Blog | Wednesday, September 17, 2014

Physician drug testing


The New York Times reported on a ballot initiative in California that would mandate random routine drug and alcohol testing of physicians, and targeted testing after major adverse patient events. The full text of the proposal is available here.

Proponents of the measure (Proposition 46) highlight the danger posed by impaired physicians and the ubiquity of drug testing for other professionals such as airline pilots and public safety officers. They also endorse the other “patient safety measures” included in the proposition, including mandating that providers check a controlled substance database similar to the New York State I-STOP database before prescribing. Their arguments are summarized here.

Predictably, the California Medical Association opposes the measure, mostly they say because it would also raise the current cap on “pain and suffering” payments in malpractice suits, and lead to higher malpractice insurance costs. Interestingly, the CMA website opposing the proposition doesn’t mention the drug testing provision.

My first reaction when I read about the drug testing initiative was one of sadness. What a shame that we have failed to maintain the public trust in our profession. But I was also reminded of a case I was involved in years ago in which a physician’s careless act led to a patient’s death. I have long regretted that I failed to insist that the physician be tested for drugs or alcohol at the time. If the death had been caused by a plane crash or a bus accident, we would all expect such testing to take place, and its omission would never be tolerated by the National Transportation Safety Board.

The mission statement of the CMA is: “Promoting the science and art of medicine, the care and well-being of patients, the protection of the public health and the betterment of the medical profession.” Seems to me that if they really mean it, they ought to be in favor of drug testing.

What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.