Mission Hijacked by Lobbyist

Mission Hijacked by Lobbyist

“The mission of the Medical Board is to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professions and through the vigorous, objective enforcement of the Medical Practice Act, and to promote access to quality medical care through the Board’s licensing and regulatory functions.”

Most of the key elements in this mission statement of the Medical Board of California (MBC) have been unwittingly ceded to the lobbyist for The Center for Public Interest Law (CPIL). The hijacked components include, “…protect health care consumers,” “objective enforcement” and the promotion of “access to quality medical care.”

Public Protection
Demonizing doctors recovering from alcohol or drug problems is dated but very easy. Merely offering untruthful scenarios of patient harm grabs the attention of the salacious media. The story of any recovering doctor possibly doing something wrong is fascinating. The story of a thousand recovering doctors doing everything right isn’t worth a side bar on page eight. Untrue allegations of one doctor supposedly doing something bad warrants page one. Mobilizing professional victims and paranoid litigators and chauffeuring them into Medical Board meetings is colorful and scintillating. CPIL’s lobbyist has attended every Board meeting and repeated these themes. The result is that the Board is unduly influenced and like the repeating scene in Invasion of the Body Snatchers, has been taken over, implanted with falsehoods and aggrandized dramas.
The truth is that the very nature of the Physician Health and Diversion programs is prevention of physician impairment and possible patient harm. Early intervention prior to the risk of harm is the focus of these programs nationwide. The real risk of patient harm results from delayed intervention. Physicians with potentially impairing illness, at an early stage, typically function at a high level for a decade or more before impairment is evidenced. The existence of illness does not mean impairment is present. Taking away early intervention through the likelihood of adverse disciplinary action tends toward delayed diagnosis and increased risk. The Medical Board’s Mission to protect the public, therefore, is best served by a system that encourages early diagnosis and treatment. . The Medical Boards idea of a ‘proactive’ approach – combining “just say no” with educating medical students about Licensing consequences – while well intended, is minimally helpful. Unfortunately for the consumer, the Board has expressed a belief these miniscule steps will eliminate the problem.

OBJECTIVE ENFORCEMENT OF THE MEDICAL PRACTICE ACT
When CPIL works with other parties to, 1) solicit false Complaints, 2) divert Board resources away from legitimate Investigation and Enforcement activities, and 3) effectively pressure the Board to discipline ill doctors simply to avoid bad press, this results in a very dangerous, destructive and unjust process. As a nation, we suffer collectively when we discover such things as abuse of prisoners, justification for torture and the stripping of Civil Rights. Likewise do we suffer when we learn of doctors being harmed in this way by the Board? The case of the CPIL targeted physician is not an example of a bad doctor being disciplined, but an innocent man and his family persecuted and harmed by those who claim to protect the Public. The Target is the most investigated doctor in the entire history of the Medical Board. CPIL’s lobbyist continuously hounds the Board to Revoke his License. Dozens upon dozens of contrived Complaints have been filed and costly investigations conducted. The Deputy Attorney General (the Board’s own Prosecutor) even told the Board there wasn’t a single valid Complaint of patient harm by the Target. In spite of that, the Board was pressured into demanding a lengthy show trial and informed the Administrative Law Judge they wanted a License Revocation. The Board got a very harsh and questionable Decision; but since it wasn’t harsh enough, they simply Non-Adopted the Decision. The patient harm issue? One patient, prior to the Target’s entry into the Diversion recovery process had a breast reconstruction and got matched “c” cups versus the “d” cups she expected (six years after her surgery she filed a Complaint, and in 2001 she sued and her suit was dismissed with prejudice for no evidence of malpractice). That is it; as far from Objective Enforcement as can be imagined. Ultimately, after the Non-Adoption all for show Hearing, the Medical Board did revoke the license of the Target. While an expensive Appeal is available, the Board has communicated its intention to file additional Accusations and reject any favorable legal outcome by the Court. In February 2009, for example, the Board refused to accept the Target’s monthly payments for required Probation monitoring fees. Why on earth would they do that? Simply put, the Board planned to file another Accusation for failure to pay the required fees, a violation of Probation.
There is an old saying, “the victors write the history books”. All the public Enforcement documents on the Target will remain for all to view. CPIL will quote the most salacious and libelous of those to support their position that doctors in Diversion harmed patients. Those who read them and believe them will conclude he was a bad guy. There will be no rebuttal, and no factual “other side “presented. This public use of hyperbolic prosecutorial writing represents both an early victory for CPIL, and a continuing effort to demonize doctors through the publication of solely adversarial documents. CPIL now demands ALL complaints be published on the Medical Board web site and posted in the doctor’s place of employment. As usual, no rebuttal or other side allowed. The real potential for malicious abuse is obvious.

When the Board had a Diversion Program, there were doctors who faced Discipline for things like DUI’s, diverting drugs for personal use, and unauthorized use of scheduled substances. These cases were thoroughly and professionally investigated by the Board. If there was no patient harm and the doctor was cooperative, the doctor was directed away from Discipline into the Diversion program so they could get the help they needed and the process monitored. The doctor’s participation in Diversion was confidential, even though the full situation was known to the Board. Some parties had concerns over this level of confidentiality. Most States have a confidential tract for those who enter voluntarily in the absence of patient harm, and most states have Boards that refer without formal disciplinary action. In California, referrals from disciplinary action have always been public. CPIL and its media Lobbyist, KSR Strategy Group, incite Populist outrage over this topic. Manipulating the press and exciting the lynch mob is easy. The modern day version of the “off with their heads” approach can resonate with an uninformed or misinformed public. However, prior to the creation of Physician Health and Diversion programs, that was the rule. It was a counter productive approach that placed patients at risk.
When the only option for a doctor with a potentially impairing illness such as substance use disorder, psychiatric illness, etc. is discipline, the doctor is driven underground and afraid to acknowledge a problem. Those close to the doctor – friends, family, medical partners, and others – are reluctant to report since they don’t want to cause the doctor more problems. When a program exists that allows the doctor to receive help without fear of professional sanction or loss of livelihood, doctors are intervened on well before their illness reaches a state of being a potential risk to patients. In this more enlightened and accepted scenario, an otherwise excellent physician is salvaged and the public is protected. There are examples in other states that saw their referrals increase over 400% when they made a transition from a punitive to a supportive system.
This writer’s personal experience is a case in point. Working in a Los Angeles County hospital Alcoholism unit in the early 70’s, the patient population represented “the cream of skid row”. They were advanced in their illness, yet had a real potential for rehabilitation. There were former doctors among them. The stunning similarity of their stories is quite illustrative:
1. They all had the skid row nickname of “doc”.
2. They all had been highly skilled and respected doctors for many years.
3. Because the Board would revoke their License if it was known they had a diagnosis of alcohol dependence, they were all professionally hidden.
4. Eventually, their illness progressed to the point that even those hesitant to report could no longer keep the secret.
5. They all lost everything – family, career, social and legal standing. They were all consumed with guilt and shame, and subsequently deteriorated to a skid row existence.

6.Most rehabilitated and once again became productive members of society. Others died.

If CPIL gets their way, this scenario will be the norm. Along the way, CPIL will keep their hands in California’s wallet, while trumpeting their virtuousness, and pointing their vicious rhetoric at doctors in recovery. CPIL seeks, without understanding, to destroy what has been carefully developed and proven successful around the country. Their vision would set California back 30 years.

Finally, the Board has a responsibility to PROMOTE ACCESS TO QUALITY MEDICAL CARE in California. By withdrawing support for any kind of Physician Health or Diversion program, they limit this important objective. Currently, there are no Addictionologists or Addiction Psychiatrists among the Board Members, with a resultant lack of knowledge about the illnesses of Alcohol or Drug Dependency. Outside these groups, few doctors were trained to recognize, intervene and treat addictive illness. The Board’s lack of understanding in this arena of health care is problematic.
We must not mismanage and marginalize physicians with addictive illness. Through their personal treatment and recovery, they become experts in identifying and managing addictive illness. They provide superior care to their patients with these disorders. Through their acquired knowledge, they recognize the illness earlier than their untrained peers, and are able to intervene. The Nation’s health care costs are adversely impacted by undiagnosed and untreated addictions. Patients are damaged when doctors are reluctant to diagnose and treat the core problem that causes illness accident and organ damage. Family members also are adversely impacted when their addict isn’t diagnosed and treated.
Addictive illness affects about 10% of the American population. Our nation spends about $375 Billion dollars per year on these illnesses but, unfortunately, 99% of those monies go to failed policies on interdiction, incarceration, and cleaning up the mess. Our nation spends less than 1% of the money on education, prevention and treatment combined, although a study by Kaiser Permanente demonstrated that for every dollar we spend on education, prevention and treatment, we save $7 in services down the road. Who will lead America out of this abyss if not those who have recovered from the illness themselves?
Again, the author draws on decades of professional experience to illustrate the point. Running chemical dependency units in large and respected Medical Centers required the training of the Attending Staff Physicians. One particular training technique was very

useful: many patients who were treated on the unit had been long term patients of the Attending Staff and had multiple previous hospitalizations. We would bring a medical chart, comprising a 3 volume or more pile of documents, and review the obvious. Repeated notes of alcohol related damage and nothing related to alcoholism itself. Yet all the major medical problems were consequences of untreated alcoholism. The doctors were reluctant to bring up the issue, either due to having the 1) moral defect notion of alcoholism, or 2) believing an alcoholic not living on skid row wasn’t an alcoholic.

The British Medical Journal published a report of the efficacy of state physician health programs in its 11/08 issue. Sixteen states PHPs studied demonstrated a 78% total abstinence at an average of 7.2 years of monitoring. With further treatment for their illness for those who did relapse, the success rate exceeded 90% at five years. Of the 904 recovering doctors studied, there was one (1) incident of patient harm – over prescribing. What other chronic illness management offers that level of success?
Any system that takes a reflexively prejudicial stance and punitive approach to doctors in need of help diminishes the value and access of these practitioners to patients who need them. It is of paramount importance that California has a vibrant, healthy Physician Health Program. Such programs are an invaluable resource for the ill physician, the medical community and, most important, the patients we all serve.