Legislator vows action on reckless prescribing of addictive pills

The leader of the California Senate says holes in the state’s oversight of physicians, exposed in recent Los Angeles Times articles about prescription drug deaths, are “extremely troubling” and need to be corrected “as quickly as we can.”

Darrell Steinberg (D-Sacramento) said he would put his political muscle behind legislation to give the Medical Board of California more investigators and broader authority to stop reckless prescribing of addictive medications.

He said he would champion other measures as well, including a bill to require California’s county coroners to report to the medical board all fatal overdoses involving prescription drugs, so the board can determine whether excessive prescribing played a role.


In interviews, Steinberg said he was acting in response to recent Times articles about the epidemic of prescription drug deaths and the role played by corrupt or negligent physicians and pharmacists.

He said he was particularly concerned that the medical board’s enforcement staff is smaller than it was a decade ago, even as the number of physicians in California has increased to more than 102,000, and that the board now opens 40% fewer misconduct investigations per year than it did 10 years ago.

“This is an example of where the recession and the budget cuts result in a real consequence for the public,” said Steinberg, president pro tem of the Senate. “This is extremely troubling and must be remedied to prevent more injuries and death.

“Ultimately, it is our responsibility to protect the public,” he said.

Fatal overdoses involving Vicodin, OxyContin and other prescription narcotics have risen sharply in the last decade, fueling a doubling of drug fatalities in the United States. Authorities have focused on how addicts and dealers obtain such medications illegally, such as by robbing pharmacies or raiding family medicine cabinets.

The Times, by studying coroner’s records across Southern California, identified 3,733 fatal overdoses from 2006 through 2011 and determined that nearly half stemmed from drugs prescribed for the deceased by his or her physician.

A small cluster of doctors was associated with a disproportionate number of those deaths. A Huntington Beach pain specialist wrote prescriptions for medications that caused or contributed to 16 deaths. A San Diego County doctor lost 15 patients to overdoses, a Westminster physician 14, coroners’ records show.

All three of those doctors have clean records with the medical board, and there is no evidence that board officials knew about the deaths.

Steinberg said he would explore ways to pay for additional investigators for the agency.

The board is funded by physician license fees. During the fiscal crisis of the last decade, governors took millions of dollars from the board’s budget to fill holes elsewhere.

In releasing a proposed state budget last week, Gov. Jerry Brown projected a surplus in the next fiscal year because of voter-approved tax increases and an improving economy. His budget proposal envisions a 1.6% increase in medical board revenue, to $57.6 million.

Brown did not propose adding staff to the agency.

The Legislature is set to take a close look at the board’s operations and spending this year as part of its Sunset Review, a process for reauthorizing state agencies.

Steinberg said he will work with state Sen. Curren Price (D-Los Angeles), chairman of the medical board’s oversight committee, to put together a “legislative package” to address gaps in its oversight of physicians.

One of those stems from limits on the board’s power to suspend the prescribing powers of doctors under investigation. In some other states, regulators can do so on their own authority. In California, they must go before a judge to seek an interim suspension order, a step they take only rarely in cases involving excessive prescribing.

The Times identified at least 30 cases in which patients died of overdoses or related causes while their doctors were under investigation for dangerous prescribing.

“It is worth a fresh look at whether or not, in the most egregious cases, there should be a faster process,” Steinberg said.

Price introduced a bill last week to require county coroners to report overdose deaths involving prescription drugs to the medical, pharmacy and other healthcare licensing boards. The medical board had requested the bill in response to the Times articles, saying it was unaware of most of the overdose deaths linked to doctors’ prescriptions.

The Times articles also focused on a state database that includes records of all prescriptions for addictive medications, including the names of patients and prescribing physicians. The system, known as CURES, was designed to help doctors and pharmacists prevent patients from obtaining and filling prescriptions from multiple doctors.

The U.S. Centers for Disease Control and Prevention has urged states to use such databases to detect reckless prescribing and dispensing by doctors and pharmacists. At least six states do so. California is not one of them.

State Sen. Mark DeSaulnier (D-Concord), a longtime supporter of CURES whose father struggled with substance abuse, said he will introduce legislation to improve the database, and to require that authorities use it to look for reckless prescribing and dispensing.

DeSaulnier said that although similar bills he proposed in the past have failed, a “critical mass” of lawmakers and state officials has coalesced around the idea, in part because of The Times’ articles.

Assemblyman Bob Blumenfield (D-Woodland Hills), chairman of the Budget Committee, said that he would push a similar bill and that he also wants regulators to use CURES to spot excessive prescribing.

“We need to put some more teeth into it,” Blumenfield said.

A spokesman for the governor said he was open to proposals to improve CURES.

Sharon Levine, president of the medical board, said its members plan to study prescription monitoring systems in other states and look forward to working with legislators to make CURES more effective.

“Our highest priority is to…make the CURES system truly a useful, functional and rapidly responsive tool to assist physicians, pharmacists, regulatory Boards and law enforcement in doing their job in identifying patients at risk and practitioners operating in a negligent or unlawful way,” she said in an email.