A California ballot initiative that addresses the growing problem of substance abuse among healthcare workers may have unintended consequences, according to two opinion pieces in the Annals of Internal Medicine.
California voters will decide on Nov. 4 whether to approve Proposition 46, which would mandate random drug and alcohol testing for physicians while increasing the malpractice awards cap fourfold. It would be the first such requirement in the nation.
But statistics indicate rehabilitation would be a far more effective response to physician substance abuse, argue Julius Cuong Pham, M.D., Ph.D., and Peter Pronovost, M.D., Ph.D., both of Johns Hopkins University School of Medicine in Baltimore. To achieve better results, they say providers should implement rehab programs that are confidential, protected under quality assurance, and start out limited to the hospital setting so internal infrastructure can support it.
"Effective drug testing programs seek to identify and rehabilitate rather than punish," Pham and Pronovost write in the Annals of Internal Medicine. "When punishment prevails, healthcare providers are less likely to seek help themselves or to report a colleague who might be impaired. Because of its punitive approach, the initiative might reduce the number of physicians referred for help."
That's why 41 states offer rehab programs that allow addicted nurses to keep their jobs, FierceHealthcare previously reported. In New Jersey's program, the retention rate is nearly 73 percent, outflanking most 12-step programs.
Furthermore, if the goal is to improve patient safety, it makes no sense to only test physicians, Yul Ejnes, M.D., of the Warren Alpert Medical School of Brown University in Providence, Rhode Island, writes in a second commentary. Furthermore, the initiative is overly broad as to which physicians are subject to it, Ejnes writes, with all physicians subject to testing regardless of their responsibilities.
"A physician with limited or no direct patient care responsibilities would be treated the same as one who routinely performs potentially life-threatening procedures, for example," Ejnes writes.