Drug testing doctors: Will Californians see through the smoke?

California is contemplating requiring physicians to submit to alcohol and drug testing.   Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired.  Physicians, as members of the human species, have the same vices and frailties as the rest of us.

I have no objection to this new requirement, if it passes. This will not be a stand-alone proposal on the ballot, but is a part of the ballot initiative.   Why would trial lawyers in the Golden State want to include it?  The meat of their ballot effort is to reverse effective tort reform that had been in place there for several years.

Sure, there are always two or more sides to every issue.  But, when the different points of view here are fairly weighed, trial lawyers’ self-serving positions are overtaken.  They offer a different spin, of course.  While I acknowledge the validity of some of their arguments, I believe that the system they advocate helps very few at the expense of many more innocents.

The California ballot initiative aims to increase the financial cap for a medical malpractice award from $250,000 to $1.1 million.   Trial lawyers and other supporters were concerned that the public may reject raising the cap as they have been enjoying the benefits of tort reform.   Focus groups supported the notion that the public would find the drug and alcohol testing proposal appealing, which would raise the probability of passage of the bill.

There’s nothing evil about any of this.  Every player in every issue uses polling and focus groups to create and tailor their message.   (Ever notice how politicians claim they never read polls whenever poll results are against them or their positions?)   I’m sure that the insurance companies who champion tort reform are using the same techniques to manage their message.

But, voters there and the rest of us should recognize why the drug and alcohol provision is included.  It was just a spoonful of sugar to make the legal medicine go down.  Why not just include the medical malpractice vote on the ballot by itself?  We’ve seen our politicians use this same technique over and over again.  Add a popular poison-pill provision to an unpopular piece of legislation.  When it’s properly voted down, criticize those who voted against it by pointing out their opposition to the unassailable add-on provision.  Follow this example.

Legislator A: I am adding an amendment to the quadruple the minimum wage bill that would give all veterans and their families free first class seating on all domestic flights.

Legislator B:  I am voting against the bill because I think that quadrupling the minimum wage is bad economic policy.

Legislator A:  Shame on Legislator A for trashing our veterans who have sacrificed so much for this country.

Should other professions be subjected to random drug and alcohol testing?  Which would you suggest?

Will Californians see through the smoke here?   We’ll find out this November.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower

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  • Unchained Medical

    Excellent article. I think my post on medical school drug testing also applies here. http://www.kevinmd.com/blog/2014/05/medical-school-drug-testing-moral-scientific-failure.html

  • James O’Brien, M.D.

    California’s Medical Control Board is already ruthless with doctors. I’ve heard stories of interns who pass part 3 denied licenses because that had one DUI in college. They dropped a diversion program years ago.

    It’s also clearly a fourth amendment violation, but in the age of NSA no one cares anymore.

    This in a state where smoking pot is legal…

    I have no faith that the authorities will be reasonable…

    • querywoman

      Yet Michael Kamrava got to practice for a long time!

    • Reese

      Why should doctors be exempt from drug testing? Nurses deal with this throughout their careers. Is it a 4th Amendment issue for them as well?

  • Eric Strong

    I’ll be fine with submitting to random drug screening when our politicians agree to do the same.

    • Ed

      Why do consider yourself better than the rest of working Americans who are subject to random screening? While I understand your view, politicians are not making life and death decisions like you do for your patients.

      • Unchained Medical

        Politicians don’t make life and death decisions? Uuuuhhh… doctors aren’t the ones who start wars, or imprison people, or withhold medications through the FDA, or who order cops to fire tear gas at people for staying up past bed time.

        • Ed

          Couldn’t agree with you more since I’ve actually carried out the lawful wartime orders of those same elected officials, no matter how distasteful. But hey, we do live in a democracy, and despite all the deficiencies, I much prefer that than the alternatives.

          • James O’Brien, M.D.

            No, we live in a Constitutional Republic where human rights take precedence of the passions of the masses.

          • Ed

            Whatever; there is a ballot initiative where Californians vote and live with the results. Again, why do consider yourself better than the rest of working Americans who are subject to random screening in this Constitutional Republic?

          • Eric Strong

            Most of working Americans are not subject to random screening. And no one is arguing that physicians are better than anyone. Random drug screening for anyone is unconstitutional, and is likely as fair and effective as random polygraphs are for detecting spies in the CIA. (i.e. unfair and completely ineffective.)

          • JR DNR

            84% of employers did drug test screening for employment in 2007.

            Personally I’m anti drug testing, but I’m also anti drug testing of pregnant women, which most doctors seem to support. I think if you support drug testing pregnant women, you should overwhelmingly support testing medical personnel.

          • Eric Strong

            Where is that statistic from? The only high-quality source I could find on the web is here: http://www.bls.gov/mlr/1996/11/art4full.pdf (which is nearly 20 years old!). I admit that after reading the attached paper, it seems that drug testing is more widespread than I thought, although it’s important to make a distinction between testing as a condition for initial hiring, and random testing during employment, since the former would not be expected to catch recreational marijuana users and other completely innocent behaviors (for example, taking a family member’s Vicodin after pulling a muscle running on a weekend – completely benign action with potential serious consequences if it shows up as a positive screen for opiates).

          • JR DNR

            I tried to find something really current and couldn’t. Actually that number was from 2006:

            http://www.drugfree.org/join-together/84-percent-of-employers-require-pre-employment-drug-tests/

            This is one from 2013 that claims 78%
            http://www.shrm.org/hrdisciplines/safetysecurity/articles/pages/employers-screen-alcohol-drugs.aspx

            I’ve seen other numbers that it’s 90%+ of large employers, but not as common on small and mid size employers.

            Keep in mind that’s employment screening rather than random testing. Random testing is much lower and harder to justify.

          • Eric Strong

            I think because most of my friends are either doctors, work at universities, or are self-employed, I was completely unaware that drug screening in the workplace was this prevalent. For the vast majority of jobs, this is a completely unjustifiable invasion of privacy. (notable exceptions being law enforcement, commercial pilots, bus drivers, and pharmacists; debatably some physician specialties as well)

          • JR DNR

            I only know because I researched it when my company implemented it and I had to comply to keep my job… and found out it was 100% legal. It certainly led to job dissatisfaction with many employees and I feel the benefits did not outweigh the serious morale crash it caused.

          • James O’Brien, M.D.

            There is a fundamental difference between employee drug screening and licensee drug screening….the former causes you to lose only one job at most. And the fact that employee screening is usually just at the beginning. I’m not a fan of either, but licensee screening is far more serious because it is run by the state, that has infinite resources.

          • JR DNR

            See – I think the tag on is going to backfire and get the bill to fail. I do think the cap should be raised though, $250k is nothing.

            I also think more doctors should face criminal charges, it seems rare that anything is done even to the worst offenders.

          • James O’Brien, M.D.

            The cap is on noneconomic damages.

          • Ed

            And why should physicians be exempt while commercial pilots are not? With all due respect, please help me understand your rationale.

          • Eric Strong

            As stated elsewhere in the responses to this post, it is difficult for a non-surgeon physician to make a decision while under the influence of drugs that results in a patient’s death. Drug selections and dosages are double checked by pharmacy (or at my hospital, by 2 independent pharmacists, and by nursing). And making an accurate diagnosis is rarely an immediate life-or-death moment; in situations where it is (i.e. a code blue), there are numerous other people around to double, triple, and quadruple check any decisions that are made. An impaired doctor might make a wrong diagnosis, but the vast majority of wrong diagnoses can be corrected the following day without significant harm. And wrong treatments can be prescribed, but as above, meds get double checked, and potentially harmful, inappropriate tests can double checked by whichever service performs the test. (i.e. ordering an MRI scan for a patient with pacemaker would get stopped by the MRI technologist and/or the radiologist).

            Also, only one person at a time is under the care of a physician, so worst-case scenario and a physician’s fatal error sneaks through the multiple safety nets, it only affects one person. When a pilot makes an error, it affects hundreds.

            Finally, while intoxicated or under the influence of most drugs, significant impairment of coordination and reflexes generally occur sooner than significant impairment of judgement. (stimulants may be an exception)

            People obviously die every day from medical errors, but the vast majority of errors are system problems, and are not attributable to any one individual’s lapse of judgment.

          • Eric Strong

            There’s legit arguments for and against drug screening pregnant women,but I’m personally opposed to the results of that screening being made available to law enforcement and/or being used in court in any actions against the mother. Punishing expectant mothers for drug use during pregnancy probably has minimal effect on actual drug use, but does incentivize the mother to avoid prenatal or even perinatal care.

          • JR DNR

            I do appreciate that you agree that those kinds of tests shouldn’t be used to prosecute. I have friends with one child that will never have a second child (even though they want more children) because of the way their first birth was handled by medical personnel (dehumanizing experience left them feeling the baby mattered more than them). I want that to change.

            There is a strong argument for doing all manner of tests on people without their consent – like HIV testing. That doesn’t make it ethical to do without consent. I understand if someone is in a state where they are unable to make medical judgments for themselves that drug testing may be necessary for the patient’s care, but that information should only be available for care of the patient and not admissible in court.

          • Eric Strong

            Totally agree with all of that.

      • Eric Strong

        Are you kidding me? First of all, politicians make life or death decisions all of the time. To pretend otherwise is delusional. If an impaired doctor makes a bad decision, it impacts one patient. If an impaired politician makes a bad decision, it impacts hundreds, thousands, or millions of people.

        Second of all, let’s consider for a moment, what terrible mistakes a physician could make while under the influence. Excluding surgeons and proceduralists, which is a totally different story, there is a relatively small chance that an impaired physician can make a fatal mistake due to intoxication. For example, as a hospitalist, the most obvious way in which I could make an error is through prescribing the wrong medication and/or wrong dose. However, when I prescribe a med, it must first be approved by pharmacist A, then filled be pharmacist B, and ultimately given by the patient’s nurse. An overt med error on the part of a doctor has 3 separate steps at which it could be caught by someone else. But if the pharmacist makes a mistake with mixing an IV antibiotic, or the nurse makes an error by giving the wrong drug to the wrong patient, there is no safety mechanism further down the process to catch those. It is completely illogical to require drug screening for non-surgeons physicians, and not require it for nurses and pharmacists.

        Other impairment-related errors would include diagnostic errors (i.e. making the wrong diagnosis). Once again however, there are all kinds of people around me to catch that (i.e. residents, subspecialty consultants, nurses, pharmacists, my fellow hospitalists…) There are so many checks and balances in the hospital that it is nearly impossible for me to kill a patient through making a unequivocally bad decision while impaired.

        Surgeons and other physicians who perform high-risk procedures (e.g. interventional cardiologists, anesthesiologists, gastroenterologists, etc…) are a different story, as it isn’t cognitive impairment to be concerned about, but rather hand-eye coordination. One might suggest that standards for them should be different and stricter, though I’d still argue that pharmacists and nurses should be subject to the same.

        This doesn’t even touch on the problems with random drug screening to begin with. Even a 1% false positive rate would mean hundreds of physicians being falsely accused of drug offenses, and potentially having their careers ruined without justification. Drug screening also disproportionately punishes marijuana use over cocaine and opiates, since the former stays detectable for 5-10x longer than the later. I could go on for a while, but you probably get the point…

        • EmilyAnon

          My comment is just to challenge your assertion how hard it is for narcotics to be stolen in hospitals.

          If you google ‘drug diversion in hospitals’ or ‘stolen drugs from operating rooms’ hundreds of articles come up about how easy it is to steal, how hospitals turn a blind eye, examples of syphoning or diluting drugs meant for patients, a surgical tech injecting herself with drugs meant for the patient, then refilling the syringe with saline, infecting hundreds of people with Hep C that went on for years before finally getting caught. An addicted anesthesiologist allowed to continue practicing because he said he was in rehab, only to be discovered dead from an overdose in the hospital changing room after one of his operations. And on and on. These were just examples of the ones who got caught, and their stories publicized.

          • Eric Strong

            I never said it’s hard for narcotics to be stolen in hospitals, but rather it’s hard for narcotics to be stolen in hospitals BY DOCTORS. Although, to be honest, I should correct myself and exclude anesthesiologists from this generalization, as they are the only doctors who are routinely allowed to keep drugs on their person while working.

        • Ed

          I do get your point. However, politicians don’t make decisions in a vacuum and there are checks and balances built in to preclude exactly what you’re alleging. Frankly, it’s delusional to compare a physician, privately smoking a joint, popping a pill, or mixing a drink, and then showing up in the OR for scheduled surgery to our nation committing it’s armed forces to war/conflict. While it may be only one patient, it certainly sucks if you’re the one. And because the physician skated before, they’ll do it again. Finally, there is no objective investigation to determine what actually transpired is there? So patients are expected to blindly trust you, you’ll police your own, and there’s nothing to worry about; is that it?

        • rbthe4th2
  • Thomas D Guastavino

    The answer to this is easy. Docs should agree to the testing as long as it applies to anyone who requires state licensure. This would include police, fire, teachers, all drivers, etc. a…and , of course, all attorneys.

    • James O’Brien, M.D.

      In California, semi truck drivers with DUIs can retain class A drivers licenses with diversion. This option is no longer available to physicians.

      What happens when someone off duty gets tested for pot and alcohol and is positive? Both of these are legal.

  • Ed

    Regardless of personal opinions, it’s a legal and effective deterrent simply because it instills the fear of being caught! Frankly, I’m amazed all physicians to the lowest assistant aren’t subject to random screening nationwide. Easy access to legal drugs, as well as the same access to illegal, equals high potential for abuse by folks who literally hold our lives in their hands. 20 plus years flying in the USAF and an airline pilot now, I’m well acquainted with random drug screening, a necessary evil!

    • James O’Brien, M.D.

      You’re falling for the false pitch. This is not about testing doctors but about raising noneconomic damages in medi-mal.

      • MKirschMD

        Exactly!

      • Ed

        I respectfully disagree. Every damn time I’ve been selected for random screening, I’ve resented the experience but I recognize the public is entitled to some reasonable assurance that the professionals who the passengers entrust with their lives are drug/alcohol free! Do you not agree?

        • James O’Brien, M.D.

          Im not opposed to it if there is probable cause. But I have no faith that California can handle random screening competently.

          How many surgeries a year (no hypotheticals, please) are botched because the doctor is high or drunk? And how many of those could have been stopped based on screening for probable cause.

          And I respectfully submit that you are still being fooled. The main ballot issue was increasing malpractice caps. Then the drug testing issue was added only because it polled well. They could have separated the two issues, but didn’t. Looks like drug testing doesn’t screen for being easily misled into voting based on emotion.

          • Ed

            We’ll never know because you folks are so good at covering each others six.

            And I respectfully submit $250,000 is chump change for those patients who have to live with the results of botched surgeries, assuming they live at all.

          • James O’Brien, M.D.

            OK, now we get to the real issue, you don’t like doctors and want MediMal hikes. Then don’t complain about increased costs and doctors leaving.

            BTW, do you work for a plaintiff’s attorney? In the interest of full disclosure, would you post your last name?

          • Ed

            I don’t even live in California and what I want is rational, objective, impartial screening for everyone administering healthcare to patients, nationwide!

            Nope, I actually fly jets for a living thankfully.

          • James O’Brien, M.D.

            But we have no way of knowing that since you only use your first name.

            Everyone is a lot of people. The cost and hassles of doing so for nurses, etc. would be incredible.

            So you admit in your case that specifically testing yourself is a waste of time and money, but you’re for it because you have to do it. A bit of Stockholm Syndrome, no?

            No whining when your bill goes up…you lose your complaining privileges…

          • Ed

            True but if I had something to hide I could easily submit a false name and you would never know the difference correct?

            I don’t do drugs and drink responsibly while strictly following the rules. And I don’t expect anyone to simply take my word for it and neither should you.

          • James O’Brien, M.D.

            I’m not for drug testing pilots unless there is probable cause. It is a waste of time and money. You’ve already established its a waste of time and money in your case so thanks for bolstering my point.

            If doctors are anything like the population at large, their biggest at work drug problem will be prescription drugs, given under the law. What are you going to do about that one? And what about pot, which is legal, and can stay in the system for weeks?

            Answer the question: why are you against random stops of trucks drivers on freeways?

          • Ed

            You’re putting words in my mouth! I actually support random screening for truckers and never said otherwise.

            Agree prescription drugs are a huge problem based my limited read of the issue and while pot may be legal in some states, those who partake better not get caught or they will justifiably suffer the consequences.

          • James O’Brien, M.D.

            I think the idea of pulling truckers off the road randomly for drug testing is ridiculous and a waste of resources. But at least you’re consistent.

    • Eric Strong

      Easy access to drugs? Clearly you’ve never worked in a hospital. The only drugs I have easy access to is lidocaine, epinepherine, phenylepherine, and sublingual nitroglycerin – not exactly common drugs of abuse. Hospitals have many safeguards in place to prevent unauthorized access to medications. There is no chance that I could sneak away with narcotics or benzos without either being caught redhanded, or without leaving a clear trail.

      • querywoman

        So you’d really have to work to be able to steal some good stuff? Thank you, Eric, for your input.
        When I had serious pneumonia, a nurse had to get another nurse to sign off on my insulin shots!

  • PoliticallyIncorrectMD

    I’ve heard somewhere that we should be presumed innocent unless proven guilty ; )

    • Ed

      Welcome to the real world Doc.

      • PCPMD

        The world is as you make it, Ed. “Be the change you wish to see in the world”. Apparently, you approve of this change, and wish to make it so. Try not to deflect from that reality.

    • querywoman

      Absolutely! Right out of the US Constitution!
      I’ve got a question about drugs, and this is not limited to doctors. I’m hunting for a new apartment. If so many jobs and apartments screen for drugs (apartments as in criminal checks,) why do so many online reviewers say this or that place is chock full of drug users and sellers?
      I live right by a major intersection that is chock full of drug dealers!!!
      The War on Drugs has not gotten the druggies off the street!

  • Suzi Q 38

    “…Will Californians see through the smoke?”

    You mean the pot smoke???
    Probably not.

  • James O’Brien, M.D.

    For those who don’t see “any harm” in this despite the obvious costs and indignities:

    From Wiki entry on Bayes’ theorem:

    Suppose a drug test is 99% sensitive and 99% specific. That is, the test will produce 99% true positive results for drug users and 99% true negative results for non-drug users. Suppose that 0.5% of people are users of the drug. If a randomly selected individual tests positive, what is the probability he or she is a user?

    Despite the apparent accuracy of the test, if an individual tests positive, it is more likely that they do not use the drug than that they do.

    This surprising result arises because the number of non-users is very large compared to the number of users; thus the number of false positives (0.995%) outweighs the number of true positives (0.495%). To use concrete numbers, if 1000 individuals are tested, there are expected to be 995 non-users and 5 users. From the 995 non-users, 0.01 × 995 ≃ 10 false positives are expected. From the 5 users, 0.99 × 5 ≃ 5 true positives are expected. Out of 15 positive results, only 5, about 33%, are genuine.

    Note: The importance of specificity can be illustrated by showing that even if sensitivity is 100% and specificity is at 99% the probability of the person being a drug user is ≈33% but if the specificity is changed to 99.5% and the sensitivity is dropped down to 99% the probability of the person being a drug user rises to 49.8%. Even at 90% sensitivity and 99.5% specificity the probability of a person being a drug user is 47.5%.

    Not that most people who support this give a damn about the math…it’s the same mentality that gave us TSA after 9/11…it’s all emotional…

    • JR DNR

      This is why I’m against all drug testing. Sure, I’m not a drug user, but I’ve been drug tested by an employer (I no longer work there). It’s demeaning. And what about a false positive?

      • James O’Brien, M.D.

        As the Bayesian analysis shows, even in highly accurate tests, 2/3 of the positives are false positives.

        But we live in a dumbed down gotcha culture that doesn’t mind throwing innocent people out with the bathwater. Cuz day don’t like dem doctors getting way with surgerizing peoples drunk and on that meth stuff and day do it all da time, I tell ya.

        Meanwhile, you can’t fire a DA who does this:

        https://www.youtube.com/watch?v=s7y7oJ266qI

        • Ladyimacbeth

          Wow, that’s scary. I had no idea there were that many false positives.

    • Ed

      “For those who don’t see “any harm” in this despite the obvious costs and indignities:”

      That’s rich coming from an MD!

      • PCPMD

        Snark is not a logical argument. Would you care to elaborate?

        • JR DNR

          Doctors frequenly aren’t concerned with cost or indignities of their treatments.

          Example: My friend’s teenage virgin child was late starting her period, so the doctor recommended the teenager get an ultrasound. After the mother left, she realized the order was a vaginal ultrasound, and the doctor didn’t mention this to her OR her child. Needless to say they got a second opinion for a regular ultrasound which was sufficient for the diagnosis.

          I’ve heard frequent stories of women not mentally prepared for this exam because they are unaware there is any other kind of ultrasound, so they get ambushed into it.

      • James O’Brien, M.D.

        Wow you really hate doctors don’t you?

        So just how many MDs are running around hurting people because they are high on drugs?

        I would submit a far greater number of perfectly sober MDs are hurting people by prescribing drugs that get patients high.

        By the way, any rebuttal to the math or the non emotional based arguments? Any sympathy for the 2/3 doctors wrongly losing their license because of a false positive?

    • James O’Brien, M.D.

      That was Wiki’s math not mine. The point was to illustrate the Bayesian influence of even small false positives when screening for a relatively rare events (not physicians using drugs, but using drugs and alcohol in a way that interferes with work).

  • ninguem

    Kind of related. A few states fingerprint doctors. California is one, last I checked.

    Does anyone know, has this fingerprinting program actually accomplished anything? Has it identified an impostor physician, a physician with an unreported criminal background, fugitive, that sort of thing?

    Even one case?

    Maybe it has, and I just haven’t heard of it.

    • querywoman

      I don’t know about that, but I can tell you fingerprinting food stamp and welfare recipients is dumb. It’s quite easy to catch people double dipping with superior modern computer matching systems off Social Security numbers. Undocumented aliens usually only get stuff for their US citizen children.
      In Texas, we are required to submit to finger imaging for driver’s license purposes. I don’t know if that also applies to non-DL ID cards issued by the same department.

      But, a car can be a deadly weapon, and I’m okay with fingerprinting for a DL. Fingerprinting for a DL can also help ID an accident victim.

  • James O’Brien, M.D.

    Who cares about stats? Kimye’s child is having a birthday!!

  • Jennifer Jonsson

    Random drug testing in the workplace is a solution in search of a problem. While few would argue that a company would be wise to test an employee who’s obviously having issues, randomly testing, or testing all employees, is ridiculous, costly and ineffective. Some industries have shown positive test results as low as 0.008%. That’s not enough to justify the enormous expense and the inherent problems of false positives (and negatives).

    • http://disruptedphysician.com/ Michael Langan

      And these numbers come from industries that employ Federal employee drug testing guidelines with strict adherence to protocol and procedures (Forensic chain-of-custody, fatal flaws, split-specimen, MRO review, etc. because most EAPs were developed with someone looking out for the interests of the employee (unions, etc.). PHPs are essentially EAPs for doctors and developed in a different manner with no oversight, regulation, or accountability. Thus PHPs were vulnerable to exploitation by outside groups.

      Compared to DOT,SAMHSA and other tightly regulated systems, the state PHP system is wild west. Junk science biomarkers, disregard for cutoff levels, drylabbing, and fraud and abuse are SOP. Doctors in PHPs have no appeal process for positive tests. Fraud is rampant. And I’m not just saying this second hand. As a victim of the MA PHP, PHS, inc. I know first hand. The Medical Board and state medical society have no regulation or control of PHS.

      Take a look at the following documents that speak for themselves. t was later found out that they sent this specimen as a “clinical” sample to bypass forensic protocol. (They requested it be processed “clinically” to bypass “forensic” protocol then reported it as forensic (and continue to maintain it is).

      It does not take a toxicologist to see what is going on here. It is indefensible procedurally, ethically, and legally.

      This has been reported to the MA DPH and the BORM several times since 2011.

      It was reported again when it was discovered PHS was ordering “clinical” tests as it brings in a whole host of new issues including violation of State Laboratory laws and HIPAA Privacy Rule violations. (PHS is not a treatment provider but a monitoring agency–they cannot order “clinical” tests -by definition limited to patient care).

      Although this evidence has been given to the MA DPH and the BORM both refuse to acknowledge the obvious. In the wake of Annie Dookhan, one might expect zero-tolerance of fraud at this level. It is a threat to the doctors of MA and in turn a threat to public health. Thus far it has been patently ignored.

      http://www.reddit.com/r/Corruption/comments/1lp9mj/documents_showing_forensic_fraud_between_ma_state/

      http://disruptedphysician.com/2014/08/11/the-addiction-medicine-control-machine/

  • querywoman

    Alcohol and drug testing violates innocent until proven guilty, which is American constitutional law. I mostly oppose it.
    I do like some people, like drivers and pilots, to be tested. Right now, I’d like to yank all their cell phones.
    But it’s become ridiculous to do it to everyone!!! A bunch of drunks fought the US Civil War!
    A doctor doesn’t have to be drunk or high to screw up and harm a patient anyway!

  • James O’Brien, M.D.

    If I were head of the CMA, I would be rounding up signatures for that ballot measure right now…

  • James O’Brien, M.D.

    Actually the biggest practical nightmare of Prop 46 involves the CURES database requirements. It’s basically another layer of EHR and a massive threat to patient privacy. Why do we even have HIPAA if we’re just going to post everyone’s scripts on a government database that is easy to get to? I know the practical answer is to prevent duplicate prescriptions but why not just limit the database to opioids prescribed over 30 days?

    http://www.noon46.com/get-the-facts/threats-to-personal-privacy/

    Note the rank hypocrisy of the DOJ in their amicus brief.

    Don’t get shingles from now on, the world will think you had genital herpes when they see you took Zovirax.

    BTW, this is all a massive fourth amendment violation. In a bill crafted by attorneys. I strongly suggest we need maintenance of certification in constitutional law for attorneys.

    To their credit, the ACLU opposes the bill. So do the state unions, since they know what this will do to healthcare costs and access.

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