An act to add and repeal Article 14 (commencing with Section 2340) of Chapter 5 of Division 2 of the Business and Professions Code, relating to physicians and surgeons.
Policy Goal: AB 526 creates a Public Protection and Physician Health Program that would provide treatment referral and monitoring to physicians with substance use disorders (alcohol and other drug use disorders) or other mental disorders. This is a reintroduction of AB 214, which was vetoed last year with a request from the Governor that we work more closely with his Administration on a plan to replace the Medical Board's diversion program.
Problems: California has more licensed physicians than any other state at over 125,000 licensees and it is estimated that 10-12% of physicians in the United States become addicted to alcohol or other drugs. Yet, California is one of only three states in the nation to lack a physician health program that provides monitoring services and attends to patient safety. These programs, which monitor urine samples for drug or alcohol use, supervise treatment and assess a physician’s ability to practice medicine, play a critical role in protecting patients from impaired physicians. The lack of such a program means that physicians only come to the attention of the state’s oversight board (the Medical Board of California) for disciplinary action when harm has already been alleged or occurred.
Argument: Protect the Public: AB 526 provides a clear path for physicians to come forward and address their disease – and to be appropriately monitored and have their practice restricted. Without that path, they will remain unknown and undetected until it is too late resulting in patient harm. Preserve Physician Health: Physicians, just like any other person, may fall victim to an addiction and they deserve the right to rehabilitation in a secure environment that protects patients.
Evidence: A recent study in the British Medical Journal followed 904 U.S. physicians admitted to physician health programs in 16 states between September 1995 and September 2001. Three quarters of the physicians monitored had favorable results at five years and 95% of those who completed the program were licensed and working as physicians five years later. During the five years monitored 81% had no positive urine screens. Out of the 904 physicians there were 10 positive urine screens that occurred in the context of patient care (on duty or on call) and one incident of patient harm was recorded (over-prescribing drugs). Almost half of the participants were not formally mandated to participate in the program by the medical board. Without a physician health program it is very unlikely that these physicians would participate.
The study concluded: “From a clinical perspective we interpret these results as evidence that the combination of identification, intervention, formal treatment, professional support, and monitoring by physician health programs is effective in rehabilitating most of these addicted physicians, over at least five years. From a public safety perspective we believe these data indicate that most physicians who could not or would not stop their misuse of substances were detected early during the course of formal treatment and this usually resulted in voluntary or involuntary cessation of practice. From a policy perspective we conclude that affected physicians are well advised to enter the supervision of a physician health program voluntarily, and that regulatory boards are well advised to continue supporting these program.”[1]
Solution: The bill will allow physicians with mental health or addiction problems to seek help leading to appropriate treatment and monitoring prior to harming a patient.
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[1] Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. A. Thomas McLellan, Gregory Skipper et al. BMJ January 2009
