Copyright © 2014 by Mark Gabrish Conlan for Zenger’s Newsmagazine • Used by permission
For Prop. 46: Kathy Olsen
Against Prop. 46: Jay Hansen
Remember those episodes of the original 1960’s Star Trek in which the Enterprise crew members destroyed seemingly all-powerful computers by feeding them tons of inconsistent and illogical information? That’s pretty much what the predominantly Queer San Diego Democrats for Equality went through at their September 25 meeting when they tried — and failed — to come to a position on Proposition 46 on California’s November 4 election ballot.
Proposition 46’s official title, “Drug and Alcohol Testing of Doctors; Medical Negligence Lawsuits,” indicates that it’s a smorgasbord of provisions relating to health care in general and protecting people from medical malpractice in particular. The description of the proposition in the California voters’ guide has five bullet points, three of which relate to the measure’s requirement that all doctors with hospital admitting privileges must submit to drug and alcohol tests and, if they test positive, their medical licenses will be suspended pending an investigation. It also requires doctors suspecting other doctors of drug or alcohol abuse to report them to the state medical board.
The measure also requires that before they can prescribe certain controlled substances — mostly potentially addictive painkillers like morphine, Valium or Oxycontin — doctors will have to check a database called Controlled Substance Utilization Review and Evaluation System, or CURES for short. The idea is to prevent patients from abusing these drugs through so-called “doctor-shopping,” which means seeing several different doctors to obtain quantities of these drugs far larger than what they would need for legitimate medical uses. Under current law doctors can register to use CURES, but they don’t have to. If Prop. 46 passes, however, they will have to as of January 1, 2016 — though, according to the legislative analyst’s official ballot description, “providers will not be required to check the database prior to prescribing or dispensing drugs.”
But the nub of Proposition 46 is its proposed changes to the Medical Injury Compensation Reform Act (MICRA), passed by the California legislature in 1975. MICRA was passed in response to complaints from doctors and hospitals that they could no longer afford medical malpractice insurance because of lawsuits resulting in high jury awards to victims. So the bill set a $250,000 cap on so-called “non-economic damages” from medical malpractice, including losing limbs, sight, hearing, or the ability to walk. The bill did not index the cap to inflation, so it remains at $250,000 even though the buying power of that sum has dropped dramatically since 1975. Prop. 46 would raise the cap to $1.1 million and index it to inflation.
Supporters of Prop. 46 claim the cap is so low many medical malpractice victims — particularly children and retired people, who can’t prove economic damages because they weren’t part of the workforce when they were hurt — can’t sue at all because they can’t find attorneys willing to take their cases for just one-third of $250,000. Opponents say lifting the cap will lead to vastly increased health care costs, as exploitative trial lawyers look for big paydays for themselves and their clients and malpractice insurance premiums go through the roof again.
The people who spoke for Prop. 46 at the Democrats for Equality September 25, legislative staff member Chris Ward and patient advocate Kathy Olsen, started with a dramatic story aimed straight at the heartstrings. “I’m the mother of Stephen Olsen, who was two years old when he was injured,” Kathy Olsen said. “He suffered from catastrophic injuries, is totally blind and has had many surgeries. We were lucky enough to get an attorney to take his case to court. The defense did not want my son in court because they thought he was a minor and that might sway people. The jury said we were entitled to $7 million, but the defense invoked MICRA and it was reduced to $250,000, $4,000 for each year of my son’s life expectancy.”
Ms. Olsen said that, thanks to MICRA, medical malpractice is the only area of liability law where there’s an absolute cap on judgments. “It’s not doctors versus lawyers,” she said. “It’s patients against insurance companies. Insurance companies have spent so much money against this because they don’t want to have to pay. Medical errors are the third most common cause of death in the U.S., behind cancer and heart disease. Four hundred thousand people per year are affected by this.”
The case against Prop. 46 was presented by Jay Hansen, chief strategic officer for the California Medical Association. “If this measure were just about the MICRA cap, we’d be having a different conversation,” he said. “But the measure has a lot of things, including drug and alcohol testing for doctors and using the CURES database, which is not supposed to work in real time. The Service Employees’ International Union (SEIU), American Federation of State, County and Municipal Employees (AFSCME), the AFL-CIO, the NAACP and Planned Parenthood are all opposed. The Los Angeles County Democratic Party also voted to oppose it, as did the LGBT [Queer] Caucus of the California Democratic Party, because we’re concerned about the [lack of] privacy of the CURES database.”
Like the ubiquitous TV commercials against Prop. 46, Hansen portrayed the measure as an attempt by sinister trial lawyers to milk the system for scads of money by filing medical malpractice suits without the MICRA cap to restrain them. “The California School Boards Association estimated the cost to them would be $2 million per year,” he said. He also accused the proponents of eliminating a requirement in the first draft of their initiative that nurses would have to report doctors apparently under the influence of alcohol or drugs so the California Nurses’ Association would endorse the initiative. As it stands, he said, “the only people who are drug- or alcohol-tested are doctors who have hospital privileges, not all doctors.”
Hansen also said that changes to laws like MICRA should be made by state legislators and the governor, not at the ballot box through an initiative — which provoked angry comments from supporters to the effect that legislators are so dependent on campaign contributions from insurance companies they won’t even consider raising MICRA. This provoked Hansen to tell a story about how, when former Los Angeles Mayor Antonio Villaraigosa was speaker of the California Assembly, “the CMA agreed to raise [the MICRA cap] to $500,000, but the trial lawyers demanded $1 million.” He also said that current Assembly Speaker Toni Atkins was against Prop. 46.
That provoked former Democrats for Equality president Craig Roberts to text Atkins to see if she had really taken a position on the measure. She texted that she hadn’t, but later sent an e-mail to another club member stating that, though she had no official position on the rest of the proposition, her experience as former director of the now-defunct Womancare women’s health clinic and former board member of Planned Parenthood — both of which, she said, “couldn’t get malpractice insurance until MICRA” — had made her dead-set against raising the MICRA cap at all.
“You have a great deal of antipathy towards lawyers,” club member Kelli King said to Hansen. “Who’s on the other side? Insurance companies. There are scumbag lawyers, but there are also scumbag insurance companies. Lawyers at least potentially represent the little guys against the insurance companies.”
“This wouldn’t be in front of us if the trial lawyers hadn’t raised $8 million to put it on the ballot,” Hansen responded. “It’s important with any ballot measure to see who’s paying for it. All the money came from attorneys. I know the trial lawyers’ lobbyists and I work with them. I also know what their motives are.” Hansen added that while there were three insurance companies contributing to No on 46, “they aren’t health insurance companies,” and in answer to another audience question he said drug companies weren’t giving to No on 46 either.
“It is the insurance companies fronting the money” to defeat 46, said Karen Olson. “They have millions of dollars to fight this. The reason they’ve put so much money into [No on 46] is they get to keep 45 percent of all malpractice premium payments, the highest percentage of any type of insurance. The doctors should be on our side.”
The Other Provisions
While the MICRA cap received the lion’s share of attention from panelists and club members alike, the other provisions of Prop. 46 — the requirement that doctors be tested for alcohol and drugs and the mandate for doctors to register for the CURES database also came up in the discussion. The California branch of the American Civil Liberties Union (ACLU) opposes Prop. 46 because, according to its Web site (https://www.aclunc.org/article/no-proposition-46-medical-malpractice-lawsuits-cap-and-drug-testing-doctors-initiative), “The initiative would require physicians to submit to random, suspicionless drug testing, which is an unwarranted intrusion into their right to privacy protected by the Fourth Amendment and the California Constitution. Random, suspicionless drug testing fails to deter drug use and is unnecessarily intrusive, particularly given the less-intrusive alternative approach of testing individuals only when there is individualized suspicion of impairment or another particularized reason to do so.”
The panelists also disagreed over whether the CURES database, on which the initiative relies to identify prescription drug abusers who are “doctor-shopping” for painkillers and other commonly abused drugs, is ready for prime time. Hansen’s argument that CURES is “not supposed to work in real time” referenced the fact that CURES was originally set up as an aid to long-term investigations and prosecutions of doctors who were enabling prescription drug abusers. It wasn’t, he said, supposed to work the way Prop. 46 wants to use it: to identify patients seeing more than one doctor for controlled substances and shut off their access to those drugs. He also questioned whether CURES would be safe from hackers and others out to steal confidential patient information.
“The legislature has been working really hard since 2009 to make sure CURES is working and will be secure,” said Chris Ward, who’s on the staff of State Senator Marty Block — though he was speaking for himself and not as Block’s representative. “We anticipate the database will be available on January 1, 2015. I believe the privacy concerns are unfounded. The encryption and security are the tightest available.”
“It’s a law enforcement database, not a medical database,” Hansen snapped back. “Initiatives become effective the day they are passed. The CMA supports making CURES operational, and it’s being paid for by a surcharge on doctors’ medical license fees, but it won’t be operational until July 2016.”
There was also a debate over whether Proposition 46 violated the single-subject rule — the provision of the California Constitution that says, “An initiative measure embracing more than one subject may not be submitted to the electors or have any effect.” The California ACLU claimed that Prop. 46 does too many things to meet the single-subject requirement. “Here, voters may well support some parts of this initiative but oppose other parts of it,” the ACLU’s Web site stated. “Californians should be able to vote their conscience separately on each of these individual provisions.”
Proponents of Prop. 46 argue that their initiative does deal with just one subject: protecting California patients from medical abuses, whether caused by alcohol- or drug-using doctors, prescription drug abuse or medical malpractice. But several club members expressed precisely the sort of frustration the ACLU was complaining about; people who might be inclined to support the drug- and alcohol-testing requirements on physicians might oppose changing the MICRA cap, or vice versa.
Club member and attorney Bryan Wildenthal said Prop. 46 “packages together four separate things, including the invasion of privacy, MICRA and CURES.” He acknowledged the concern of Prop. 46’s supporters “that professionals don’t police themselves,” but questioned whether it was appropriate for an initiative to mandate that people use a particular database and said the smorgasbord of issues crammed into Prop. 46 was “liable to have us debating at cross-purposes.”
“I was actually inclined to vote for this until tonight’s forum,” said former club president Roberts in explaining why he was making a motion for the club to take no position on it. “I respect Toni’s opinion. I’ve known her 20 years and her heart is still in the right place.”
David Warmoth, current president of the Democrats for Equality, said he would vote against Roberts’ motion because “we have a legislature that on these particular issues is bombarded with lots of money and lots of competing lobbying that will prevent them from acting on any of these issues.” Eventually, however, the club passed Roberts’ “no position” motion by a voice vote; though no one asked for a roll call, the club seemed to be about 2-1 in favor of it.