California's Proposition 46: A Wolf in Sheep's Wool
Authors: Julius Cuong Pham, Peter J. Pronovost
Journal: Annals of Internal Medicine (2014)

In the Balance16 December 2014California's Proposition 46: A Wolf in Sheep's WoolJulius Cuong Pham, MD, PhD and Peter J. Pronovost, MD, PhDJulius Cuong Pham, MD, PhDFrom Armstrong Institute for Patient Safety & Quality and Johns Hopkins University School of Medicine, Baltimore, Maryland.Search for more papers by this author and Peter J. Pronovost, MD, PhDFrom Armstrong Institute for Patient Safety & Quality and Johns Hopkins University School of Medicine, Baltimore, Maryland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2167 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Preventable harm is the third leading cause of death in health care (1). One third of physicians will have issues related to impairment in their ability to practice medicine during their career (that is, impairment from all causes, including substance use disorders) (2). Alcohol and drugs impair performance and, directly or indirectly, increase risks for error. Although we do not know the extent to which preventable harm and physician drug and alcohol use overlap, given the prevalence of both, they likely do. These facts make for a compelling argument for physician drug testing.We have previously described the key principles ...References1. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9:122-8. [PMID: 23860193] doi:10.1097/PTS.0b013e3182948a69 CrossrefMedlineGoogle Scholar2. Leape LL, Fromson JA. Problem doctors: is there a system-level solution? Ann Intern Med. 2006;144:107-15. [PMID: 16418410] LinkGoogle Scholar3. Pham JC, Pronovost PJ, Skipper GE. Identification of physician impairment. JAMA. 2013;309:2101-2. [PMID: 23629590] CrossrefMedlineGoogle Scholar4. Bowen D. Proposition 46, the Medical Malpractice Lawsuits Cap and Drug Testing of Doctors Initiative. In: Official Voter Information Guide. California Secretary of State; 2014. Accessed at www.voterguide.sos.ca.gov/en/propositions/46/ on 21 September 2014. Google Scholar5. Pronovost PJ, Wachter RM. Progress in patient safety: a glass fuller than it seems. Am J Med Qual. 2014;29:165-9. [PMID: 23939487] doi:10.1177/1062860613495554 CrossrefMedlineGoogle Scholar6. DesRoches CM, Rao SR, Fromson JA, Birnbaum RJ, Iezzoni L, Vogeli C, et al. Physicians' perceptions, preparedness for reporting, and experiences related to impaired and incompetent colleagues. JAMA. 2010;304:187-93. [PMID: 20628132] doi:10.1001/jama.2010.921 CrossrefMedlineGoogle Scholar7. Shore JH. The Oregon experience with impaired physicians on probation. An eight-year follow-up. JAMA. 1987;257:2931-4. [PMID: 3573292] MedlineGoogle Scholar8. McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:a2038. [PMID: 18984632] doi:10.1136/bmj.a2038 CrossrefMedlineGoogle Scholar9. Federation of State Medical Boards. Policy on Physician Impairment. Euless, TX: Federation of State Medical Boards; 2011. Google Scholar Author, Article, and Disclosure InformationAuthors: Julius Cuong Pham, MD, PhD; Peter J. Pronovost, MD, PhDAffiliations: From Armstrong Institute for Patient Safety & Quality and Johns Hopkins University School of Medicine, Baltimore, Maryland.Acknowledgment: The authors acknowledge the contributions of Gregory E. Skipper, MD, Director of Professional Health Services at Promises Treatment Centers (Santa Monica, California), to this article.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2167.Corresponding Author: Julius Cuong Pham, MD, PhD, Department of Emergency Medicine, Department of Anesthesia Critical Care Medicine, Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 East Pratt St, 15th Floor, Baltimore, MD 21202; e-mail, jpham3@jhmi.edu.Current Author Addresses: Dr. Pham: Department of Emergency Medicine, Department of Anesthesia Critical Care Medicine, Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 East Pratt Street, 15th Floor, Baltimore, MD 21202.Dr. Pronovost: Department of Anesthesia Critical Care Medicine, Department of Surgery, Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, 750 East Pratt Street, 15th Floor, Baltimore, MD 21202.Author Contributions: Conception and design: J.C. Pham, P.J. Pronovost.Drafting of the article: P.J. Pronovost, J.C. Pham.Critical revision of the article for important intellectual content: J.C. Pham, P.J. Pronovost.Final approval of the article: P.J. Pronovost, J.C. Pham.Administrative, technical, or logistic support: J.C. Pham, P.J. Pronovost.This article was published online first at www.annals.org on 30 September 2014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCalifornia's Proposition 46 and Mandatory Physician Drug Testing: A Cause for Concern Yul D. Ejnes Physician Drug Testing Is Unscientific and Is Unlikely to Achieve Stated Aims Martin Donohoe Physician Drug Testing Is Unscientific and Is Unlikely to Achieve Stated Aims Gregory E. Skipper , Julius Cuong Pham , and Peter J. Pronovost Metrics Cited byPhysician Drug Testing Is Unscientific and Is Unlikely to Achieve Stated AimsMartin Donohoe, MD 16 December 2014Volume 161, Issue 12Page: 913-914KeywordsAlcoholsAnesthesiaCritical careDatabasesDrugsHealth careHealth care providersLegislationSafetySubstance abuse ePublished: 16 December 2014 Issue Published: 16 December 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...