My interview with a doctor about Prop 46 (part 2)

{you may read part 1 of my interview here}

No on Prop 46: An Interview with Dr. Mario Martinez, Family Physician at UCSF Fresno, Part 2


Q: Are there already systems in place at most employers or hospitals that provide for drug or alcohol testing for physicians?

A: Physicians today have an ethical obligation to report impaired colleagues. Anyone can report an impaired physician to the California Medical Board. And hospitals have quality review committees that review physician care and any reported concerns.

Certainly, we all want to do more to ensure patient safety, but the drug- and alcohol-testing program required under Proposition 46 is simply a cynical attempt to gain voter support for Prop 46. In short, the drug testing provision was included for political, not policy reasons.

The lawyers who wrote and funded getting Prop 46 on the ballot have never gone to the state legislature to propose drug testing of doctors. In fact, the consultant for Prop 46, Jamie Court, cynically told the LA Times on December 10, 2013, that drug testing of doctors was “the ultimate sweetener,” designed to deceive voters from the real reason behind the initiative, to make lawsuits easier and more lucrative for the lawyers who wrote and funded Prop 46.

Q: Do you already have to work within the CURES database on some level? What is your experience like if so? And if so, how does this affect your day-to-day operations/patient care?

A: This database sounds simple, but it’s not. While the CURES database is already in existence, Prop 46 would mandate that both prescribers (doctors) and dispensers (pharmacists) check the CURES database prior to prescribing or dispensing certain medications. This mandate takes effect the day after the election. This will force the CURES database to respond to tens of millions of inquiries each year – something the database simply cannot do in its current form or functionality. It already goes down frequently or is frozen and locks people out when they try to gain access to the database.

This poses two problems:

·         Jeopardizes patient access to their prescriptions. A non-functioning CURES database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients.

·         Prop 46 contains no provisions and no funding to upgrade the database with increased security standards to protect personal prescription information from government misuse, hacking, theft or improper access by non-medical professionals.

Q: What problems do you see coming from mandated use of the CURES database?

A: The single biggest issue with Prop 46’s mandate to use the CURES database is that the technology itself isn’t ready to handle the increased demand. Even the state staffer charged with overseeing CURES has said that the current system is “is not robust enough, not sufficient to carry out the mission that we need.”

So, if one of my patients were to break a bone and need pain medication, I would be required to check the CURES database to ensure the patient wasn’t “doctor shopping” for narcotics – even if that patient were a child. If the database was down, I would be left with a choice: abide by my Hippocratic Oath or abide by the law.  

Q: What are the overarching, 3 biggest problems Central Valley physicians face?

A: As a recent report from the California HealthCare Foundation underscored, the San Joaquin Valley already faces a troubling shortage of both primary care doctors and specialists. It concluded that “in California, those most in need of health care services have the least access.”

Compared to the Bay Area, for example, we have: far fewer primary care physicians and specialists; more residents living in poverty; fewer patients who receive regular medical care; and more people in fair to poor health.

My concern is that, if Proposition 46 were to pass, Central Valley residents could have a harder time accessing specialist care; their waits for appointments would be longer; and they would be sicker when they are finally treated. Worse, some Valley residents could lose their trusted doctors altogether if this measure were to become law.



Q: What keeps you going despite the obstacles you face to practice in the Central Valley?



A: Like many kids in the Central Valley, I grew up with asthma. I was in and out of the hospital frequently, and the pediatrician who took care of me was, in my eyes, a superhero. I wanted to help others like he helped me.



Growing up, I had my heart set on becoming a doctor, to help sick people and to save lives, particularly in the underserved areas of the Central Valley. My experience and desire to help people are what inspire me in my practice every day.

This post is completely my own interview and Dr. Martinez's responses. I have not been paid by the campaign in any way to blog about this issue - it is just something I care about. Also, I will not be posting comments on either post, parties on either side of Prop 46 are passionate about their beliefs, and in some cases offensive and hurtful, and I do not publish rude or attacking comments on my blog. I encourage everyone to always do their research and become as informed as possible on any issue, then get out and vote on election day. At the end of the day, there are parts of this Prop I can understand, but it's an all or nothing pass or not - which means enacting three major changes, as they are. Food for thought...
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