JUST SAYIN’-Over the last few weeks, I have addressed a number of legislative issues. Today’s column is devoted to clarifying a somewhat bewildering Proposition 46. This proposition covers several different matters (it undoubtedly would have been far preferable to separate some of these issues into different bills in keeping with “California’s love for legislating by initiative”). Its authors are certainly well-intentioned but when we get below the surface and parse the details, its passage would produce immediate unintended and deleterious consequences!
Taking us back to the first administration of Governor Brown, the Medical Injury Compensation Act (MICRA) was passed in 1975 that limited the medical malpractice cap to $250,000 (and, despite inflation, that amount remains to this day). Because there was a shortage of OB/GYN doctors in California during that period, an agreement was made to create this cap—which seemed reasonable at the time. Without it, many doctors were considering retiring or moving out of state entirely (because the increase in their insurance premiums was becoming increasingly unaffordable for them).
I remember my own doctor asking me (and all his patients) to sign a waiver because he had been forced for financial reasons to drop his malpractice insurance altogether. I signed it because I had faith in his abilities (so much so that I had asked him to walk me down the aisle when I got married). Perhaps that was foolish, but I wanted him to continue to be my doctor. Thinking back, it was probably foolish of me, but that is history now.
One outcome of passage then would be raising the malpractice cap from $250,000 to over a million dollars (based in part upon inflation figures). This, in turn, would raise doctor and clinic premiums substantially, an amount that far too many insurees would not be able to afford. Not surprisingly, then, this bill is overwhelmingly endorsed by trial lawyers (the higher the award, the greater their share). No question, victims of malpractice and/or their families (40,000 to 50,00 each year) need reasonable compensation for pain and suffering. It is how it is done that can make such a dramatic difference.
A great number of our citizens (5.4 million) rely on the 1200 California Community Health Centers and Clinics for their preventive and primary care. Each clinic must pay for its own malpractice insurance—the Federal Tort Claims Act does not cover these incidents for them, should they occur). Many of their patients reside in poorer urban or rural communities. Most patients are women, people of color, and others who find themselves living below the poverty line. A substantial hike in malpractice insurance for these clinics and for their medical providers would force many to hire fewer doctors, reduce hours of service, reduce services, and in some cases, close altogether!
While I was working my way through school, I was employed by two local hospitals and soon became aware of drug and other abuses by doctors on the staff. I was concerned then about their ability to perform at their optimum level and for their accountability, and I am concerned now for the same reason.
Therefore, when I read that Proposition 46 would address this issue, I immediately thought, It is about time! I also learned that focus polls indicated the voting population was overwhelming in its support as well. Then I took another look: This provision could drive doctors out of California or force them to retire because of the draconian demands on these physicians.
Doctors are given 12 hours (period!) once they are contacted to get drug tested in order to get it done. That does not take into consideration that the doctor may be out of the country or in surgery or otherwise out of communication which would make it impossible to satisfy the requirement in a timely manner. The result of non-compliance would be a loss of the doctor’s license.
Should this proposition pass on November 4, it would go into immediate effect the next day, meaning an addition of approximately 200,000 new patients in the data base. As we saw with the ACA, sometimes computers will freeze or crash because of overwhelming demands (myriads of doctors seeking access at the same time). Doctors would be required to input CURES (Controlled Substance Utilization Review and Evaluation System) before prescribing for a patient. Thus the physician would be presented with quite a conundrum: Wait until access to the data base is available to avoid penalty or with the possibility of being held out of compliance, give the patient a prescription or, under exigent circumstances, administer an immediate application of drugs.
The reasoning behind this provision is to make sure that patients are not doctor shopping and would thus preclude a patient’s ability to be overprescribed potentially dangerous drugs. This program would be overseen by the California Department of Justice and is voluntary now but once passed, the law would require compliance by all doctors yet does not take into consideration other healthcare professionals who work with patients, such as nurses, in-take administrators, etc. The bill (not particularly well-thought out) also does not provide for pharmacists to make the same check.
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What is more, the ongoing efforts to gain the trust of and bring in the undocumented to these health centers (for their own good but also to prevent contamination of others through contagious illnesses), would be turned on its head because ICE would have access to this information (despite the HIPAA law—Health Insurance Portability and Accountability Act which was passed in part to insure patient privacy). Thus, these and many other people would avoid seeking medical help when such services can be so necessary.
There is indeed a broad coalition of organizations and individuals who are opposing this particular proposition (with the hope that its contents can be rewritten for further and future consideration, but only once there is clarity of mission and logic regarding its implementation). Hopefully, we shall all be voting on November 4, 2014, so it is important that we know on what we are voting and what its ramifications are. I hope I did a good job elucidating this issue. As for me, I am voting NO. It is my hope I have convinced you to do the same!
Just sayin’.
For more info:
● California Primary Care Association: 916-440-8170/cpca.org
(Rosemary Jenkins is a Democratic activist and chair of the Northeast Valley Green Alliance. Jenkins has written Leticia in Her Wedding Dress and Other Poems, and Vignettes for Understanding Literary and Related Concepts. She also writes for CityWatch.)
-cw
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CityWatch
Vol 12 Issue 75
Pub: Sep 16, 2014