Several patient advocates had the opportunity recently to attend a Citizen Advocacy Center (CAC) forum in San Francisco. Participants met from across the country to discuss the Regulatory Management of Chemically Dependent Healthcare Practitioners. These are policy filled terms that translate to “what to do with doctors and health care workers in our health system who abuse drugs or alcohol.”

Now, most people may wonder why we have an interest in this topic of chemical dependence amongst physicians and other healthcare professionals. Well, unfortunately, alcohol and drug addiction is not an uncommon problem amongst some physicians and licensed workers in the medical field and patients are subject to serious harm while being treated by an impaired caregiver. It is an issue that is considered a confidential matter between a physician and his or her employer and licensing board. The licensing board and lobbying interests do not want California consumers to know this is an issue and whether their physician has an addiction problem. Yet, the issue was serious enough that legislation was enacted to create a physician diversion program which went into effect on January 1, 1980. This legislation required that the Medical Board of California (MBC) seek ways and means to identify and rehabilitate physicians and surgeons with impairments due to abuse of dangerous drugs or alcohol, or due to mental illness or physical illness.

The California Physician Diversion program continued to rehabilitate and monitor physicians until July 2007 when the combination of five failed program audits, the testimony of Northern California patient advocates, and increased media attention caused the MBC to vote to abolish the program. At the time, the MBC abolished the program citing that they understood that the program was putting California patients at risk.

Since California is the only state that has abolished its physician diversion program, a good portion of the discussion at the CAC conference was dedicated to the ineffectiveness within its program. The information revealed how ineffective the monitoring of impaired physicians was and some of the myths surrounding the former diversion program. One such myth is that most physicians self-enroll into diversion. In fact, most physicians self-enroll due to a last ditch effort to avoid conviction from drug or alcohol-related legal issues or to avoid discipline by the Medical Board due to impairment issues.

The majority of the CAC conference participants either ran diversion programs, were a member of a state board that maintained a diversion program, or were a past or current member of a diversion program. Needless to say, most of the participants were in support of diversion programs and the lack of transparency related to such programs. But several of us attending as patient advocates had come to know of the program for very different reasons. We had either been personally harmed by a physician who had alcohol or drug problems or had lost a loved one at the hands of an impaired physician. The destruction left behind when a physician chooses to abuse drugs and alcohol while continuing to treat patients, and when the state’s licensing board and medical association choose to look the other way to protect their physician member’s livelihood, impacts more than the victimized patient; it can destroy families.

The recurring themes from proponents of confidential physician diversion programs are that addiction is an illness; that healthcare professionals have the right to their livelihood; and that no patient is harmed in the process. In other words, “rehab but don’t tell” was the general message within the audience. We hear the same message when we testify before the California state legislature and present the consumer’s experience with impaired physicians. It appears that the lobbying interests believe that if they continue to tell us that no patient is harmed, then in time we will believe it. Fortunately, Consumers Union understood the need to ensure that the discussion was more balanced and sent patient advocates to the conference to share our perspective.

One could be amazed at the courage of the CAC conference’s physician participants, who admitted to their past problems with drug abuse and who acknowledged that one trip through a diversion program did not resolve their dependency issues. One healthcare professional actually admitted that it not only took multiple attempts at diversion but also other forms of intervention to work through their addiction issues.

I feel empathy for their struggle, but on the other hand it makes me wonder how many times other physicians have participated in rehab and monitoring. Do our loved ones see physicians with alcohol or drugs abuse problems? Have you checked to see if your doctor has been arrested for drug or alcohol-related crimes?

I can tell you that I was uninformed and I didn’t check and now I am left alone to grieve and to fight for patients’ rights. I can not bring back my lost love but I can attempt to make positive change in order to help save someone else from such a tragic fate. Our work in physician transparency might just save your life.
-Michele Monserratt-Ramos