic, and in direct response to legislative prodding, the Medical Board has used the state’s CURES database to investigate physicians who are unsafely and inappropriately prescribing narcotics. The Board also learns of over-prescribers from law enforcement investigations into local pill mills or the sale of prescriptions for cash. Enforcement actions against doctors who over-prescribe have doubled over the last four years.
A bill sponsored by the California Medical Association would tie the hands of law enforcement trying to investigate these drug-dealing doctors. Officers investigating drug diversion use the state’s prescription drug database, called CURES, to check the record of over-prescribing doctors. SB 641 would tie their hands, imposing an onerous warrant requirement before drug enforcement officers can obtain this vital information about physicians’ prescribing histories. Public safety officials are making great strides in the attempt to address the opioid overdose crisis in California. Restricting use of this key tool will reverse those gains.
Sen. Lara recently took a big leap towards fixing this bill by amending it to eliminate provisions that would have also severely restricted the Medical Board’s ability to use CURES when investigating negligent doctors. To protect patient safety, the bill must also be amended to remove the warrant requirement for doctors’ prescribing histories. The Senate Public Safety committee votes on the bill Tuesday the 18th.
A second bill, SB 572 (Stone), would render the Medical Board toothless by requiring that a patient be permanently maimed or killed by a doctor’s negligence before the Medical Board could investigate and discipline the doctor. While the Medical Board has a poor enforcement record, it does take action against some very dangerous behavior by physicians. If SB 572 were to pass, even repeat offenders could escape any accountability if their actions did not cause permanent harm or death. For example, a doctor could get away with seeing patients drunk, as long as his colleagues caught him before he killed someone. The bill would prevent the Medical Board from even reprimanding the doctor, let alone mandating substance abuse treatment and random drug testing if the doctor continues to practice. SB 572 will be voted on by the Senate Business and Professions committee on Monday the 17th. It has no redeeming qualities and should be rejected.
The following Monday, the same committee will consider a bill to extend the Medical Board’s charter for the next four years.
When patients complain to the Medical Board, those complaints are rarely fully investigated. When they are investigated, it takes years for those enforcement actions to be completed. And if a doctor is placed on probation or faces other disciplinary action, patients are not informed. The Medical Board has failed to protect patients from harm after years of promised reforms. Lawmakers must require the Board to clean up its act, or refuse to renew its charter.
It would be unthinkable to decide the merits of a rape case without collecting evidence and interviewing both the victim and the accused. It is equally inconceivable that the Medical Board closes complaints involving potentially life-threatening negligence after a medical expert gets only the doctor’s side of the story, yet that is the current state of affairs. The Board should be required, at minimum, to interview the person harmed or who submit the complaint, obtain records directly from both the complainant and the doctor to get both sides of the story, and be prohibited from closing any investigation when the basic facts of the case are in dispute.
The committee must also require that the Medical Board write new rules to require doctors to inform their patients, before an appointment, if they have been placed on disciplinary probation for a patient care violation. Recent history has shown unequivocally that neither the medical lobby or the Medical Board are willing to make any serious effort to inform patients of this vital information. The Chair of the Medical Board complains that such disclosure would eliminate any trust between doctors and patients. Patients might say that trust disappears the moment a doctor decides to keep a drug problem, unnecessary death or record of sexual assault secret. Patients of the nearly 600 doctors currently on probation for violations as serious as sexually assaulting a patient, drug abuse and incompetence that caused a patient’s death, deserve to be told.
Thorough investigation of patient complaints and disclosure to patients when their doctor is on probation should be pre-requisites to lawmakers renewing the Board’s charter for another four years.