Why doctors shouldn’t have their own secret programs to fight addiction

Like any scientist, doctors should have the ability to shun conclusions that have been proved wrong over and over again--especially cures that don't work.

That reality evidently stops at the door of the California Medical Assn. For the fifth time since 2008, CMA is pushing a measure in the state legislature to reestablish a substance abuse program for physicians that was repeatedly shown to be a failure during its 27 years of existence before its abolition in 2008. Like some of the association's previous efforts, this one has features that could actually damage patient safety.

What's the CMA's motivation? 

The organization's leadership declined a request to be interviewed, instead offering three lines of boilerplate describing the group's proposal as "a credible, statewide program that provides coordinated and reliable treatment options for physicians."

But the bill could set the stage for awarding a fat state contract to a treatment program co-founded by the CMA. Although the legislation mandates that all program costs be paid by doctors in the program, previous bills would have financed the program partially through physician licensing fees.

The bill also would strengthen the secrecy surrounding doctors' participation in substance-abuse programs. That may be good for doctors in treatment but not for the public.

"Patients won't be able to find out if their doctor has a substance abuse problem," says Julianne Fellmeth, a regulatory expert at the Center for Public Interest Law at the University of San Diego. "The bill makes that information confidential from the Medical Board too." 

Introduced by state Sen. Cathleen Galgiani, D-Stockton, Senate Bill 1177 is scheduled for a hearing April 18 before the Senate Business, Professions, and Economic Development Committee. Not to be indelicate, but the committee should pull the plug and hang a do-not-resuscitate tag on it.

Among its numerous shortcomings, the bill would prevent the Medical Board of California from tracking the progress of licensed physicians through their substance abuse programs.

Unless the board itself had ordered a doctor to undergo treatment, say, as a condition of probation, it would have no right to know whether the doctor had failed a drug test or flunked out. That's important because many physicians are forced into programs by their hospitals or partners or seek treatment voluntarily, without the board's intervention.

If the board is the referring agency, the bill says it would be entitled to reports on the doctor's progress. But it would be forbidden to use the information in a disciplinary case. 

Under most other scenarios, the records of the doctor's drug treatment would be confidential. 

Substance abuse among physicians and surgeons certainly is a serious public health issue. Some 10% to 12% of doctors are estimated to fall prey to drug or alcohol abuse during their careers, according to a 2009 survey by Keith H. Berge of the Mayo Clinic and Marvin D. Seppala of the Hazelden Foundation. 

That's about the same rate as the general population, but it raises special public policy concerns. Impaired doctors can present a risk to their patients' lives. But their "elevated social status," Berge and Seppala observed, can delay diagnosis and treatment.

Yet given the availability of private substance abuse programs, critics of the CMA bill ask why physicians and surgeons need a special state-sanctioned program, especially one with heightened rules of confidentiality. "No group in this country has more status or money to seek treatment," says Lisa McGiffert, director of the Safe Patient Project at Consumers Union.

California's record in government intervention has been especially troubled. The so-called diversion program for physicians and surgeons was established by the legislature in 1980 and placed under the Medical Board's jurisdiction. It proved to be a bad match. 

As the Medical Board's enforcement monitor from 2002-05, Fellmeth found the program "significantly flawed." For many participants, diversion was merely a device to avoid disciplinary sanctions.

"As with the CMA's four previous attempts," she told the state Senate committee in a blistering April 4 letter, "there is no need for this bill or the program it would create."

In five successive audits (including two by Fellmeth) state officials found that the program didn't adequately supervise its participants or validate their drug tests. In some cases, doctors could even time their drug use to be undetected.

At any given time, there were fewer than 275 physicians in the program although the number of licensed doctors in California exceeded 100,000. "This program was not even attracting the very tip of the iceberg of statistically-likely impaired physicians," Fellmeth wrote.

The program was killed by the legislature as of April 2008. At that point the CMA began its efforts at resuscitation, sponsoring bills in 2008, 2009, 2012, and 2014.

The first was vetoed and the others failed to reach the floor. The 2012 version died when an Assembly legislative analyst recognized that it was cleverly designed to deliver a state-funded contract to California Public Protection and Physician Health, the treatment program created by the CMA and other medical organizations.

"It would appear," the analyst wrote, "that the CPPPH built into its business plan the assumption that a [program] would be legislatively mandated, including funding through license fees." The bill would have done both. CPPPH is still around, and some of its executives and advisers are still active in pushing for a diversion program. 

The new bill doesn't have a provision for state funding, though critics believe such an amendment might yet appear. Plans are already underway for the bill to be amended so that it conforms to standards set by the Medical Board for substance abuse programs under its jurisdiction.

The board's staff in October recommended that any such program report any physician dropped from the program for any reason, including failing a drug test, and provide "strict documentation" of monitoring of the doctor's performance in the program. Those standards are ignored by the original bill, but sources in Sacramento say there are plans to amend it to meet the board's specifications. 

Still, if the legislature really believes that substance-abusing doctors are a threat to public safety--and they are--then creating a state program via SB 1177 is the wrong way to address the problem. In fact, it achieves something that the medical profession considers a cardinal sin: It makes things worse.

Michael Hiltzik's column appears every Sunday. Read his blog every day at latimes.com/business/hiltzik, reach him at mhiltzik@latimes.com, check out facebook.com/hiltzik and follow @hiltzikm on Twitter.