The state medical board, meeting in South San Francisco Thursday, decided to abolish its controversial "diversion" program a physician monitoring system that critics say has protected irresponsible doctors at the cost of patients. Stating that the primary mission of the board is consumer protection, the members decided that operating such a program was "inconsistent" with its policies.
By this time next year, physicians will likely face immediate suspension of their medical licenses if they are determined to have a substance abuse problem. The onus will likely be on them to complete a treatment program and prove they won't jeopardize patient care if they want to get their licenses back.
"The board did something which very few agencies ever do: It gave up part of its turf, because they recognized this isn't properly protecting the public," said Julianne D'Angelo Fellmeth, leader of a 2004 audit of the program. "They took a courageous step forward."
There are typically 250 to 300 doctors in the program at any given time, but their participation is confidential and patients have had no way of knowing whether their doctor or prospective doctor may be battling an addiction.
But several high-profile cases of doctors who relapsed while participating in the program spurred calls for its elimination.
Redwood City physician Dr. Timothy Trompeter had his license revoked in 2005 after he was arrested in possession of crystal methamphetamine. He had previously participated in the diversion program for five years.
The program was created in 1980 to give physicians with substance abuse problems a second chance.
"A lot of doctors who came before us in discipline had hurt no one but themselves," Dr. Gene Feldman, the medical board president at that time, said in a 1994 presentation. "They were being disciplined at an average cost of $30,000 per case, and most had already gone into rehabilitation programs and were clean and sober. But we were required to discipline them and ruin their lives."
Supporters of the program say it has protected the public by providing impaired doctors with immediate access to treatment services and then monitoring them for several years to ensure they have recovered and are capable of treating patients safely.
"Now that there will be penalty automatically associated with the knowledge they have a problem, no physician is going to willingly say that they do," said Dr. Jim Hay, officer of the California Medical Association, a lobbying group which represents 35,000 physicians in the state. "So the only physicians that will be known to have a problem are the ones who get drunk driving arrests or come to work intoxicated, where they already created a problem."
Despite such support, five separate audits of the program have found that early intervention hasn't always kept physicians from harming their patients. The public has been left vulnerable because there has been no way to find out whether a doctor has a chemical dependency issue.
"The diversion program allows doctors to kill silently," said Janet Lynn Mitchell, a former patient of a Southern California physician who was found guilty of fraud. The doctor, she said, helped an anesthesiologist in the diversion program cover up the death of a patient that occurred after the anesthesiologist left the operating room to get high.
"The doctors haven't suffered," said Mitchell, "it's the citizens of California who have suffered."
In her 2004 audit Fellmeth found that some physicians in the program had collapsed on duty because of substance abuse. The horror stories are rampant, she said, with some doctors admitting to "gaming" the system so that they could continue practicing while continuing their drug use. One nearly graduated from the five-year program even though he had continued to use drugs all along.
Auditors have determined that random drug tests weren't so random; that tests often failed to catch illicit substances; and that "work site monitors" people who shadowed doctors in the program at work at times lied to cover up the extent of the doctor's addiction problems. One monitor was a doctor's own office manager, who feared that if she didn't do as he said, she could lose her job.
In more than a handful of cases, doctors had relapsed at least four times before even being considered for termination from the program.
"These doctors were allowed to practice," Fellmeth said, "while not being adequately monitored."
Contact Julie Sevrens Lyons at firstname.lastname@example.org or (408) 920-5989.