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June 19, 2014
Viewpoints: Ballot measure not the right prescription for substance abuse by doctors

Sutter_Hospital.JPG(June 19 - By Ken Murray, Zócalo Public Square)

Larry was a doctor trainee at a hospital where I taught in Burbank. I recommended that he not pass, due to very poor preparation and work habits. But he did, and set up practice nearby.

He had trouble with general practice, and drifted into addiction medicine over time. He moved outside the immediate area, but word was that he was one of the local "go-to" guys for getting prescription narcotics, and people who encountered him thought he might be high. The Drug Enforcement Administration entered his life, and he put a gun into his mouth and pulled the trigger.

An initiative on California's November ballot includes a provision that would require physicians to be drug-tested prior to practicing at any hospital, or after an "adverse event." This is packaged with other measures that appear punitive towards all physicians.

But the drug-testing provision bears scrutiny because, while drug testing is widespread in American business, and required of nurses and many medical workers, private doctors are not routinely tested.

I'd like to tell you it isn't a problem for doctors, but unfortunately, I've seen first-hand that there are physicians who practice while they are "under the influence." And we physicians often find it hard to speak up when we see something. The attitude is: If it isn't my patient, it isn't my problem.

I personally made it my practice never to have a drink at lunch or in the evening when I was on call. Inasmuch as I was on call for most weekdays for 30 years, I never felt free to drink during my career.

Sadly, that was not always what I encountered from my fellow physicians. I remember practicing as a young ER physician new to a small community hospital in California, and calling in a prominent surgeon to perform an emergency appendectomy.

When he arrived, he strongly smelled of alcohol. There was no other choice for a surgeon, and a delay exposed the patient to significant risk. The operation went ahead, and the patient did fine. However, as I asked around, this surgeon was known as a boozer, and frequently came into the hospital drunk. This still haunts me, and I left that hospital rather quickly.

That was my first experience with the difficulty of dealing with physicians who abuse alcohol or drugs. I didn't make any sort of formal report on the surgeon; I would have felt intimidated. I passed the word along to colleagues, but that was all I did. Today, as a senior physician in the latter part of my career, I would hope that I'd do more.

And that was a case when I recognized a problem. It can be hard to recognize that a colleague has a substance abuse problem even if you're a trained observer of addicts.

Until a few years ago, the licensing board for physicians in California had a diversion program for those who were identified as having an abuse problem. It had a 75 percent long-term success rate and allowed for anonymous reporting of suspected abuse.

However, the licensing board, in its wisdom, recently discontinued this program, stating that the board's primary mission was patient protection, not physician rehabilitation. Funding should not have been an issue: the program was paid for by physician licensing fees, not by taxpayers. Nothing has appeared to take its place, and so California is without a confidential reporting system for doctors.

I've spoken with a number of practicing physicians recently, and surprisingly, I hear a lot of support for mandatory testing. This support may have less to do with protecting patients, than with a feeling of impotence in dealing with colleagues who abuse drugs.

Mandatory testing will cost a lot of money, and it is intrusive to the daily practice of medicine. But patient safety concerns justify such testing for doctors, just as air safety concerns justify testing for pilots. And even with testing in place, doctors should not be excused from their obligation to report colleagues, and the government should provide a way to make such reports confidentially.

None of this, however, should be done by a deeply flawed ballot initiative; instead, the Legislature should craft a careful law that will work in practice.

Ken Murray is a retired clinical assistant professor of family medicine at USC. He currently writes and speaks on topics involving ethics and wrote this for Zócalo Public Square.