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<p>Physicians in California who are grappling with addiction often fear discovery, particularly from the state board that can revoke their medical licenses.</p>
<p>“Doctors are intimidated by the medical board,” remarked Dr. Greg Skipper, an addiction specialist from Southern California. “The board operates like a blunt instrument, comprising primarily lawyers and law enforcement.”</p>
<p>Fear leads to concealment, and this poses risks, say experts and regulatory authorities. In light of this, the <a href="https://www.mbc.ca.gov">California Medical Board</a> intends to propose to state lawmakers a new alternative recovery program that operates independently of its disciplinary framework.</p>
<p>Although existing law permits state licensing boards to establish <a href="https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=200720080SB1441" target="_blank" rel="noreferrer noopener">recovery initiatives for health workers</a>, the medical board has not instituted one in over ten years. Physicians criticize the current law as poorly constructed, ineffective, and detrimental.</p>
<p>They cite the experiences of nurses in a similar program allowed by current state legislation, expressing feelings of entrapment. Some <a href="https://calmatters.org/health/2024/12/board-of-registered-nursing-addiction-recovery/">nurses find the programs excessively punitive</a>. Physicians seek a system that emphasizes early intervention and treatment for substance use disorders or mental health conditions rather than punishment.</p>
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<p>However, they may encounter resistance to their initiative. Patient advocates who supported the existing law oppose the doctors’ proposed approach, favoring the transparency and enforcement inherent in current programs.</p>
<p>Both factions claim to prioritize patient safety.</p>
<p>The doctors' <a href="https://www.mbc.ca.gov/About/Meetings/Material/31378/phwpipm-AgendaItem2-20241024.pdf" target="_blank" rel="noreferrer noopener">proposed initiative</a> would function independently from the licensing board and afford confidentiality to physicians who maintain sobriety and do not jeopardize patient safety. It would also be mandated to report any noncompliant physicians or those deemed unsafe to practice to the board.</p>
<p>Additionally, it would obligate other licensed practitioners to report colleagues if they suspect impairment. Physicians accused of harming patients would still face disciplinary action.</p>
<p>Other health professionals, such as dentists and nurses, would not be included in the medical board's proposed legislation.</p>
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<p>“Ultimately, we hope this will motivate physicians to seek treatment sooner, thereby preventing any patient harm in our system,” said Medical Board President Kristina Lawson.</p>
<p>In the absence of a recovery program, the medical board can only investigate reports of patient harm after incidents have occurred—a process that can take years.</p>
<p>California stands as one of the few states lacking a recovery program commonly referred to as physician health programs, which allow physicians to seek treatment while being monitored for sobriety. Research indicates that between 10% to 12% of healthcare workers face substance abuse challenges over their careers.</p>
<p>Experts experienced in managing programs in other states assert that confidentiality and acknowledging addiction as a chronic illness are essential for encouraging doctors to seek help when needed.</p>
<p>“The most critical aspect of physician health programs is that they provide a safe haven,” affirmed Dr. Paul Earley, former medical director of Georgia’s physician health program, during a recent California Medical Board session. “I can dock here and receive care without fear of repercussions.”</p>
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<p>In other states, these programs are usually run by independent nonprofit organizations responsible for assessing physicians suspected of impairment, overseeing their treatment, and monitoring them for a five-year period.</p>
<p>Patient advocates criticize this model as unsafe, arguing that California's medical community has previously attempted this approach without success. In 2008, a similar program was terminated after a <a href="https://www.sandiego.edu/cppc/publications/mbc-final.php" target="_blank" rel="noreferrer noopener">series of audits</a> indicated that physicians had dodged drug testing and workplace monitoring. Advocates contend that confidentiality merely allows dangerous doctors to evade accountability.</p>
<p>“Any transparency that the public has enjoyed would vanish,” stated Michele Monserratt-Ramos, a patient advocate with Consumer Watchdog. Monserratt-Ramos, whose fiancé died in 2003 following a procedure by a physician with a substance abuse history, was a key advocate pushing for the elimination of the medical board's prior program in 2008.</p>
<p>She argues that the current laws and regulations, which mandate <a href="https://www.dca.ca.gov/enforcement/uniform_standards_4_2021.pdf" target="_blank" rel="noreferrer noopener">rigorous oversight of physicians with addiction issues and penalties for relapse</a>, perform as intended.</p>
<p>“We believe that the standards established adequately protect everyone, and the board is willing to abandon them,” Monserratt-Ramos stated.</p>
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<p>Lawson acknowledged the doubts surrounding this new proposal due to the previous program's inconsistent performance. Nevertheless, she asserted that ample evidence from other states indicates that programs similar to what is being proposed are successful.</p>
<p>“I believe, as does the board, that the absence of a program increases risks for patients,” she remarked.</p>
<h3 class="wp-block-heading" id="h-complaints-about-other-addiction-recovery-programs">Concerns Regarding Other Addiction Recovery Programs</h3>
<p>Previous efforts to establish a program for California's doctors under current legislation—such as those available for nurses, dentists, and other health professionals—have faltered. While these recovery programs are intended as a voluntary alternative to permanent public discipline, they are still bound by the same regulations governing disciplinary actions against practitioners who break the rules. Physicians claim this undermines the intended purpose.</p>
<p>Many criticisms expressed by physician groups have been echoed by nurses in recent <a href="https://www.rn.ca.gov">Board of Registered Nursing</a> meetings.</p>
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<p>Nurses report incurring significant debt, being barred from employment for extended periods despite demonstrating sobriety, and becoming trapped in a cycle of shifting program requirements.</p>
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<p>California's regulations have cultivated a “draconian reputation” compared to those in other states, Earley noted. He recounted advising doctors against taking training opportunities or positions in California if they were involved in a recovery program.</p>
<p>This type of system compels physicians and other health practitioners to conceal their issues from authorities, which endangers patients, according to California addiction specialist Skipper.</p>
<h3 class="wp-block-heading" id="h-medical-board-can-suspend-doctors">The Medical Board's Authority to Suspend Physicians</h3>
<p>Currently, only 141 physicians are on probation for substance abuse, as per the medical board.</p>
<p>“There should be around 2,000 individuals in monitoring based on the number of physicians in California. They are clearly missing many cases,” remarked Skipper, who managed Alabama’s physician health program for over a decade.</p>
<p>Ramos, with <a href="https://consumerwatchdog.org">Consumer Watchdog</a>, expressed uncertainty about whether the state identifies a sufficient number of impaired healthcare professionals but insists existing laws should remain unchanged. Physicians who inflict harm on patients due to substance abuse or mental health issues should face repercussions, she argued.</p>
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<p>“When we consider instances where someone is harmed or loses their life in a vehicle accident, there are consequences…There’s a continual push for more legislation and enhanced penalties because lives are lost. How is it any different inside a hospital?” she questioned.</p>
<p>Experts contend that effective programs are designed not to allow impaired physicians to escape consequences but rather to intervene before any harm occurs. Dr. Chris Bundy, executive medical director of Washington Physicians Health Program and chief medical officer of the Federation of State Physician Health Programs, elaborated during a recent medical board meeting.</p>
<p>Bundy mentioned that he routinely consults with his Washington medical board colleagues to report on program outcomes and discuss anonymized cases that may necessitate disciplinary reporting. Notably, Washington state law grants him more discretion compared to California's regulations, allowing him to effectively meet the chronic illness needs of participants.</p>
<p>A remarkable 92% of participants in Washington's program have maintained clean records over five years and reported lower burnout rates compared to the general physician population. To Bundy, this exemplifies success.</p>
<p>“The focus should not be merely on completing the program but on how this initiative can transform your life positively, leaving you grateful,” Bundy added.</p>
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<p><em>Kristen Hwang is a health reporter for <a href="https://calmatters.org">CalMatters</a>, covering access to healthcare, reproductive health, workforce matters, drug pricing, and significant public health issues.</em></p>
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