Activists advocating statewide mandatory drug and alcohol testing for doctors took their case this weekend to the streets of Anaheim, just outside the Disneyland Hotel as doctors and their advocates met inside for the annual convention of the California Medical Association, which represents 35,000 doctors statewide.
“I don’t see why in the world it wouldn’t be appropriate for them to be drug tested,” said James Kennedy of San Clemente, who has testified that his son Joseph, who was addicted to prescription medication, died from an overdose after a “dirty doctor” known as “the Candy Man” prescribed a dangerous combination of Xanax and methadone in exchange for $150 in cash.
“For goodness sakes, even car salesmen are drug tested before they can be employed,” said Kennedy, adding that he suspects many of the doctors who supply addicts are themselves under the influence.
Activists with the group Consumer Watchdog are advocating the testing requirement as part of a package of medical reforms in a proposed statewide ballot measure for next November.
The Troy and Alana Pack Patient Safety Act would also require doctors to report colleagues they know are under the influence while on duty, check a patient’s prescription history before prescribing narcotics and increase the state’s $250,000 cap for non-economic losses in medical negligence lawsuits.
It needs about 505,000 signatures by Feb. 10 in order to qualify for next November's ballot.
The campaign comes amid growing attention to the issue of prescription drug addiction – with prescription drug-related deaths nationwide now outnumbering those from heroin and cocaine combined.
About 21 percent of the general population suffers from drug or alcohol abuse at some point in their lifetime – with similar rates for healthcare professionals, according to a Medical Board of California publication.
“Yet the person who’s operating on your child’s heart doesn’t have to undergo drug testing,” said Balber. “Shouldn’t doctors have to pee in a cup too?”
The California Medical Association's president, Dr. Paul Phinney, said the activists’ proposal was simply a ruse raise the cap on negligence lawsuits and divert more healthcare money into the pockets of attorneys.
“The activity that you see going on today here around Disneyland is really window-dressing. What the proponents are trying to do is change a law that works very well to protect patients and access to care,” said Phinney.
“Were it to pass, community clinics would have to close, patients would have a lot of trouble finding a doctor, and a lot more money would go into the pockets of trial lawyers. It’s a simple as that, and it’s really too bad that these folks have chosen to bring such an unhappy message to the Happiest Place on Earth.”
Activists disputed Phinney’s claims, saying the measure stems from the experience of Bob Pack, whose young children were killed by a painkiller-addicted driver.
Pack “lost his two children – Troy, who was 10, and Alana, who was 7 – on the side of a road in Danville while they were walking to get ice cream with their mom, because a drug-addicted driver who had taken a handful of Vicodin and drank vodka fell asleep at the wheel, careened across the road, and ran over his wife and two children. His wife survived, the children died at the scene,” said Balber.
Pack “found out that the driver had been overprescribed thousands of narcotic pills from six doctors at the same Kaiser facility. So no one was checking if this patient needed those medications, what her prescribing history was. No one was checking to see if she really needed all the pills that they had prescribed her,” she continued. “So it was reckless prescribing.”
When Kaiser wouldn’t change their policies, Balber said, Pack decided to sue in order to force them “to change their practices and make sure this kind of overprescribing didn’t harm another family.”
“But because of this $250,000 cap on the value of his children’s lives, lawyers couldn’t afford to take that case. So because California’s law limits recovery in cases of medical negligence for things like a child’s death, most parents can’t hold the doctors accountable in court, because it’s too expensive to bring one of these cases,” said Balber.
The $250,000 cap – known officially as MICRA – was set in 1975. The proposed law would adjust that amount based on inflation.
“At the end of the day, this is definitely about updating California's patient safety laws that haven’t changed in 38 years,” said Balber.
Asked about the specifics of the proposal, the medical association chief repeated that the activists’ proposal isn’t really about improving patient safety.
“My heart goes out to families like that, that have something happen that is tragic,” Phinney, said of Kennedy. “But that’s not what this initiative [is] about. What this initiative [is] about is changing a law that works really really well to protect patients and protect patients' access to care.”
“Frivolous lawsuits don’t help anybody, except pull more money out of the system into the pockets of trial attorneys,” he added.
Phinney said efforts should continue to find better ways to prevent the rare cases of doctors abusing prescriptions.
“We need to look every day at ways to increase the appropriateness of finding that occasional doctor who needs to change. And that’s going on now,” he said.
Phinney mentioned the association’s support for a recently-passed state law that boosts funding for an antiquated computer system that tracks prescriptions issued by doctors statewide.
Activists shot back that the medical association actually weakened that measure, SB 809, before it was signed into law.
The bill had required that doctors actually check the database, known as CURES, before prescribing narcotics – something that the medical association successfully lobbied to remove, activists said.
The medical association says that while it’s not necessarily aware of inaccuracies with the system, it should be in good operating condition before doctors have to check it.
“From our perspective it’s important to get the CURES database up and running before we start mandating” that it be checked by doctors, said Molly Weedn, a spokeswoman for the medical association.
As it stands, the system is “basically like using dial-up internet,” she added, with information not tracked in real-time. That means someone could be prescribed pills at a doctors office, then go to the emergency room and the system wouldn’t show ER doctors what the patient had just been prescribed, said Weedn.
Activists also said that the medical association successfully lobbied to remove a section from another bill – SB 62 – that would have required coroners to report prescription drug overdose deaths to the state Medical Board.
Yet the medical association says they didn’t take a position on that bill.
Additionally, activists said the medical association gutted provisions from another bill – SB 670 – that would have given the state Medical Board greater power to temporarily suspend a physician's license when they recklessly or illegally prescribe medication.
The medical association said it had significant concerns about that provision, which would have “interrupted the continuity of care for patients.”
Weedn said that original bill’s standard for suspending a license – probable cause – was too low.
“For us that’s not a high enough standard to take away someone’s ability to take care of their patients and their livelihood,” she said.
The association believes that “clear and convincing evidence” should be the standard, said Weedn, adding that the medical board has other options at its disposal like getting a court-ordered injunction or temporary restraining order.
Activists, meanwhile, say the medical board investigations often drag on for years with virtually no action against overprescribing doctors.
A Los Angeles Times investigation last year identified 71 physicians in Southern California who each prescribed drugs to three or more patients who ultimately died from prescription drug overdoses.
Most of those physicians had clean records with the state Medical Board, the Times found.
“The doctors are the gatekeepers [for] how these drugs get to the street, and we need to start monitoring what they’re doing and how they’re doing it,” said Natalie Costa, who produced a documentary on prescription drug abuse in Orange County.
The medical association reiterated that the activists’ efforts are simply a distraction.
“Other provisions in the measure…are again – nothing more than windowdressing for the real issue here, and that's raising the cap on MICRA,” said Weedn, the association’s spokeswoman.
The parents, meanwhile, say their motivation is to prevent more unnecessary deaths.
“Our fight is not with the wonderful doctors who responsibly treat their patients every day and save lives. Our fight is with the system that would rather protect dangerous doctors than protect patient safety," said Tammy Smick, who said her son Alex died after he was prescribed a lethal combination of medications at a hospital and was then left unmonitored.
“In memory of our beloved son, we fight for change in hopes that no other parents suffer the unbearable loss of a child due to negligent doctors.”