The prescription drug epidemic is a serial killer, claiming thousands of lives in the U.S. each year.
Opioid pill mills, trading in dangerous narcotics like oxycodone, have been shut down in Southern California and beyond, but investigators say there's more work to be done.
Doctors have been arrested and prosecuted, including a Rowland Heights physician convicted of murder a year and a half ago in the deaths of three patients who overdosed on prescription meds.
So here's a quiz.
A bill pending in Sacramento would:
A) Strengthen protections for patients and the general public.
B) Stiffen sanctions against offending doctors.
C) Make it easier to prosecute dirty doctors.
D) Make it harder to prosecute dirty doctors.
Hard to believe, but the answer is D.
As the law stands now, officers who investigate tips about doctors who write questionable prescriptions can check a monitoring database maintained by the California Department of Justice. There, they can look for patterns, or connections to criminal enterprises including big-time distributors and gang operations.
This database, which goes by the unfortunate name of the Controlled Substance Utilization Review and Evaluation System (CURES), is a vital resource, law enforcement officials say.
Is this helping patients or doctors?
But under Senate Bill 641, by Sen. Ricardo Lara (D-Bell Gardens), law enforcement officials would need to get a search warrant before using CURES to check on a doctor.
Why the change?
"Given the sensitive and confidential nature of the information within this system, there is a need to strengthen patient privacy protections," Lara said in a statement emailed to me by his staff.
Lara, who is running for state insurance commissioner and is the author of California's pending single-payer healthcare bill, said New York and Oregon require judicial permission before investigators can access their prescription-monitoring systems.
The patient privacy spin is also coming from the bill's biggest cheerleader — the California Medical Assn., a powerful lobbying force on behalf of doctors.
"People expect their medical records to be kept private," Joanne Adams, associate director of communications for Cal Med, said in a statement. "But the law does not currently hold medical information in CURES … to the same standards that protect medical records in hospitals and doctors' office."
Well, if it's such an invasion of patient privacy, why hasn't there been an outcry from patients in the decade or so that CURES has been in use?
Critics argue this isn't at all about protecting patients. Rather, it's about protecting doctors by trying to keep investigators out of their business. In a somewhat related matter, there's a case before the state Supreme Court right now in which a doctor is arguing that the state medical board violated his patients' privacy in using information obtained from CURES to suspend him for three years.
Why make it harder to catch bad doctors?
Prosecutors aren't going after good doctors, but the tiny minority of those who shouldn't be in practice. So why do we need this bill at all?
Lara's staff denies it has anything to do with $11,000 in campaign donations to Lara from the California Medical Assn. He's received loads more from other medical industry sources, by the way.
Lara's staff claims the senator is trying to find a fair balance between investigative authority and privacy rights. The bill has already been amended and may come in for more fine tuning in the future. Lara has been at odds with Cal Med in the past, his staff notes. Last year, the doctor lobby was no fan of a Lara bill (SB 482) that required doctors to check the state's prescription monitoring database before writing scripts for opioids.
Some people are confused about where Lara really stands.
"I'm very surprised he is carrying this bill," said Bob Pack, a Bay Area man who worked with Lara on SB 482.
Pack, who has written two letters to Lara's office protesting the current bill, has a personal connection to the issue. His two children, 10 and 7, went out for an ice cream with their mother in 2003 and were struck and killed by a driver who was under the influence of alcohol and prescription drugs. Pack, who works in tech, helped design CURES. And he isn't buying the patient-privacy argument.
"Law enforcement has to get a warrant in order to investigate a patient. That's already required," said Pack. "Why would you try to inhibit looking for and catching a bad doctor who is going to cost lives or has cost lives?"
Time to pull the plug?
L.A. County Deputy Dist. Atty. John Niedermann is with him.
"You're basically saying law enforcement can't investigate bad doctors without first establishing probable cause, while at the same time you're eliminating one of the most effective tools at providing probable cause," said Niedermann.
The prosecutor handled the case of Dr. Hsiu-Ying "Lisa" Tseng, who was sentenced last year to 30 years in state prison for the deaths of three patients. An L.A. Times investigation found that at least eight of the doctor's patients had died of overdoses from the same type of drugs she had prescribed to them.
Niedermann said information obtained on CURES helped establish Tseng's deadly prescription writing habits.
"You need that data," said former L.A. County Sheriff's Sgt. Steve Opferman, who worked as an investigator and supervisor for a special drug task force. "If you get a tip that someone has died from an overdose, you want to check and see if that doctor is overprescribing."
Assistant U.S. Atty. Ben Barron said CURES data were critical to the prosecution of Dr. Nazar Al Bussam of Los Angeles, who was prescribing narcotics more than twice as much as the next highest script writer in California. Al Bussam, linked to three patient deaths in an L.A. Times investigation, was sentenced to seven years in prison in 2011. Prosecutors said he had generated nearly $2 million in cash while prescribing addictive narcotics to addicts and drug dealers.
Opferman and other law enforcement officials, current and former, said there's no time or manpower to launch full investigations on every tip or hunch, so CURES helps them focus resources and zero in on true offenders. They also said they've often used CURES to determine that a doctor is clean and no investigation is warranted.
If patients have an issue with the way investigators are attacking this epidemic, I haven't heard from them. I suspect that like me, they appreciate the strong journalism and aggressive prosecution that are bringing down dirty doctors.
This is a bad bill. Time to pull the plug.