Driven around Oakland lately, and noticed anything, well, large and troubling? That would be a billboard at 22nd Street, almost at Grand, boldly declaring that 2 in 10 doctors will be alcohol or drug impaired, with a toll-free number to report suspected abusers.
Say what? That’s 20 percent. And what does “will be … impaired” mean, exactly? Bending over a fractured tibia while in the operating theatre? At a weekend barbecue? Happy hour poolside at the retirement community?
The sign, which went up in January, is intended to grab attention as part of a public education campaign by the nonprofit advocacy group, Consumer Watchdog of Malibu, whose separate political wing is lobbying to get a ballot initiative before voters next November that would require mandatory drug and alcohol testing of physicians, says Carmen Balber, Consumer Watchdog’s executive director.
“The billboard specifically is to raise awareness; hopefully by raising awareness the public is participating in making reform happen,” Balber says. “All of our work intends to catalyze change.”
But nailing down the number of abusing doctors is tricky, as many agree.
The 2 in 10 statistic comes from a 2000 report by the state medical board, which estimates that 18 percent of physicians may abuse drugs or alcohol in their lifetime, based on treatment professionals. It gauges the rate in the general population at 15 percent. The report also notes the difficulty in getting accurate numbers.
Frank Miller, a California Medical Board analyst, says Consumer Watchdog’s selective wording is misleading, pointing out that the report also says, “it is important to note that although the lifetime risk for [all] abusers may be 15 to 18 percent, the percentage of those who are addicted and need treatment at any given time is closer to 1 to 2 percent of the population.”
“The board encourages people who suspect physicians of substance abuse to report it to [us],” Miller adds.
While hospitals, HMOs, or other employers may have their own internal drug and alcohol testing programs for physicians, it’s not required by law. The medical board, the agency tasked with licensing, de-licensing, and reprimanding doctors, investigates claims of malfeasance, including ones related to substance abuse. And the National Practitioner Data Base, or NPDB, tracks problem doctors such as those who’ve had their licenses revoked, to prevent interstate practice hopping.
One window into the problem’s scope comes from the board’s actions. In 2012–13, for example, it investigated 483 claims of personal misconduct, which includes drug and alcohol abuse and conviction of a crime, out of 128,641 licensed doctors. Of the 483, it took 46 enforcement actions against physicians for drug and alcohol abuse, ranging from revoking a license (eight) to probation, without a license suspension (21).
But this only covers complaints reaching the board, which is a limited sample.
Neither the board, the national practitioner data base, or the Substance Abuse Mental Health Services Administration, or SAMHSA, has recent estimates of abusing doctors. SAMSHA puts the general adult population abuse rate at 8.5 percent.
Balber acknowledges the challenge. “We don’t know 100 percent how accurate the number is,” she says referring to the 18 percent. “If there’s one alcohol or drug abusing doctor out there, it’s too much.”
Zealous and effective, but often incendiary, Consumer Watchdog is known for attention-grabbing tactics and draws fans and critics.
The November ballot initiative, called the Troy and Elana Pack Patient Safety Act, for the two children killed by a drunk, painkiller-fond driver in Danville in 2003, is about far more than doctor drug testing. Bob Pack, the children’s father, is the initiative’s sponsor.
The initiative also proposes to require physicians to consult the state’s online CURES database, which tracks narcotics’ prescriptions to curb doctor shopping by addicts, before prescribing controlled substances to new patients. (CURES also was initiated by Pack.) And it requires inflation adjustment to the $250,000 cap on malpractice compensation for noneconomic damages such as pain and suffering, which was established in 1975. So far, Consumer Watchdog has collected around 830,000 petition signatures—enough to qualify the measure for the ballot, Balber says.
The California Medical Association is among groups opposing the potential initiative.
“The measure would drive up health care costs, limit access to care, and make it easier for lawyers to sue doctors and hospitals,” said Molly Weedn, association spokesperson. “What’s more, its proponents are deceptive about their real intention, which is to increase the limits on medical malpractice awards so that trial lawyers make even more money.”
Balber counters that the opposite is true: “We’re talking about preventable injuries, and these drive up health care costs,” she says.
Founded in 1985 by lawyer Harvey Rosenfield, who counts Ralph Nader among his former bosses, Consumer Watchdog has primarily targeted the insurance industry, but its issues also include energy regulation and citizen privacy, as well as patient safety.
Impacts from its actions include passage of the automobile insurance pricing reform measure Proposition 103 in 1988, a Medicare expansion of prescription drug coverage, a Los Angles prescription drug-savings program, and California’s Patient Bill of Rights, among others.
The group’s eye- or media-catching antics include delivering a truck load of manure to an insurance company when battling for car insurance pricing reform, dumping pinto beans to symbolize bean counters at an HMO conference when fighting for patient’s rights, and chartering two trainloads of seniors to Canada to buy prescription drugs during the 2004 Presidential debates, dubbed the Rx Express. Live pigs at hearings. Gov. Gray Davis on milk cartoons.
It’s heralded, and it draws detractors.
Most recently in the Bay Area, the organization was criticized for hooking a funding drive to the deeply emotional and polarizing case of Jahi McMath, the young girl who was left brain dead after a complicated tonsillectomy at Children’s Hospital and Research Center Oakland. Her family fought successfully to move her to an undisclosed location. Their attorney, Christopher Nolan, told the Associated Press that it was wrong for Consumer Watchdog to invoke the girl’s name to raise funds.
Then there’s ComsumerWatchdogWatch.com, a website launched by Steven Maviglio, a Democratic activist who runs a Sacramento-based public relations firm. Maviglio, among other things, questions Consumer Watchdog’s funding, calling for more transparency.
Balber calls Maviglio, “A political hack paid for by the insurance industry.”
The billboard’s Oakland location was pointed at the hometown of Kaiser Permanente’s headquarters, Balber says. Consumer Watchdog has been asking the past president of the state medical association, a Sacramento-based Kaiser physician, to respond to questions about physician substance abuse, and hasn’t heard back.
As for the billboard’s toll-free reporting number, which connects to Consumer Watchdog: Zero calls so far. “I do think it’s raising awareness, but it certainly isn’t generating a flood of responses,” Balber says.