The State – Not Your Physician – is Your Doctor by Pat Conrad MD

It might be considered poor form, and against the standards of this stately gathering to begin a column by screaming profanities so loudly that … sigh. This is that bad.

The Medical Board of California has begun to retroactively persecute, and even administratively prosecute physicians for their opioid prescribing habits years in the past.  That’s right, I said r-e-t-r-o-a-c-t-i-v-e-l-y.  Unwilling to wait for the actual invention of a time machine, the Golden State’s compassion troopers are panning and sifting the records of over 500 physicians and mid-levels for evidence of opioid overprescribing…years ago.  

 The “Death Certificate Project” is aptly named, as it heralds the end of even the appearance of physician autonomy, and the absolute crushing of any remaining vestige of patient privacy.  “Investigators matched the names of the dead with the prescription drugs they had filled, which are listed in the state’s prescription database along with the names of the doctors who prescribed to them.”

While sifting these nuggets, the goons sometimes target doctors who “did not necessarily write the prescriptions that led to a death. That makes it the most comprehensive project of its kind in the country.”  What a blithe term for a deadly dragnet. 

 As in other states, doctors are immediately trying to lower their visibility, with the obvious mixed-bag results we have seen in other states (my own Florida has stupidly substituted state law for clinical judgment.  All I can do is shrug).  Frightened doctors with families and mortgages are calling this an “inquisition” and a “witch hunt,” and they are right.  Yes there are bad actors out there, and yes they should be held accountable.  The claim is, “In California, the number of opioid prescriptions per 100 people dropped from 54.9 in 2013 to 47.9 in 2015, according to IMS Health in Danbury, Conn.”  If even close to true, that is a ridiculous amount of opioids, and I am glad to see that come down for a number of reasons.

 But once again, the physician is being held accountable for the patient’s bad behavior.  Prescribers are being investigated even when the patient was doctor shopping, or committed suicide by intentional overdose.  This is the same bad blame shifting that gets bartenders sued when a patron gets into a fatal crash 2 hours after leaving the bar. 

“Kimberly Kirchmeyer, executive director of the Medical Board of California, defended the project. She said, ‘I understand their frustrations,’ she said of the complaining doctors, ‘but we do have to continue our role with consumer protection.’”  Which is what apparatchiks nationwide say when they want to justify their budgets and rationalize their abuses:  the public must be protected, and how can YOU be against public safety?? 

State and federal prescribing laws, as well as insurance guidelines are already tightening things – why is necessary to go after doctors as far as nine years back? 

Hell, why stop at in this century?  Standards have taken a radical swing away from the everybody-gets-Oxycontin prescribing pushed by the dehumanizing federal government and their JCAHO enforcers.  But that didn’t shield docs who tried to fit in and go with the tide.  So let’s give these Medical Board thugs wider license, and attach the estates of doddering old demented docs in plush Palm Springs retirement centers.  Just because laudanum cough syrup and cocaine cough drops were the standard then is no reason not to punish those evil bastards now.

 But oh, this is just the beginning.  One pain management specialist was threatened by a $1,000 per day fine if he did not promptly respond to a complaint from seven years ago.  And the purge doesn’t end with doctors whose patients died. 

“A San Diego internist, said three of his patients received board letters last year that seemed to question his quality of care when all he did was try to relieve their well-documented pain.”  Did they copy the patients’ attorneys, to save time?

 “In an unknown number of cases, the board has sent letters to living patients asking them to authorize their doctors to relinquish their medical records. If they don’t, the patients are told, the documents will be subpoenaed.”  Make no mistake, that distant thump you hear is not your heartbeat, but the sound of a jackboot.    

The implications of persecuting shifting standards retroactively is a godsend to government and trial lawyers.  It is bad, very, very bad for patients and physicians.  It is more terrifying than ever to remember, “As California goes, so goes the nation.”

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127050cookie-checkThe State – Not Your Physician – is Your Doctor by Pat Conrad MD