How California Could Lose a Generation of Doctors

How California Could Lose a Generation of Doctors

When California voters go to the polls on November 4, they won't just be choosing their members of Congress. They'll also be making a decision on Proposition 46, a three-part ballot measure that could have profound effects on the cost of their health care and the privacy of their medical records.

The primary provision -- though not the first listed on the ballot -- would hike the cap for "pain and suffering" reimbursements in medical-malpractice cases from $250,000 to $1.1 million. It is important to note that such damages are not the only method of recompense in these unfortunate cases. Monetary damages to pay for the patient's loss of future income are unlimited and can easily run into the millions of dollars.

The present caps were instituted in the 1970s after doctors in Los Angeles County went on strike to protest skyrocketing medical-malpractice premiums. Pain-and-suffering damages in California were out of control, often in the tens of millions of dollars. The Medical Injury Compensation Reform Act (MICRA), signed into law by Governor Jerry Brown, was passed to limit these settlements.

Proposition 46 would adjust the MICRA reforms for inflation -- which after almost 40 years means more than quadrupling them. These increased costs would not be borne solely by doctors. They would be passed on both to patients and to employers who pay for health plans, including state and local governments. The California Medical Association has estimated that raising the cap to $1 million would increase health costs by $9.9 billion per year -- or more than $1,000 for a family of four.

While increasing the cap on non-economic damages is the centerpiece of Proposition 46, the general public is largely not even aware of it. Instead, television jingles urging "Yes on 46" ask, "Shouldn't Doctors Pee in a Cup Too?" -- a provision described as "the ultimate sweetener" by Proposition 46 supporter Jamie Court of Consumer Watchdog. While it is a worthwhile goal to ensure that physicians be of sound mind when treating patients, urine drug screens are an extremely problematic method of achieving this.

Toxicologists decry the use of urine drug tests due to their frequent false positives and false negatives, not to mention the fact that the presence of drugs in someone's urine does not indicate acute intoxication. Under Proposition 46, a physician who took cold medicine (known to cross-react with the amphetamine screen) the morning of a random urine drug screen would suffer an immediate suspension pending further investigation by the California Medical Board. While this measure polls well with the public, its practical effect will be to make practicing medicine in California a perilous proposition.

The third provision of Proposition 46 would mandate that doctors and pharmacists check a state-run database every time they prescribe Schedule II or III drugs to a new patient. Unfortunately, there is no additional funding to increase cybersecurity on this newly developed database, even though mandating its increased use leaves this private medical information more vulnerable. When a tech giant like Apple can't reliably guard its customers' private photos, trusting an underfunded state program to keep its newly minted database secure in the face of a radical uptick in usage could result in unforeseen privacy issues.

As a native San Diegan in my final year of medical school, I would like to stay in my home state to practice medicine. But spiraling malpractice premiums and regulatory uncertainty would make that dream much less attractive. Should Proposition 46 become the law of the land, young doctors may decide to hang their shingles in another state.

Zachary David Skaggs is a medical student at the Keck School of Medicine of the University of Southern California.

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