A new California ballot initiative being touted as a patient safety measure may create more problems than it solves, according to two new commentaries being published in Annals of Internal Medicine. Proposition 46, the Medical Malpractice Lawsuits Cap and Drug Testing of Doctors Initiative would mandate random drug and alcohol testing of physicians and quadruple the cap on medical malpractice awards to $1.1 million.
The authors argue that physician drug and alcohol testing should be unrelated to malpractice lawsuits and it is not only wrong, but potentially dangerous to tie the two together. The proposed law suggests that physicians undergo drug and alcohol testing randomly and following an adverse event, but does not define what constitutes an adverse event. The authors suggest that a positive test result would mean immediate punishment with temporary suspension of the physician's license pending an investigation and hearing. This punitive approach may deter physicians from getting help themselves or from reporting their colleagues. Thus, physicians might seek to avoid detection as long as possible, might not be reported as early, and might come to attention only after egregious patient harm. The authors agree that physician impairment is a significant problem that needs to be addressed. However, they argue that more time and thought needs to be invested in solving the issue. They write that Proposition 46 is not the right solution.
Should California Voters Take the Initiative on Mandatory Testing of Physicians? Yul D. Ejnes, MD, MACP, of The Warren Alpert Medical School of Brown University, Annals of Internal Medicine, published 29 September 2014.
California's Proposition 46: A Wolf in Sheep's Wool, Peter J. Pronovost, MD, PhD, of Johns Hopkins University School of Medicine, is lead author, Annals of Internal Medicine, published 29 September 2014.