Five years ago, a state program to help doctors struggling with addiction was shut down after repeated audits found it failed to hold addicts accountable and fell short in protecting the public. While there is widespread support for current legislation that would replace the program, the process has been contentious.
Consumer advocates and the Medical Board of California are insisting that the new program not be run by leaders of the former version. A legislative analysis questioned whether the bill might unfairly steer the contract to one group before bids were sought.
And debate over how to best protect patients from drug-addled doctors, while giving doctors needed support, has continued even as today's deadline to amend bills was approaching.
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“Helping physicians get the help they need to practice medicine safely, before something bad happens to a patient, is ultimately in the best interests of patients and the public,” Senate Pro Tem Darrell Steinberg, who is carrying the bill, said in a statement. He said California is one of only five states in the nation that does not have a program to oversee services for doctors with addiction or mental health challenges.
The proposed physician health program would levy a $40 license fee on doctors. The funds would create a committee to oversee a contractor that would educate doctors about addiction, serve as a resource and track their rehabilitation efforts. Doctors would pay for their own rehabilitation.
Lawmakers have made several changes to the bill in recent months.
One set of changes erased language that, according to one legislative analysis, seemed to “unfairly give an advantage” to one nonprofit that may get a multimillion dollar contract to run the program.
The analysis says the nonprofit California Public Protection & Physician Health Inc. stated on its website that it hopes to see a law passed authorizing a fee that would support its mission to help doctors who are dealing with addiction.
“It would appear from these statements that the CPPPH built into its business plan the assumption that a (physician health program) would be legislatively mandated, including funding through license fees,” an analysis of the bill, SB 1483, says. “This bill does both.”
The California Medical Association, which represents 35,000 doctors and co-sponsored the physician health bill, shares a board president and other leaders with California Public Protection & Physician Health. Key staff members of the nonprofit, the organization's website shows, also held key roles running the former diversion program, which was criticized for shielding addicted doctors from the scrutiny of the medical board.
Lisa McGiffert, director of the Consumers Union Safe Patient Project, which opposes the bill, said the passages on contracting did “not pass the smell test” and made it appear that the contractor was hand-picked even before a law was passed.
The state medical board, which oversees doctor discipline, wrote a letter to Steinberg saying it would take a neutral stance on the bill if it were amended to prevent those in charge of the prior doctor-diversion program from leading the new program. The Center for Public Interest Law is seeking the same amendment.
In July, the bill was amended to eliminate requirements that seemed to favor California Public Protection & Physician Health as a leading contract contender. Language removed from the bill said the appointed contractor would “have established relationships with local medical societies and hospital well-being committees. …”
Members of the two other co-sponsors for the physician health bill, the California Psychiatric Association and California Society of Addiction Medicine, along with the California Medical Association, make up all but two seats of the nonprofit's board.
Russ Heimerich, a spokesman for the state Department of Consumer Affairs, which would house the new physician health program, said the department has rigorous contracting requirements that go through several layers of review.
The California Medical Association did not return a call for comment but did share a letter in support of the bill.
“The physician community believes that it is critical that we create and finance this effort ourselves, for our fellow physicians, in order to provide a single place for them to go when seeking information on and help acquiring treatment,” the letter to Assembly lawmakers says.
Edward Howard, of the Center for Public Interest Law, said he hopes to see the new program avoid the pitfalls of the prior one, meaning that doctors will not be shielded from the scrutiny of authorities who investigate negligence or other bad behavior.
While the medical board accepts complaints about doctors from the public, physician peers, hospitals and insurers, the former diversion program handled all complaints about addiction. The new bill does not divert those complaints from the medical board.
“Whenever there is a physician in this program, and that physician fails their drug tests, fails the program or withdraws, and could currently be seeing children, the elderly or performing surgery, the fact that that physician flunked out has to be reported immediately to (the medical board),” Howard said.
As of Wednesday, the bill said doctors would be reported to the medical board for failing to meet the requirements of a drug treatment program. Yet the bill did not say disciplinary authorities would be notified if a doctor is terminated, leaves a rehab program or is deemed unfit to practice medicine.
Mark Hedlund, a spokesman for Steinberg, said the bill was expected to be amended to ensure reporting to the medical board in each scenario.
Correction: A previous version of this story misstated the organization seeking an amendment to the bill and the organization affiliated with Edward Howard. They are both the Center for Public Interest Law.