Lawmakers want the medical board to use a state database to identify doctors who prescribe drugs recklessly.
SACRAMENTO — After hearing emotional testimony from parents whose children died of drug overdoses, lawmakers in Sacramento called Monday for the Medical Board of California to mine a statewide database of prescriptions to help identify doctors who recklessly prescribe narcotics.
"If we are going to take seriously the role of patient protection, then we have to be proactive in determining if there is a pattern of overprescribing," said Assemblyman Richard Gordon (D-Menlo Park), who co-chairs a joint legislative panel that oversees the medical board.
One of the chief criticisms of the medical board has been its approach to investigating physician misconduct. Currently, the board launches investigations only in response to complaints. Several legislators said Monday that it should actively look for patterns of reckless prescribing in the state's database, known as CURES.
"We ought to be mining that database rather than waiting for complaints," Gordon said. "I don't think that the complaint-driven system has produced the appropriate results."
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Using CURES to target doctors who abuse their prescribing powers is a controversial step that has been discussed for years. Some physician groups said they fear using CURES that way would discourage doctors from prescribing the medications for legitimate pain treatment. The U.S. Centers for Disease Control and Prevention and many medical experts, however, recommend that states use such databases as an investigative tool.
In California, the database is used mainly to identify "doctor-shopping" addicts, who feed their habit by obtaining multiple prescriptions from different doctors. Even that type of identification is done on a very limited basis because of the system's technical shortcomings and bare-bones budget. Earlier this month, California Atty. Gen. Kamala Harris sponsored a bill that she said would upgrade the database and establish two criminal enforcement teams to investigate suspicious patterns of prescribing.
Monday's hearing before the joint Senate and Assembly committee was part of a review process to renew the medical board's legislative authority. Much of the hearing focused on issues raised in a series of Los Angeles Times articles that found that drugs prescribed by doctors played a role in nearly half of the prescription drug overdose deaths in Southern California from 2006 through 2011.
The Times reported that 71 physicians prescribed drugs to three or more patients who later fatally overdosed and several had a dozen or more patients who died. In most cases, the board was unaware of the patients' deaths. Cases in which doctors were investigated dragged on, sometimes for years, and patients died during the process, the paper reported.
Medical board President Sharon Levine told lawmakers that the articles helped raised "the profile and visibility of this issue," saying it was one that "everyone underappreciated."
Although Levine appeared to be reluctant to detail potential solutions without consulting with the full board, she said it had become clear to her that doctors in the state are prescribing too many dangerous narcotics. She attributed the problem to mandatory physician training in California that emphasizes the use of potent drugs to treat pain, "despite very little medical evidence" that they work on a long-term basis for most patients.
"We do have a physician workforce that we need to re-educate," Levine said. "In many ways, physicians have been misled by people exhorting them to treat pain."
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When asked why her agency didn't tap into the CURES database, Levine said her agency lacked the legislative authority to take such action. She also declined to take a position on data-mining, saying that her board had not yet discussed it. Later, in an interview with The Times, she acknowledged that she misspoke and the medical board does have the authority to mine the database, but lacked the staffing resources to do so.
Levine also said judges typically are reluctant to grant subpoenas for medical records on the basis of CURES data alone without a patient's signed complaint.
Gordon, in his interview with The Times after the hearing, said that if the standard for obtaining a subpoena for medical records on a suspicious physician is too high, then lawmakers should change the law.
"It seems to me that is the kind of thing we ought to be addressing in legislation if that is the problem," he said. "There is a way to balance the due process rights of a physician with patient protection. I'm not convinced that that line has been well drawn at this moment. We may need to redraw the line."
Sen. Ed Hernandez (D-West Covina) agreed, saying after the hearing that lawmakers need to give the board whatever it needs to start data-mining and physicians should welcome the scrutiny.
"If you are doing everything right, then you have nothing to worry about," said Hernandez, an optometrist whose privileges include writing prescriptions for narcotics. "It shouldn't bother anybody who is practicing ethically."
The most gripping testimony Monday came from parents — many of them wearing matching T-shirts with the word "ENOUGH" — who criticized the medical board for doing little or nothing to stop doctors from harming patients with their prescription pads.
"It's like the fox guarding the henhouse," said James Kennedy, an Orange County man who said his son paid cash for prescriptions for methadone and Xanax from a doctor so well known among addicts that he had been dubbed the "candy man."
Kennedy said his son, Joseph, fatally overdosed three years ago, and the doctor who prescribed to him is still practicing.
"The medical board does nothing to police their own," Kennedy said.
His comments were echoed by Tim Smick, whose 20-year-old son Alex, fatally overdosed last year after being prescribed drugs by a doctor.
"I'm a contractor. In my industry, if somebody dies on my job, the job is immediately stopped and everybody goes home," Smick said. "How many more deaths will be allowed before the California medical board stops dangerous doctors who fail to adhere to their own industry standard?"
Consumer advocacy organizations that monitor the board were also critical of the agency.
"The sun shouldn't rise again on this doctor-run medical board that has turned its back on patient safety for four decades to protect dangerous, drug-dealing, over-prescribing and other dangerous doctors," said Jamie Court, president of Consumer Watchdog, a patient advocacy organization based in Santa Monica. "Gov. Brown should reject this board's renewal if the Legislature is unwilling to significantly overhaul its makeup, culture and transparency."
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Girion reported from Sacramento. Glover reported from Los Angeles.
