Will Proposition 46 suffer from an over-the-top advertising debacle?

A recent advertisement for Proposition 46 depicts a purported doctor in white coat adorned with casually strewn stethoscope over his shoulders sitting at a bar while ordering a drink, presumably other than ginger ale, while his pager goes off -- he's being called to the emergency room, no matter if he's in a drunken stupor. 

With this final flailing effort, Consumer Watchdog appears to have hurled its last lightning bolt in support of Proposition 46, the initiative to raise trial awards for pain and suffering in malpractice suits from $250,000 to $1.1 million. Consumer Watchdog, down to its last one million dollars, reportedly wagered the entire store on this last-ditch effort. It's a gamble that may have misfired.

While consumers are not as mesmerized by physicians as once they were, they're still not at a level where they believe that doctors in general have sunk to this level.  Physicians are still generally admired by the public. Physicians who fall short of public expectations suffer mightily in the court of public opinion and are subject to discipline by the medical board.  The public, more sophisticated than Consumer Watchdog realizes, are not easily misled. 

This latest ad depicting a presumably inebriated doctor on his way from the saloon to the emergency room may have overshot the mark and turned undecided Proposition 46 voters into NO votes on 46.  Consumer Watchdog reportedly depleted its campaign funds with this desperate advertisement and along with it sacrificed its own credibility.

Proposition 46 -- last word, well, almost!

Proposition 46, most voters have figured out, is about raising the limit on "pain and suffering" from $250,000 to $1,100,000 if not more. This amount would be in addition to unlimited economic damages which is already the law. In other words, a cadre of lawyers whose specialty is medical malpractice would be emboldened to sue in circumstances where they might otherwise decline. Ask yourself what would be the consequence of so doing according to Proposition 46?

1) Most likely, insurance companies will raise their annual premiums for a family of four by about $1,000 to $1,250.

2) State and county hospitals, supported by tax dollars, often get virtually hopeless accident cases where medical error may occur even in the hands of the most skilled surgeons. To cover the costs of increased malpractice payouts it is likely that state and county taxes will go up. 

3) What about the system whereby physicians would be obliged to find out what drugs their patients were on before prescribing analgesics for pain. Truth is, I personally called into the system months ago to ask about a patient. That was before Proposition 46 was known. Nobody was home. I was advised that although the program existed in theory it wasn't funded well enough to have full time staff with telephone exchange and answering services. Not to worry, increased taxes should take care of that deficiency. But isn't this system the one we depend upon for privacy about our medical prescriptions? Additional safeguards will be needed. Not to worry about that, either -- increased taxes should pay for enhanced privacy protection, shouldn't it?  

Conclusion: the trial lawyers didn't do a scholarly enough job in putting Proposition 46 together. As written Prop. 46 puts ordinary citizens at risk for increased costs for health insurance premiums, for increased state and county taxes, and for invasions of privacy. It should be defeated. Vote No on 46.

Proposition 45: pro and con

Robyn G. Young, MD, president, California Neurology Society, presents her case for Prop. 45 in her editorial available on ca-neuro-society.org (it is also summarized in our previous blog in the end-of-article listing of references).

Now comes Stuart A. Bussey, MD, JD, president, Union of American Physicians and Dentists, who writes in the "The UAPD Pulse" why Prop. 45 does not deserve passage.

Bussey's piece makes these points:

1. Prop 45 would shift regulatory authority from an independent commission to one political figure who would then become a "pressure point" subject to special interests.

Comment: the independent commission is also subject to special interest pressure, but it's more difficult to get to an entire committee than one person. On the other hand, commissioners get their jobs by appointment, political appointment, not by scoring well on achievement tests.

2. Bussey points out that under the ACA administrative costs are limited to 20% -- anything over that "must revert back to patient services."

Comment: Trouble is that the insurance companies often try to sneak administrative costs into the "patient services" sector. Example are utilization reviews requested by insurance companies that seek to disguise them as "consultations."

3. If  Prop. 45 passes a likely revenge step the insurance companies will take will be to slash provider reimbursement. Agreed, that's what they'll do, not that they don't already do it. The independent commission has not roared its disapproval of provider abuse.

Comment: It's also likely that the insurance companies and MPNs (Medical  Provider Networks) will jettison hundreds of doctors as a way to reduce expenses (not that that hasn't already been done). That in turn will force the remaining doctors to see more patients faster (the short visit you get now will be made even shorter).

My opinion: if Proposition 45 passes, the next step will be the implementation of rules and regulations. Proponents should be ready to take that matter on from Day One. That means day-to-day readiness to participate in the regulatory process. Proponents feel they have a better chance at fair regulation with Proposition 45 than without it. Opponents are skeptical, and with good reason, e.g., the unions bent over backwards to get Brown elected Governor only to find out yesterday that he vetoed all three of their bills. Would a single insurance commissioner be different?

The latest re the ACA: a laboratory in San Jose has just  billed a doctor's office for laboratory work done for Medicare patients. The lab in question said that changes in the Affordable Care Act made in January of 2014 allows them to do so. We'll look into this matter and see what the current insurance commissioner wants to do --  it'll be a prelude to what he'd do were Proposition 45 to pass.

In our next blog, we're planning on a few parting shots re Prop. 46,

Question: When should lawyers be tested for drugs?

Answer: When they're awake.

LEGISLATIVE FLAME-OUTS RE MEDI-CAL, OPHTHALMOLOGY, AND FAIRNESS IN CONTRACTING

AB 1805 (Skinner & Pan), which would restore the 10% cut in Medi-Cal reimbursement for Medicaid patients in California, is bogged down, mired in the mud of the Assembly Appropriations Committee where it is being held hostage. The 10% cut was imposed by the state budget in 2011 and recently was denied restoration by Governor Brown's recently revealed budget for 2014. It is clear that the Governor isn't going to do much to help Medi-Cal recipients or their treating doctors. Even if the bill passes, it'll have to survive his Gubernatorial veto. Readers interested in the survival of this bill will be obliged to rely on the democratic process, i.e., they'll need to call their elected state reps.


AB 2400 (Ridley-Thomas), sponsored by the California Medical Association, which would have allowed providers the ability to negotiate changes unilaterally made by health plans and their insurance companies, or to terminate the contract if agreement could not be reached, has bitten the dust. The tilt of the current administration, like the one that preceded it, is towards big business and against hapless patients and their beleaguered providers. This bill was residing uncomfortably in Senate Health Committee. Now it rests in not so peaceful repose. Readers interested in this bill will need to try to restore interest and build a wider coalition in 2015 than they had this year.


SB 492 (Hernandez) which would allow optometrists to practice aspects of ophthalmology that they are not currently licensed for has had better success. This bill passed Assembly Business and Professions Committee. It is opposed  by the California Medical Association, the Union of American Physicians and Dentists, the California Neurology Society, and a host of professional organizations whose weight in this case is negligible since their combined opposition is regarded as turf protection. 


One success is the failure of SB 1215 (Hernandez) to clear the Senate Business and Professions Committee. This bill would have eliminated the in-office exception for specific procedures such as physical therapy and advanced imaging including CAT and MRI scanning, ultrasound, and other procedures, thereby sending patients on a perpetual run-around. Readers can learn  more about this bill on the Advocacy and Legislation sections of the California Neurology Society website. The CMA, UAPD, CNS, et al were opposed and were part of a wide coalition in opposition.


An aulde lesson in these bills is the importance of coalitions not all of whose members need necessarily have a stake in the outcome. Protection of public welfare still plays a role albeit not as much as many of us would like.

ALERT: The trial lawyers' malpractice initiative has now been officially designated as Proposition 46 while the campaign against it, which we support, will be known as the No on 46 Campaign. The idea is to add Proposition 46 to our list of flame-outs lest its carelessness and callousness burn irreparable damage into California's health care.

Malpractice and drug testing: Pee Pee Politics (PPP)

We've been asked several times to provide the dates of our posts on the Pee Pee Wars, namely,  the trial lawyers' attempt to disguise advantageous malpractice reform in their favor while making it seem as though they want to protect the public by testing doctors for drug abuse. The Triple P moniker arises from the method of testing, namely, micturition into little cups. Here's the dates of our posts: 6/25/14. 5/28/14, 4/27/14, and 4/24/14. - RLW, editor

P.S. The trial lawyers' initiative, The Troy and Alana Pack Safety Act,  has now been officially designated Proposition 46. Accordingly, we recommend support for the NO on 46 campaign. - rlw, ed.

Interim Bill Review: AB 1340, 2400, 1805, 1886, and the thinly disguised malpractice initiative

This post includes late additions to the original posting


Assembly Bill 1340 (Achadjian) that would establish Enhanced Treatment Programs is a life-and-death issue for nurses, technicians, and doctors who take care of the sickest and the meanest among us. For this privilege the trial lawyers would like to force the doctors, but not themselves, to pee in a cup. That's the program the trial lawyers are hiding behind in their shameless effort to get higher malpractice awards for themselves under the guise of the Troy and Alana Pack Safety Act which has as its most likely main benefit for a family of four the opportunity to pay $1,000 more annually for health insurance.


Assembly Bill 2400 (Ridley-Thomas) would level the playing field so that Big Biz insurance companies would not be as able as they are now to drive down access to care for patients with chronic and expensive illnesses. For this privilege the trial lawyers want the doctors to pee in a cup. The trial lawyers who have even gone so far as to concoct bogus statistics actually are the ones who should pee in cups. Their campaign cited a report from March of 2000 by the California Medical Board which said "many believe" that 15% of the general population has problems with substance abuse and that among health care professionals the lifetime level might even be 18%. This rough estimate was a supposition, not a researched statistic. Moreover, this lifetime risk translates to no more than 2% at any one time. The trial lawyers' addled research team that thought this one up should pee in as many cups as can be distributed as quickly as possible.


As for the convicted drunken driver who fled the scene  after running down 10 year old Troy and 7 year old Alana Pack,  it is known that she had three drunken-driver convictions before the accident.  Because she fled the scene and evaded the authorities for two days, a timely blood alcohol test was not obtained. While she was on the run, her apartment was searched. Cocaine was found. She eventually told police she'd taken vicodin prescribed by her treating doctor. Her legal defense at trial was that it was her doctors' fault because they prescribed the medicine for pain relief. She did not assert that they also told her to drive under the influence. Her sentence: 30 years in prison.


Our reward, as doctors whose duty includes the relief of pain, is now supposed to be to pee in cups while prosecutors who get wrongful convictions because they withheld exculpatory evidence from the defense booze it up when what they deserve is to pee in cups and then serve out the time they foisted upon defendants who've since been released because of wrongful convictions. It's a logical next step to have every lawyer,  as he passes through security to enter the courthouse, pee in a cup.

Late flash: the trial lawyers' initiative has been officially designated Proposition 46. The campaign against it will be known as the No on 46 campaign. We support the No on 46 Campaign.


Medi-Cal: we support AB 1805 (Skinner and Pan) which would restore the 10% cut in Medi-Cal remuneration that was installed by the State Budget Act of 2011.  It isn't lost on us that devoted  doctors who take care of the sickest and poorest among us would also be obliged to pee in the trial lawyers' cups. Of course, some might say that Gov. Brown already did that for them when he sent through his recent budget bill which managed once again to give the short end of the stick to the doctors who care for Medi-Cal patients. His having done so raises the ugly spectre of  a possible veto of the Skinner-Pan bill even if it passes handily.


AB 1886 (Eggman): Its original aim, while modified pursuant to amendments obtained by the CMA, remains unchanged, e.g., indefinite posting of disciplinary actions, civil judgments, and arbitration awards against doctors, just enough to make sure that good doctors who  run afoul of one or another disciplinary board become persona non grata to whatever managed care, HMO, or PPO organizations that want to use even minor misdemeanor convictions to ruin careers. It's all about the control and humbling of what used to be an honored profession. Doctors need to learn to say "no" to their would be overseers.
 
So here are our recommendations: yes on AB 1340, yes on AB 2400, yes on AB 1805, and no on AB 1886 and no, no, no on the Troy and Alana Pack Patient Safety Act, now officially designated as Proposition 46. Accordingly, we urge support for the No on 46 Campaign.


References


www.politicsofhealthcare.com, 4/29/14, Oppose AB 1886 (Eggman) Unless Amended, and California Medical Association Legislative Hot List, 6/02/14 (author accepted CMA's amendments , CMA now neutral);
www.politicsofhealthcare.com, 6/24/14, AB 2400 (Ridley-Thomas), Deserves Support plus an amendment;
www.politicsofhealthcare.com, 6/23/14, AB 1340 (Achadjian), Deserves Safe Passage;
www.politicsofhealthcare.com, 6/18/14, AB 1805 (Skinner & Pan), Supporting Medi-Cal and 6/16/14, Medi-Cal Patients Snubbed by State Budget;
www.politicsofhealthcare.com, 4/24/14, Random Drug Testing for Lawyers and 5/28/14, Drug Testing for Lawyers and Pharmaceutical Executives

DRUG TESTING FOR LAWYERS AND PHARMACEUTICAL EXECUTIVES

District Attorney Tony Rackauckas representing Orange County and County Counsel Orry Korb from Santa Clara County have filed a consumer protection lawsuit against five opioid manufacturers. The accusation is that the five companies conducted a more than decade-long marketing campaign to mislead doctors about the risk of long-term opioid management. The named defendants are Purdue Pharma, Teva Pharmaceutical Industries Cephalon, Janssen Pharmaceutical, Endo Health Solutions, and Actavis. The lawsuit also names the American Pain Foundation, the American Academy of Pain Medicine, and the American Geriatric Society.

The lawsuit asserts that "opiod makers were not the first to mask their deceptive marketing efforts in purported science. The tobacco industry also used key opinion leaders in its effort to persuade the public and regulators that tobacco use was not addictive or dangerous."

We owe this information to Tom Lynch whose editorial, "Another Day, Another Battle in the War on Over-Prescribing," was published as a column by WorkCompCentral on 5/28/14.

Our interest is how this matter now dovetails with the Malpractice Initiative that the trial lawyers are expected to qualify for the November ballot in California in an effort to repeal the MICRA reform instituted by Gov. Brown during his first administration. The Initiative is aimed at drug-testing for physicians and doesn't mention that annual insurance premiums for a family of four may be increased by as much as $1,000.

Although the trial lawyers espouse drug testing for physicians, pilots, and others, they do not include themselves.

We now recommend that they find a way to include drug testing not only for themselves but also for pharmaceutical companies, their executives, and all of their employees including sales department personnel.

Just call it The Full Employment Drug Testing Act (FEDTA).

Late Flash: the trial lawyers' initiative to increase malpractice awards for themselves has been designated Proposition 46 while the campaign against it, which we support, will be called the No on 46 Campaign.

Additional References

"When Should Lawyers be Drug Tested?" by Dr. Robert Weinmann, www.workcompcentral.com, 4/28/14

"Random Drug Testing for Lawyers," The Weinmann Report (www.politicsofhealthcare.com, 4/24/14)

"California's Ballot initiative will mandate random drug testing ONLY for doctors (why not attorneys?)," by Rehan Sheikh, facebook.com/PhysiciansForFairness, {https://www.facebook.com/PhysiciansForFairness}, twitter.com?Voice_MD {https://twitter.com/Voice_MD} 5/20/14


 

Is SB 1429 (Steinberg) an aborted last ditch effort to settle medical malpractice liability ...

... or a possible vehicle for Gut and Amend at the end of the scheduled legislative session?    

In a nutshell, our opinion as of 28 April 2014 is that SB 1429 is almost dead in the water -- that's why we didn't discuss it in our previous article (RANDOM DRUG TESTING FOR LAWYERS: WHEN SHOULD LAWYERS BE DRUG TESTED?, 4/24/14)  about involuntary drug testing for lawyers. As matters stand now, the trial lawyers have committed their efforts to the initiative which has as its primary goal more money for lawyers who successfully prosecute malpractice cases. The initiative  would also impose random drug testing for doctors and require doctors to use a statewide data base when prescribing narcotic medication.

Steinberg's bill is less ambitious. His idea is to gather the parties together to work out a strategy that would be mutually satisfactory. Reasonable, you say? Not exactly because the lawyers aren't looking for a compromise on nickels and dimes and the doctors are dismayed about how much they already pay for malpractice insurance. Hence, a small increase in settlements as might be expected if non-economic damages were increased slightly or indexed for inflation doesn't interest the lawyers who, by the way, rejected a cost-of-living adjustment several years ago. Any increase in malpractice premiums doesn't sit well with the doctors whose incomes have been eroded over the last few years as managed care plans, HMOs, PPOs, and Covered California take over.

As for the statewide data base called CURES, just try to use it. Usually their phones if they have more than one go unanswered or the caller does not get the information requested. We've been advised that the database is underfunded and can't get the coverage it needs. So one of the first services to cut was knowledgeable persons answering phones.

It looks like both sides have stepped away from SB 1429, but, in theory, that could change under the proper circumstances. That would imply mutual  cooperation which at the moment does not appear likely in California's  House of Cards. SB 1429 lurks in the corner, a candidate for Gut and Amend.

Late Flash: the trial lawyers' initiative has now been designated Proposition 46 while the campaign against it will be known as the No on 46 Campaign. We will support No on 46 and advise our readers to do the same.

RANDOM DRUG TESTING FOR LAWYERS

WHEN SHOULD LAWYERS BE DRUG TESTED?

The correct answer is when they are awake and can give consent. The next question is why aren't they already tested when they go to court especially when they represent known felons, drug traffickers, or persons indicted for murder? The correct answer is because lawyers write laws to suit themselves.

A medical tech who was reportedly addicted to drugs and who stole fentanyl that was expected to be used for patients awaiting cardiac surgery caused the death of two patients and got a few dozen others infected with hepatitis C when he altered the contents of their syringes, stole the fentanyl and replaced it with saline that turned out to be infected. That bloke is now doing 39 years in prison. As this man drifted from job to job, protected from having to reveal his erratic job history, he was protected by law. Wrongful administration of fentanyl was also associated with Michael Jackson's death. This time the culprit was a physician. Now comes an effort to correct this situation, an effort, we believe that is steeped in hypocrisy and swimming in money. 

In California we expect the Troy and Alana Pack Patient Safety Act to qualify for the initiative process. The goal is to alter MICRA's (Medical Injury Compensation Reform Act) $250,000 ceiling cap on non-economic damages so that malpractice lawsuits become more lucrative for trial lawyers. So far CAPP (Californians Allied for Patient Protection) have thwarted the trial lawyer's goal. Proponents point out that there is currently no law that requires doctors to take random drug tests. They don't mention that there is also no law that requires lawyers to take random drug tests. Proponents argue that surgeons don't have to be tested randomly before operations but imply that that should be done. The same proponents don't mention that lawyers who are trying to put someone to death or save someone from the hangman's noose are also not tested. Why not? Both the surgeon and the trial lawyer are involved in death-struggles although, truth be told, it's the lawyers who as prosecutors are allowed to strive to put someone to death and may win kudos for so doing. But now the lawyers, especially those whose specialty is malpractice, want to impose random testing on doctors while continuing to exempt themselves. The idea, they say, is to stop the abusive overprescribing that in the case of 10 year old Troy and his 7 year old sister, Alana, was linked to their being killed by a drugged driver who had overdosed on prescription medication.

Trouble is that this noble concept has been hijacked by the trial attorneys who for years have been trying to increase malpractice liability in the hopes of higher payouts and better paydays for themselves. A recent study by the Berkeley Research Group reported declining malpractice claims and lower awards. This trend would be turned around were the Troy and Alana Pack Safety Act enacted into law -- one estimate is that attorneys would win about $127,500 more on average than they do now were the initiative to succeed. That explains why the ballot summary for this initiative conceals the initiative's true purpose, not patient protection, but lawyer enrichment.

So why not amend the Troy and Alana Pack Safety Act so that it also includes lawyers, e.g., random drug testing for any lawyer within a few hours of a scheduled court appearance, or anytime a lawyer is arguing a death penalty case? Lawyers, from time to time, steal from client's trust funds, sometimes to support drug habits, so why not also test lawyers randomly?

Sometimes lawyers miss statutes of limitations. Test all of them who do that. Sometimes lawyers create false documents or prosecutors fail to turn over exculpatory data to defendants. Test all of them, too. In cases where a wrongful prosecution has led to wrongful imprisonment, why not skip the drug testing and have the prosecutor finish up the sentence that was wrongfully imposed on the hapless defendant? Some lawyers, some doctors, and even some judges benefit from loopholes in the system.

If we plug these loopholes by amending the Troy and Alana Pack Safety Act, then, just maybe, with a level playing field, the proponents would improve their credibility with the public. At the moment, the initiative is tilted more to trial lawyers' enrichment than to anybody's safety.

Late flash: the trial lawyers' initiative to award themselves increased malpractice payments has been designated Proposition 46 while the campaign against it, which we support, will be known as the No on 46 Campaign.