In summary
California doctors are asking the state to create a ‘safe harbor’ program for addiction recovery. They say the current system discourages doctors from participating because they regard it as punitive.
California doctors struggling with addiction often don’t want anyone to find out, especially the state board that has the power to revoke their medical license.
“Doctors are afraid of the medical board,” said Dr. Greg Skipper, a Southern California addiction specialist. “The board is a blunt instrument. It’s basically lawyers and cops.”
When doctors are afraid, they hide, which experts and regulators say is dangerous. That’s why, in the coming year, the California Medical Board plans to ask lawmakers to allow it to create an alternative recovery program that’s disconnected from its disciplinary power.
Current law already lets state licensing boards create recovery programs for health workers, but the medical board hasn’t made one for more than a decade. Doctors call the existing law poorly written, ineffective and harmful.
They point to the experience of nurses enrolled in a version of the program currently allowed by state law who say they feel trapped by it. Some nurses regard the programs as too punitive. Doctors want a program that prioritizes early intervention and treatment of substance use disorders or mental illness over punishment.
They could face opposition to their proposal. The patient advocates who lobbied for the current law are opposed to the approach the doctors want. They favor the transparency and discipline in the existing programs.
Both sides say they want to protect patient safety.
The doctors’ proposed program would run independently from the licensing board and grant confidentiality to doctors who remain sober and do not endanger patients. It would be required to report to the board noncompliant doctors or those whom it believes cannot practice safely. It would also require other licensed doctors to report if they suspect a colleague of impairment. Doctors who are suspected of harming patients would not be exempt from discipline.
Other health workers, such as dentists and nurses, are not included in the medical board’s proposed legislation.
“At its most basic level, we hope that it will cause physicians…to get into treatment sooner rather than later, so that treatment happens before any patient harm would occur in our system,” Medical Board President Kristina Lawson said.
Without a recovery program, the medical board can only investigate reports of patient harm after they have happened, a process which sometimes takes years.
California is one of few states without a recovery program — commonly called physician health programs — that offers doctors the chance to seek treatment and help while monitoring them for sobriety. Between 10% to 12% of health care workers will struggle with substance abuse throughout their career, research shows.
Experts with experience running programs in other states say confidentiality and recognition of addiction as a chronic illness are crucial to getting doctors to admit when they’re struggling.
“The single most important thing physician health programs offer is a safe harbor,” said Dr. Paul Earley, former medical director of Georgia’s physician health program, who testified during a recent California Medical Board meeting. “I can tie up to this dock and get some care, and I’m not going to get hammered.”
In other states, programs are typically administered by an independent nonprofit organization that is responsible for evaluating doctors suspected of impairment, managing their treatment and monitoring them for five years.
Patient advocates say this approach is unsafe. They argue that California’s medical community has tried this before and failed. In 2008, the board ended a similar program after a series of audits suggested doctors evaded drug testing and worksite monitoring. Patient advocates also argue that confidentiality only lets dangerous doctors hide from consequences.
“Whatever transparency that the public has had will disappear,” said Michele Monserratt-Ramos, a patient advocate with Consumer Watchdog. Monserratt-Ramos, whose fiance died in 2003 after an operation from a doctor with a history of substance abuse, was one of the advocates who lobbied for the medical board to abolish the program in 2008.
Monserratt-Ramos believes the state’s current laws and regulations, which require strict oversight of doctors with addictions and penalties for relapse, are working as intended.
“We feel there were standards set in place that protected everybody, and the board is willing to dispose of them,” Monserratt-Ramos said.
Lawson said the board acknowledges skepticism of this new approach because of the previous program’s spotty track record. However, Lawson said plenty of evidence from other states shows that programs such as the one it is proposing are effective.
“My belief, and I think that the board shares the belief that not having a program puts patients at greater risk,” she said.
Complaints about other addiction recovery programs
Previous attempts to create a program for California doctors under the current law — such as those that already exist for nurses, dentists, and other health professionals — have stalled. Those recovery programs are supposed to be a voluntary alternative to permanent and public discipline, but they still must adhere to the same regulations that govern disciplinary proceedings for rule-breaking workers. Doctors say that defeats the purpose.
Many of the criticisms raised by doctors’ groups have been expressed by nurses during recent Board of Registered Nursing meetings.
Nurses say they’ve been saddled with thousands of dollars of debt, prohibited from working for months on end despite documented sobriety and caught in a cycle of constantly changing program requirements.
California’s regulations have a “draconian reputation” among other states, Georgia addiction specialist Earley said. During his time leading Georgia’s physician health program, Earley said he counseled doctors on multiple occasions that they should not accept training opportunities or jobs in California because of their involvement in a recovery program.
That kind of system leads to doctors and other health professionals hiding their problems from authorities, which is dangerous for patients, said California addiction specialist Skipper.
Medical board can suspend doctors
Only 141 physicians are on probation for abusing substances, according to the medical board.
“They ought to have like 2,000 people in monitoring. They’re missing a lot of cases,” based on the number of doctors in California, said Skipper, who ran Alabama’s physician health program for more than a decade.
Ramos, with Consumer Watchdog, said it’s hard to say whether the state is catching enough impaired health workers, but the law should stand as-is. Doctors who cause patient harm due to substance abuse or mental illness should face consequences, Ramos said.
“If we look at a comparison when someone is harmed or dies in a car accident, there’s consequences…They continue to come forward with more legislation and increase those consequences and strengthen them because lives have been lost. How is it any different behind the walls of the hospital?” Ramos said.
But experts say successful programs are not meant to help impaired physicians evade consequences. They are meant to intervene before a doctor harms anyone, said Dr. Chris Bundy, executive medical director of the Washington Physicians Health Program and chief medical officer of the Federation of State Physician Health Programs, who testified during a recent medical board meeting.
Bundy said he meets regularly with his Washington medical board staff to report program results and discuss anonymized cases that may need to be reported for discipline. Washington state law, in contrast to California’s regulations, also gives him more flexibility to exercise his judgement in how participants are monitored and ensure their chronic illness needs are met, Bundy said.
Ninety-two percent of Washington state participants have had clean records over five years and reported feeling burned out less than half as much as the general physician population. To Bundy, that’s success.
“It’s not about getting through this program. It’s about, how does this program change your life in a way that is transformative and that you’re grateful for,” Bundy said.
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.