Sen. Barbara Boxer (D) and Rep. Nancy Pelosi (D) have earned their credentials as champions of liberal issues and defenders of the defenseless, but they have it wrong this time with their support of California Proposition 46. Follow below to find out why.
At first blush Proposition 46, with its goal of raising the 39 year old cap on non injury compensation awards for victims of prescription drug abusers and physician negligence (MICRA) from $250,000 to $1.1 million, would seem made to order for progressive activists. Add to that the support of Barbara Boxer and Nancy Pelosi and you've got a slam dunk, right? Boxer is even featured in an add supporting 46, but curiously focuses on the drug testing of doctors over raising the compensation cap, perhaps because her husband is a personal injury lawyer and doesn't want to play into the hands of the opposition whose loudest complaint has been that the proposition was written by and for trial lawyers. This expeditious strategy is certainly driven by focus groups and a collective disdain for lawyers.
SAN FRANCISCO (KCBS)— Senator Barbara Boxer came out swinging Wednesday on behalf of Proposition 46 in a new ad campaign. Boxer (D-CA) is hoping that her considerable political clout and the emotional case made by grieving parents can offset huge campaign spending by the measure’s opponents.
The first ‘Yes on 46’ ad stars the senator herself. In it she asks viewers to look at pictures of children flashed on the screen and points out that all of them lost their lives due to medical malpractice.
The Proposition was written by millionaire Bob Pack, father of two children killed by a "doctor shopping" driver high on drugs prescribed by multiple doctors. Pack is a former AOL executive and founder of NetZero and the new mobile shopping app, Shop O' Lot.
http://www.protectconsumerjustice.org/...
Pack's story is truly tragic, and does illuminate the serious problem of prescription drug abuse, but Prop 46 has a poison pill--well, actually several poison pills--and is really more of an act of vengeance upon doctors than a solution to a real problem.
My sister is a family practice doctor in Orange County, an unwavering progressive and long time supporter of Boxer and Pelosi. Much of this diary is based on her explanation of the impact of Prop 46 on her practice, as well as my understanding of the proposition after reading it through carefully several times.
Firstly, the legislative analyst states that "raising the cap on noneconomic damages would likely encourage health care providers to change how they practice medicine in an effort to avoid medical malpractice claims." (California General Election, Official Voter Information Guide, November 2014). The legislative analysis states that this might cause doctors to order more tests or procedures and "could reduce future health care costs by preventing future illness." Well, sure that sounds great, but the fact is most doctors are already acutely sensitive to this subject and run as many tests as they think are necessary to help them make a complete and accurate diagnosis of a disease and protect them from liability. It is the insurance companies who are the gate-keepers on these extra procedures. Insurers frequently require the doctor get their approval for non-emergency procedures in order to keep costs down. Doctors who want to challenge the denial of a test are often required to have a "doctor to doctor" discussion with an insurance company physician. Insurers have a limited number of physicians available for this purpose and doctors and their staff frequently have to spend 40 minutes or more in the process, taking valuable time away from providing patient care.
The requirement that physicians check the Controlled Substance Utilization Review and Evaluation System (CURES) before prescribing scheduled medications would certainly exacerbate this temporal vortex. The proposition applies to all scheduled drugs including sleeping pills like Ativan, ADD medications like Adderall, and cough syrup containing codeine so a CURES report would need to be done on all of these prescriptions as well as pain medications.
Most physicians, in my sister's opinion, generally find the idea of CURES to be reasonable and it can certainly be helpful when dealing with a new patient requesting narcotics or other scheduled drugs, but the requirement to check CURES for all new prescriptions including those for long time patients further limits time devoted to actually providing care. Many patients have different spellings of their names, some with a middle initial and others because of marriage for example, or have changed addresses making the verification process elusive and ponderous.
My sister and one of her partners have tried to register for CURES but have been unsuccessful because the system cannot handle the current level of requests on-line and phone calls go unanswered. In her office a couple of providers have CURES access and they occasionally find people who appear to be misusing the medications. It takes a lot of time to do this and doing it for every scheduled prescription would require an increasing amount of physician time therefore reducing time spent for patient care. It is her opinion that for non-urgent cases her practice would probably stop prescribing scheduled medication all together and refer patients to a pain care specialist, rather than risk any future lawsuits.
While the database — called the Controlled Substance Utilization Review and Evaluation System, or CURES — could go a long way in limiting unnecessary and dangerous prescriptions, only about 8 percent of doctors in California use it, according to Pack. Proposition 46, one of the most controversial statewide ballot initiatives this year, would change that by requiring all doctors sign up for CURES and check the database before prescribing some of the most addictive narcotics.
http://www.eastbayexpress.com/...
Paul R. Phinney, former chief of pediatrics at two Kaiser Permanente facilities in the Sacramento area for over 14 years and the most recent past president of the California Medical Association expressed his concerns about the proposition in his opinion piece published in the Sacramento Bee.
The database in question – the Controlled Substance Utilization Review and Evaluation System, or CURES – is problem-plagued and slow. Even the state staffer who oversees it has testified that the system currently “is not sufficient enough to carry out the mission that we need.”
http://www.sacbee.com/...
A third problematic section in the measure, especially for civil libertarians and some liberals, is the requirement that all doctors in California undergo random drug testing.
Civil rights advocates argue that the physician drug-testing program would be unprecedented, overly broad, and a clear violation of doctors' privacy rights. And so while the mandatory use of CURES could go a long way in curbing prescription drug abuse and overdoses by doctor shoppers — a cause that may resonate with many California voters, given the current narcotics epidemic — the provision to force doctors to undergo drug tests could prompt many liberals to vote against the measure.
http://www.eastbayexpress.com/...
Drug testing of doctors has nothing to do with the tragic event that inspired Proposition 46. It was added by proponents of the measure because it tested well in focus groups and so "they thought it would make the package of doctor accountability reforms more appealing to voters." A disturbing flaw in this component is that almost anyone can file a complaint of possible drug or alcohol use by an "on duty" physician, or "failure to follow the appropriate standard of care." A disgruntled employee can file a report. A patient who was refused an unnecessary prescription or M.R.I., can file a report. If unable to comply within twelve hours the doctor's license is suspended in the interim making it impossible for them to practice and make a living until the matter is resolved. To add insult to injury, the doctor is required to pay for the test. And the question of what constitutes "on duty" is not spelled out. Does it include a doctor on call, answering a question from a patient or another medical professional over the phone? Does it include a doctor who is not on call but is contacted by phone or email about an unforeseen event such as a premature delivery or an injury?
Mandatory drug tests will also be required in the case of so-called "adverse events" and that term refers to a wide range of medical errors.
"If there's an adverse event, you have to return in twelve hours, or you are presumed negligent," said Richard Thorp, president of the California Medical Association, and president and CEO of Paradise Medical Group in the Central Valley. In some cases, he noted, an adverse event may not come to light for days or even weeks after a patient received care. That means that a drug test would not reveal anything about whether the doctor in question was under the influence while on duty.
http://www.eastbayexpress.com/...
Doctors could therefore have their licenses suspended simply because they did not submit to a drug test in the required twelve-hour period.
Then there is the matter of the state DOJ keeping this data base of patients who have been prescribed scheduled medications. This data includes name, address and date of birth. The DOJ has been keeping watch on these medications for a long time but now the number of people accessing it and the amount of data entered will multiply. It will be available to doctors, pharmacists, and "some other persons," including law enforcement and perhaps the occasional hacker. This could be considered a violation of doctor/patient confidentiality and in light of the many data breaches of on-line databases is a concern for many voters across the political spectrum.
And Proposition 46 will of course raise the cost of malpractice insurance to Doctors. My sister's family practice group expects their premiums will go up, just how much they don't know, while surgeons, gynecologists and other higher risk specialties will rise even more. These costs will be passed on to the consumer.
The independent Legislative Analyst’s Office cautions that Proposition 46 could increase state and local government costs by up to “several hundred million dollars annually.” Another estimate says the overall burden on California’s still-fragile economy would be even higher – roughly $1,000 annually for a family of four. Taxpayers would be stuck footing the bill.
http://www.sacbee.com/...
Many doctors – particularly in high-risk specialties such as obstetrics and gynecology – could be forced to reduce or eliminate vital services, especially for patients in underserved areas, one reason why California Association of Rural Health Clinics and the California State Association of Counties oppose the proposition.
CSAC is the unified voice in Sacramento for California’s diverse 58 counties. It is the latest respected local government organization to oppose Proposition 46, joining the League of California Cities, California Special Districts Association, California School Boards Association, Urban Counties Caucus and Rural County Representatives Association of California. In fact, every local government association in California that has taken a position on Prop 46 opposes the measure.
“Proposition 46 would make it much harder for California counties to deliver vital care to millions of patients and will increase costs for local governments and taxpayers by hundreds of millions of dollars a year,” said Matt Cate, the executive director of the California State Association of Counties. “This fiscally irresponsible measure must be defeated to protect patients and taxpayers.”
http://www.noon46.com/...
Politics can sometimes forge strange alliances, and this is certainly the case with Proposition 46. The CMA, ACLU, the California Teachers Union, Planned Parenthood of California, the President of California Association of Nurse Practitioners, California Association of Rural Health Clinics, the California Dental Association and the Chair of the American Academy of Pediatrics, California, the Republican Party, progressives and libertarians have joined the insurance industry in opposing this initiative. Boxer, Pelosi and Erin Brockovich and Consumer Attorneys of California, have joined mothers of victims of preventable medical error and Consumer Watchdog in support. Here is the link for a complete list of organizations opposed to Prop 46: http://ballotpedia.org/...(2014),_opponents
Here is the link for the list of the seven organizations supporting Prop 46: http://ballotpedia.org/...(2014)
I believe Boxer and Pelosi are wrong on this one, and I never thought I'd be siding with insurance companies and the Republican Party on anything. Despite its good intentions however, Proposition 46 tries to fix far too many problems in one measure. Even though it was inspired by a real and probably preventable tragedy, it is poorly written and is really an insult to the thousands of medical professionals who are conscientiously and expertly providing care and saving lives every day in this state. Every single piece of this measure brings the hammer down on doctors. I'm all for doctor accountability but what about patient accountability? Doctors and Pharmacists already explain the proper use of these medications when prescribing and dispensing them, and the directions are printed on the labels and accompanying documents. And if they suspect a problem then they can and already do check CURES. Preventable medical errors and drug testing should be dealt with separately. I do believe it is time to revise and update MICA, but in their attempt to solve all of these other issues the measure's authors overreach. All of these problems need to be addressed specifically in more effective ways. Some progressives may be tempted to vote Yes believing this is the best opportunity to raise the cap on non-injury compensation awards and that the other items will be struck down later in court. I say we can't take that chance. Please Vote NO on Proposition 46.