Saturday, May 17, 2014

Physicians With Substance Abuse, Depression, Burnout Issues - LA Times' Article Criticizes Proposed Assembly Bill 2346

In California, the State Bar has a program for attorneys that allows them to go in and get treatment at an early stage. In California, there is no such program for physicians. The only program for physicians is to wait until they have a problem that becomes so grave that it is noted by the California Medical Board and results in an Accusation. There is no incentive for early treatment or encouraging physicians to join a confidential treatment program. There was a Diversion Program but it was shut down some years ago.

Assembly Bill 2346 the "Physician and surgeon assistance program" provides as follows:

"Existing law, the Attorney Diversion and Assistance Act requires the establishment and administration of an Attorney Diversion and Assistance Program to provide services for the treatment and recovery of attorneys for the abuse of drugs or alcohol or mental illness, and who may be enrolled as inactive members of the State Bar."

"This bill would authorize establishment of a similar assistance program for physicians and surgeons. The bill would authorize the Medical Board of California to make available the means to rehabilitate a physician and surgeon with impairment due to abuse of dangerous drugs or alcohol, or mental or physical illness, that affects his or her competency so that a physician and surgeon may be treated in a manner that will not endanger the public health and safety. The bill would require the board, if the program is established, to contract with another entity for provision of the administrative services for the program. The bill would make participants in the program responsible for all expenses relating to treatment and recovery, and would authorize the board to charge a reasonable administrative fee to participants for the purpose of offsetting the costs of maintaining the program. The bill would require the board, if the program is established, to engage in outreach to make physicians and surgeons and others aware of the existence and availability of the program."

The Los Angeles Times' opinion writer Michael Hiltzik opposed this bill on the ground that it would compromise patient safety. I think his views are short sighted and show a lack of understanding about depression, mental health and addiction issues. The goal of this bill is not to cover up physician misdeeds but to encourage physicians to seek treatment. If a physician commits gross negligence, has a settlement over $20,000 to a patient or is the subject of a patient complaint - the Medical Board would still have jurisdiction to investigate and impose discipline. In fact, this bill would encourage someone to get treatment before there is misconduct.

I have represented many professionals with mental health issues such as depression, OCD, bipolar and other issues that do not mean there was a problem with patient care.  In fact, sometimes the depression is as a result of the physician being so obsessed with their practice that they have neglected their family and friends and have become isolated. In addition, alcohol and drugs can become an issue when the physician used drugs initially to work long non-stop hours or in an effort to sleep after long shifts or working at night.  That is often why physicians are at risk. However, if we expect physicians to be less than human and truly god like and not allow for confidential treatment before cases go to the Medical Board, and simply want a punitive approach after problems happen, then do not adopt AB 2346. 

I think AB 2346 is necessary and as physicians will see is no cakewalk or place to hide. In the State Bar program, I have seen attorneys who had some alcohol related arrests during college or law school be required to complete the program successfully as a condition of being admitted to the Bar. That committee is tough and has experts on addiction. They spot problems before they happen and can do it at the application process instead of waiting for clients to be harmed. I accompanied one client to an evaluation by that State Bar Committee and they knew every excuse and even though he was not an alcoholic, they required him to quit drinking because they saw that a couple of alcohol related arrests (without convictions) were signs of a potential future problem. I support AB 2346 and think it will help physicians and their patients in the long run.

Posted by Tracy Green, Esq.
Phone: 213-233-2260


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