Profession
California ends beleaguered program for impaired doctors
■ The physician diversion program has received bad reviews since first audited in 1982.
By Damon Adams — Posted Aug. 27, 2007
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California medical leaders want to hold a summit to determine how to rehabilitate impaired doctors now that a state program is being abolished.
The Medical Board of California on July 26 voted to end its physician diversion program by June 30, 2008. The board concluded that running the confidential program that supports and monitors physicians who have drug, alcohol or mental problems was inconsistent with its mission to protect the public. Doctors refer themselves, or the board places them in the program instead of disciplining them or as part of discipline.
The board's vote came after a June review -- the fifth audit of the program in its 27 years -- found the program is not protecting patients.
Lapses in monitoring cited
"I think it's worse than any of us know. It's scary," said Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego School of Law. She audited the board and its diversion program in 2004. "It has flunked all five of those audits."
Fellmeth's report said the board did a poor job overseeing the program. She said the program failed to monitor physicians and many were not tested as frequently as required.
A June California State Auditor report cited similar problems, pointing to inconsistent monitoring of doctors and poor medical board oversight. The audit said the program failed to conduct random drug tests, did not require doctors to immediately stop practicing after testing positive for alcohol or drugs, and did not quickly identify missed drug tests.
At the July 26 medical board meeting, Fellmeth and others criticized the program.
"If the program is not adequately monitoring doctors, patients are at the mercy of this program," she said.
Medical board president Richard Fantozzi, MD, said ending the diversion effort is the right choice.
"Some doctors would game the system. They were supposed to have an office monitor, and it was somebody who was working for them," said Dr. Fantozzi, a head and neck surgeon in San Diego. "All the audits pointed out the flaws."
Seeking other solutions
But some groups, including the California Medical Assn. and the California Society of Addiction Medicine, argued to improve, not eliminate, the program.
"The diversion program protects patients better than not having a diversion program. We think they're now driving the problem underground," said CMA Speaker of the House James Hay, MD, a family physician in Encinitas, Calif.
Dr. Hay said the diversion effort encourages physicians to seek help before a patient is hurt. Without it, discipline would be the only option for impaired physicians, a formal process that could take a year or more to get a physician to stop practicing while subjecting patients to risk.
"We believe the likelihood of patient harm has been increased," Dr. Hay said.
California is one of a few states whose medical board operates its impaired physicians program. Other state medical boards contract with private companies or a state medical society to run their programs, according to experts.
Advocates say a program is needed
Luis T. Sanchez, MD, president of the Federation of State Physician Health Programs, said his group would offer its help to California leaders seeking solutions.
He said physicians do not get appropriate help unless a state offers a physician health program that treats them fairly.
Dr. Fantozzi, of the medical board, said approximately 300 physicians in California's diversion program would be transferred to private programs. He said the board has called for a summit this year with professional organizations, consumer groups and others to explore a new way to monitor impaired physicians. He said a statewide diversion program could be created to oversee all licensed professionals in the state.
Fellmeth, of the Center for Public Interest Law, said there should be a new diversion program, just not one run by the medical board.
"I certainly don't want to discourage physicians from seeking help," she said. "But the way that this program was run clearly did not protect patients."