The Question
Should California require random drug testing of doctors, require doctors to check a statewide database before prescribing certain drugs, and raise the cap on noneconomic damages in medical negligence lawsuits?
The Situation
California does not require drug testing of doctors. The state has a database to track prescriptions of certain controlled drugs, but does not require doctors to check the database before prescribing drugs.
There are two kinds of damages in medical negligence lawsuits: economic damages, which pay for the financial costs of an injury, such as medical bills or loss of income, and noneconomic damages, which pay for items such as pain and suffering and loss of quality of life. Attorneys in malpractice cases typically work on contingency; that is, they don’t charge for their time, but instead take a percentage of the damages awarded their clients.
In 1975, California enacted the Medical Injury Compensation Reform Act (MICRA), which placed a cap of $250,000 on noneconomic damages in medical negligence litigation, and limited the percentage of a damages award that an attorney can take. Neither cap has ever been raised. (There is no cap on economic damages.)
The Proposal
Prop. 46 would
- mandate random drug tests of doctors, in addition to tests after events of possible medical negligence or if the doctor is suspected of using drugs or alcohol;
- require doctors to check a statewide database before prescribing certain drugs to prevent patients from “doctor shopping” for multiple prescriptions;
- raise the cap for noneconomic damages in malpractice lawsuits to $1.1 million (reflecting inflation since 1975) and index it to inflation going forward. The cap on attorney’s fees would remain unchanged.
Fiscal Effect
State and local governments fund significant health care services including Medi-Cal and health care to employees and retirees. The cap increase likely would increase costs of malpractice insurance and payments of malpractice claims. Conversely, the higher cap could encourage medical providers to practice medicine in a way that would decrease malpractice claims. There would likely be a very small percentage increase in health care costs in the economy overall as a result of raising the cap (less than 0.5% of the annual general fund budget), but that increase could have a significant effect on government health care spending, from tens of millions of dollars to several hundred million dollars annually.
Use of the drug database could reduce the amount of drugs prescribed, saving drug costs. Prescription drug abuse would be reduced, lowering governmental costs associated with drug abuse, including treatment, rehabilitation, law enforcement and incarceration.
Testing doctors could prevent some medical errors. Savings are uncertain, but potentially significant, and would offset to some extent the increased governmental costs from raising the cap on noneconomic damages.
A YES Vote Means
A YES vote on this measure means: The cap on medical malpractice damages for such things as pain and suffering would be increased from $250,000 to $1.1 million and adjusted annually for future inflation. Health care providers would be required to check a statewide prescription drug database before prescribing or dispensing certain drugs to a patient for the first time. Hospitals would be required to test certain physicians for alcohol and drugs.
A NO Vote Means
A NO vote on this measure means: The cap on medical malpractice damages for such things as pain and suffering would remain at $250,000 and not be subject to annual inflation adjustments. Health care providers would not be required to check a statewide prescription database before prescribing or dispensing drugs. Hospitals would not be required to test physicians for alcohol and drugs.
Supporters Say
- Prop. 46 will save lives by cracking down on prescription drug abuse by doctors and protecting patients from impaired doctors.
- Increasing the cap on compensation for pain and suffering will fairly value lives and hold doctors accountable for medical errors.
- Use of a statewide database will reduce over-prescription of dangerous drugs and save lives.
Your Neighbors for Patient Safety: www.yeson46.org
Opponents Say
- Prop. 46 uses drug testing of doctors to disguise its real intent: to increase the limit on medical malpractice awards.
- Increasing the cap on damages will cause many doctors to move to states with lower malpractice insurance rates.
- Use of the online database of personal prescription drug history allows for the invasion of an individual’s privacy.
Patients and Providers to Protect Access and Contain Health Costs: www.noon46.com
http://vig.cdn.sos.ca.gov/2014/general/pdf/proposition-46-title-summary-analysis…
