Diversion Program fails to keep public safe

Diversion Program fails to keep public safe

The Medical Board will hold a summit to discuss the future of program meant to identify physicians who are abusing drugs, alcohol

The state has failed to protect patients from physicians who abuse drugs or alcohol, requiring swift action from the California Medical Board or the state legislature will step in to resolve the issue.
In July, the Medical Board voted to ax its beleaguered Physician Diversion Program after receiving five out of five external audits that found the program is not sobering up physicians and keeping patients safe.
The Medical Board''s diversion program is meant to identify physicians who are abusing drugs and alcohol, then remove them from practice, and get them into a rehabilitation program. Founded by state statute in 1980, the program is scheduled to end July 2008.
Dr. Richard Fantozzi, president of the medical board, said "victims of botched surgeries performed by diversion program participants urged abolition" of the program. Fantozzi stated that the board considered the testimony of "patients injured by the diversion program participants while being denied a possibility of protecting themselves" from the impaired doctors who were "shielded" by the confidentiality of the program.
Five audits documented major loopholes in random drug testing and monitoring practices that allow impaired doctors to continue seeing patients. The latest report completed by the Bureau of State Audits in June echoes recommendations made in two years ago by a state-hired enforcement monitor, Julianne D''Angelo Fellmeth, administrative director for the Center for Public Interest Law at the University of San Diego School of Law.
Despite the fact that the board pumped an additional $500,000 into the program to correct deficiencies, the state auditor showed little improvement. Irregularities included insufficient collection of state-required monitoring reports from therapists and facilitators, a lack of random drug testing, insufficient program staffing, and no real standards requirements for monitors. Fellmeth produced two reports, one in 2004, and the other in 2005.
Annually, about 250 physicians complete the confidential program, which receives its funding from state licensing fees. The law allows doctors to refer themselves instead of facing charges if there is "no evidence of patient harm," according to the board.
The diversion program also requires participants to stay drug and alcohol-free for a minimum of three years. They must attend Alcoholics or Narcotics Anonymous meetings twice weekly, have ongoing worksite or hospital monitors, and report to a case manager monthly.
In reality, Fellmeth said, case managers remain overworked, with the three Northern California caseworkers supervising up to 80 physicians at a time. "The program is severely, chronically understaffed," Fellmeth said.
She also noted that the program had no requirements for the "worksite monitors" who were supposed to evaluate physicians, so that often doctors used their own office managers. The "random" drug tests were often rescheduled to Tuesdays instead of Saturdays, "and if you''re a smart doctor, you can figure the pattern out and adjust your abusing accordingly," says Fellmeth. In addition, she found that drug tests were not administered as often as they should have been.
The medical community argues that impaired doctors improve after undergoing the diversion program, but it flunked the state auditor''s test. In her report, Elaine Howle noted that the board''s oversight committee inadequately scrutinized participating physicians.
Although the program should have received 51 therapists'' reports from participants, only 17 had submitted them. The audit also noted that due to failures in timely drug test reporting, the program "did not always immediately require a physician to stop practicing medicine" after testing positive for alcohol or nonprescription drugs.
Program advocates boast a 75 percent success rate, but Fellmeth doubted this number in her testimony to the board. Since there’s no post-graduate tracking, the program "has no idea whether those physicians are safely practicing medicine or have died from a drug overdose." She also said 10 percent of the 60 participating doctors in 2004 had previously "successfully graduated."
However, the California Society of Addiction Medicine urges its members to write letters to the board objecting to the program''s demise. "Addiction is a medical condition, not a crime," said CSAM''s Tim Cermak. "The Medical Board''s total reliance on enforcement is discriminatory, regressive and ultimately less effective than a more humane and comprehensive response." Cermak concedes that the program has deficiencies, but blames them on "budget constraints."
The proposed summit hearing agenda may include items such as amending a pilot program that refers consumer complaints to both the medical board''s investigators and the attorney general''s office. Because the board has trouble recruiting investigators who research physician misconduct, new legislation may include a provision to raise the agents'' salaries to make them commensurate with the attorney general''s examiners.
At the summit, Medical Board President, Dr. Fantozzi, wants to discuss two primary questions -- what, if any, diversion program is possible with the legal mandates to protect patients, and whether the program should be operated by the state or an independent entity.
In addition, Dr. Fantozzi said he would like to discuss the possibility of a statewide diversion program for all healthcare professionals.
Sen. Mark Ridley-Thomas, (D-Los Angeles), chairman of the Senate Committee on Business and Professional Economic Development, had proposed legislation extending the program, but dropped the bill at the Board''s request. Instead, the senators will take a "wait-and-see" attitude until after a summit early next year.
After that, the board will "protect the consumer by removing doctors who abuse drugs or alcohol from the practice of medicine," according to Linda Whitney, legislative liaison for the board. While many doctors contend the program offers a less punitive alternative for what is essentially a disease, the board found itself in a conflict of interest between protecting patients and addressing the substance abuse problem.
The medical board posts both current diversion program audits online at www.medbd.ca.gov

Eren Goknar is a contributing writer for Healthcare Journal of Northern California.

--By Eren Goknar