Secret Treatment Pathway for Addicted Doctors Won’t Protect Patients
Lisa McGiffert at Consumers Union’s Safe Patient Project wrote me recently about a plan to create a pathway that would allow physicians with substance abuse problems to seek treatment without any impact on their medical license. As regular readers of Antidote know, I have mixed feelings about these types of programs. I thought her comments to me were so compelling that I asked her to write a guest post. - William Heisel
When the California legislature ended its work last week, one bill that appeared to be on a smooth track for passage was pulled from the agenda, at least for now.
This was good news for California patients because it would have created a secret system for protecting dangerous physicians.
Consumers Union and California patient safety activists opposed SB1483 by Sen. Darrell Steinberg. The bill would have established a multimillion-dollar referral service within the Department of Consumer Affairs for impaired physicians, including those with substance abuse and mental health problems.
According to a Senate Committee analysis, the backers of the bill (mostly medical associations) indicate this is "a serious public health risk for the state as these troubled practitioners present a very real and immediate threat to patients."
To mitigate this risk, Steinberg proposed a treatment program that would allow doctors to volunteer to participate or be referred by hospitals and medical societies. Doctors would enter the program without the knowledge of the Medical Board of California or the public. This is the wrong approach.
If public safety is truly at risk from impaired physicians – and we don’t doubt that it is – then this is not the solution. It is not a proposal to protect patients but one to protect doctors. Doctors (and others) should absolutely get help to end their addictions, but this idea of creating a secret system for physicians to undergo treatment without any impact on their licenses continues to gain currency in California and elsewhere, even though a very similar system was dismantled by the state of California just a few years ago. Here’s what lawmakers and the citizens who vote for them should consider about these types of proposals:
1. Why create a state sanctioned pathway to divert substance abusing doctors from the state’s own system charged with oversight? Hospitals and medical societies that are aware of such problems should refer these dangerous doctors to the medical board, not a secret program that will keep unsuspecting patients in the dark.
2. Can’t doctors be treated for substance abuse without a state-sanctioned referral service? Any doctors who want treatment can get it. They can check into the Betty Ford clinic or any other confidential addiction program on their own.
3. Doesn’t existing law already establish guidelines for handling addicted doctors? A law created in 2008 by SB 1441 established standards for the Medical Board of California and other healing arts boards when dealing with substance abusing professionals. The state needs to implement current law not create a new system.
4. And lastly, haven’t we tried this approach before to bad effect? The Medical Board of California operated a diversion program for many years, in which disciplinary actions would be secretly set aside while doctors were in treatment. The program was audited five times. Each audit revealed flaws in oversight such as monitoring drug testing and responding quickly when relapses occurred. The program was ended by the Board in 2007. The same people connected with the failed diversion program were seeking to establish a new referral program through SB 1483.
In opposition to this bill, Michele Monserratt-Ramos, from Los Angeles, told of the death of her fiancé Lloyd Monserratt. She testified:
Lloyd died three days following elective surgery with no reason given for his death. I hired a pathologist and brought in the coroner to consult…[they] determined that Lloyd’s death was caused by surgical errors, and infection untreated which led to severe sepsis. Lloyd’s physician lied to me and to Lloyd when asked of his true condition. It did not make sense that this physician could abandon him hours before Lloyd died telling me that Lloyd could speak so he thought he was okay and left the hospital. What occurred in that hospital was so alarming that I felt that I had to be missing something. There had to be some other factor that could contribute to the complete lack of care. In time, I discovered that Lloyd’s physician had an arrest record. His arrest record spanned a ten-year period including felony possession of crack cocaine amongst other crimes. The fact that the State of California allowed this doctor to practice with no reference to his criminal past and drug abuse led me to this path of advocacy.
Today, since the diversion program has been disbanded, this kind of information is available to the public.
Bottom line is that substance abusing physicians pose significant risks to patients, who typically are unaware of the problem. When these issues come before the medical board, they should be addressed through rigorous, conscientious and publicly transparent action. Of course doctors deserve help for their substance abuse issues – as do their patients. But they shouldn’t get a free pass to skate around existing regulations meant to protect the public from medical negligence.