Wednesday, July 29, 2009


In a quiet and underpublicized scheme, Gov. Schwarzenegger's administration is causing the State of California to lose money. Here's one of the methods it uses that pertains to physicians, psychologists, and injured workers.

The Schwarzenegger administration, repeatedly alleging fiscal responsibility to the State of California, allows doctors without California licenses to practice medicine in California without paying fees to the Medical Board of California (MBC). At a cost of $808 dollars per license, it takes only 1,000 such licenses for MBC to lose $808,000. Not enough to make a difference, say Schwarzenegger's devotees. But enough to have caused the MBC to assert that it can't separate valid complaints against doctors from invalid ones for the purpose of posting one and not the other. Hence, the MBC allows both kinds of reports, ones validated against doctors and ones proved invalid, to be posted on official websites. Careers are ruined on the altar of fiscal incompetence.

Why can't the MBC separate valid from invalid complaints and allow only the valid complaints to be posted? The answer reported to legislative committees seeking to pass corrective legislation (e.g., AB 245, Ma) is that MBC cannot afford the expense of hiring clerical personnel to do the paperwork. In other words, the MBC is broke.

Meanwhile, Gov. Schwarzenegger persists in opposing legislation that would require doctors who do Utilization Review (UR) to be licensed in California and to pay fees to the MBC. The Governor persists in this stand even though his own MBC has stated that UR is part of medical practice. UR doctors have the authority to delay, deny, modify, or approve diagnostic and treatment prescriptions from doctors who are licensed in California. UR doctors have the power -- without actually interviewing or examining injured workers -- to deny, delay, modify, or approve the prescriptions of licensed doctors!

UR doctors are responsible only to their employers or surrogate UR companies. On one such occasion a Connecticut UR doctor from 3,000 miles away denied treatment to an injured worker in California. Upon reviewing the documentation selected and sent by the insuror, the CT doctor nixed the hapless injured worker's prescription and communicated the denial to his UR employer in Dallas. From there the denial of care was issued against the interests of an injured worker in California.

Insurance companies assert that since treatment is supposed to be evidence-based it shouldn't matter where the UR doctor actually is -- and that, therefore, a California license isn't necessary. The insurance companies also argue that UR is required and that there is no significant difference in the education and training of doctors -- so the geographical location of the doctor isn't important. Red flag here!

The Inconvenient Truth is that in California there is a requirement for California-licensed doctors to take a 12 hour pain management course. This requirement need not be met by non-California licensed doctors.

Insurance companies prefer their hired guns to be responsible only to them, not to public policy. Doctors who are licensed are responsible to the public policy of the state in which they're licensed and are subject to discipline by the state board. Doctors risk their licenses for spurious delays and denials of care.

Not so if one doesn't have a license. In fact, a non-California licensed UR doctor isn't responsible to any state board at all. The non-California licensed UR doctor isn't responsible to the MBC since the doctor isn't licensed in California and isn't responsible to the medical board of his own state, either, since that state doesn't have jurisdiction in California.

There is corrective legislation on the horizon: AB 933 (Fong) has cleared the Assembly. Because of Schwarzenegger's guaranteed veto, the bill is being held in the Senate until January of 2010. Assemblyman Paul Fong's legislation would require doctors who do UR in California to be licensed in California no matter where they reside. Because Texas passed similar legislation in 2007, we have an interesting anomaly: California doctors without Texas licenses are prohibited from doing UR in Texas. Texas doctors without California licenses are welcome to do UR in California. How d'ya like those apples, Mr. and Mrs. Injured Worker in California?

There is a caveat: Some insurance companies, e.g, State Compensation Insurance Fund (SCIF) and Zenith use only California licensed doctors for UR. Other companies assert that there aren't enough California-licensed doctors to do all the UR that is needed. Another red flag here!

The California Medical Association is on record as saying that this assertion is false. In fact, at least one utilization review company in California has a waiting list for doctors who want to do UR. Injured workers who are denied treatment by UR should file protests if the UR doctor who denied treatment is not licensed in California especially if one of the issues is the diagnosis and treatment of chronic pain.

UPSHOT: Gov. Schwarzenegger is turning somersaults to protect insurance company profits while doing cartwheels to prevent injured workers from getting the care their doctors prescribe. Simultaneously, he is making sure that an official agency of the state, the Medical Board of California, is deprived of income it could have from out-of-state doctors. Injured workers, their unions, their doctors, and lawyers on both sides should raise Cain about this despicable application of Utilization Review.