California gets tougher on substance-abusing physicians

After external auditors' critical reports and news media scrutiny, the California Dept. of Consumer Affairs in November announced strict new standards to make it more difficult for physicians and other health professionals who abuse alcohol and drugs to keep their licenses.

The standards call for doctors and other health professionals who were put on probation by state licensing boards to get tested 104 times a year for the first year and at least 50 times a year thereafter, for an unspecified duration. A positive drug test will mean an immediate month's suspension from work and a change in license status to "inactive," which will be disclosed publicly. Failing a drug test could mean a suspended or revoked license.

"Our first priority is protecting patients," said Erin Shaw, a spokeswoman for the California State and Consumer Services Agency, which oversees the Dept. of Consumer Affairs. "We are not in the business of rehabilitation."

The rules were developed by a committee representing the state's health licensing boards, including the Medical Board of California, pursuant to a state law enacted in September 2008. The medical board voted in July 2007 to abolish its physician diversion program due to auditors' reports that found it ineffective. The program, which allowed physicians with substance-abuse problems to get help and be monitored in a confidential setting, ceased operation on June 30, 2008.

The California Medical Assn. has "concerns about the standards," said Amber Pasricha Beck, a CMA spokeswoman. The abolition of the diversion program "left a void in resources."

In June, the California State Assembly passed a bill, supported by the CMA, to create a voluntary physician health program that would give doctors an avenue to get help with substance-abuse problems without that information being disclosed to the medical board. At this article's deadline, the bill was before the Senate Appropriations Committee.

"We want to know if a doctor's impaired, so we can get them the help they need without harming the patient," Pasricha Beck said. "We want to take proactive steps."

But Julianne D'Angelo Fellmeth, who audited the medical board and its diversion program in 2004 and 2005, said the program had proven useless.

"Our basic finding was that the program did not adequately and consistently monitor these substance-abusing doctors," said D'Angelo Fellmeth, administrative director of the University of San Diego School of Law's Center for Public Interest Law. "It was chronically understaffed from the day it was created, and the medical board itself was not properly overseeing the administration of this program."

She argued that drug tests were conducted only on weekdays, making it easier for abusing physicians to avoid detection. D'Angelo Fellmeth said most physicians did not self-refer to the diversion program, but only used it to avoid disciplinary action. Currently, 122 California doctors are required to undergo drug testing as a condition of a probationary order, according to a Dept. of Consumer Affairs spokesman.

Tough approach questioned

An October Dept. of Consumer Affairs memo "proposes to eliminate all diversion programs effective Jan. 1, 2012, and to make it the policy of healing arts boards to place licensees who have substance abuse or mental health problems on probation, where restrictions can be placed on their practice and where they can be monitored." At this article's deadline, a bill was before the California Senate Committee on Business and Professions that would abolish all the state's diversion programs.

Physician health experts nationwide said California's enforcement-only approach to dealing with doctors who have substance abuse problems is troubling.

"Every state should have a physician health program to allow physicians to meet confidentially with that program ... to get physicians the help they need prior to its becoming a licensing issue or a disciplinary issue," said Luis T. Sanchez, MD, a psychiatrist who directs Physician Health Services Inc., a nonprofit program run by the Massachusetts Medical Society. "It's an avenue that's protected and confidential that allows physicians to come forward without fear of consequences to get help."

Dr. Sanchez is advising an informal work group of physicians, hospitals and health plans seeking to re-establish a physician health program in California.

Addiction psychiatry specialist Peter A. Mansky, MD, said pursuing an enforcement-only approach is "very dangerous to public safety, because if you don't have a program that doctors feel comfortable coming into, and coming into anonymously, they'll stay underground and likely do some patient harm."

Dr. Mansky is president of the Federation of State Physician Health Programs, which has 42 state members. He said the new standards calling for drug testing twice a week -- as opposed to the usual four to six times a month -- were adopted without any evidence that frequency of monitoring would be helpful or useful.

"I don't know of any addictionologist who would recommend that," said Dr. Mansky, director of the Nevada Health Professionals Assistance Foundation, which operates Nevada's physician diversion program. "It seems more political or intuitive than scientific."