Title
Approve a recommendation by the Legislative Committee, to take an oppose position on Proposition 46: Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute., also known as The Troy and Alana Pack Patient Safety Act of 2014.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors approve a recommendation by the Legislative Committee, to take an oppose position on Proposition 46: Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute., also known as The Troy and Alana Pack Patient Safety Act of 2014.
SUMMARY
On November 4, 2014, California voters will consider approval of Proposition 46, commonly referred to as The Troy and Alana Pack Patient Safety Act of 2014. If passed, the measure will enact changes to the Medical Injury Compensation Reform Act (MICRA) limit on non-economic medical malpractice awards effective January 1, 2015. This would result in significant increases in County costs due to our unique role as operators of a public hospital and clinics, providers of health care, and employers who purchase health care insurance for County employees and retirees. The Board's Legislative Committee discussed Proposition 46 at their meeting on August 25, 2014, and made a recommendation that the Board of Supervisors take an oppose position on the initiative.
DISCUSSION
Proposition 46, would enact changes to the MICRA limit on noneconomic medical malpractice awards effective January 1, 2015. Among other things, the measure would:
Raise the noneconomic damages cap for medical malpractice from $250,000 to approximately $1.1 million.
· Requires drug and alcohol testing of doctors and reporting of positive test to the California Medical Board (Board).
· Requires medical professionals to report any other doctor suspected of drug or alcohol impairment or failure to follow the appropriate standard of care to the Board.
· Requires physicians to pay for the costs of the substance use tests.
· Requires hospitals to report positive test results or refusals of a physician to submit to the test to the Board, which may then suspend the physician's license.
· Requires health care practitioners to consult the state prescription drug history database, the Controlled Substance Utilization Review and Evaluation System (CURES) maintained by the State Department of Justice, prior to prescribing or dispensing controlled substances to a patient for the first time.
According to the State Legislative Analyst's Office (LAO), passage of Proposition 46 would result in an increase in medical malpractice insurance premium costs averaging 10% - potentially more than $100 million dollars - which will directly impact the physicians and facilities that purchase medical malpractice insurance as well as the patients served by those entities (both State and County). It is also anticipated that it will increase the overall award amounts and settlements in medical malpractice cases as well as an increase in the overall number of injury claims. Additionally, it will increase oversight and administrative costs for a number of state health-related Boards, including the state Medical and Pharmacy Boards, as well as investigation and prosecution costs for the state Attorney General's Office.
Analysis of the measure by the California State Association of Counties (CSAC) indicates that Proposition 46 has the potential to significantly increase County costs due to our unique role as operators of a public hospital and clinics, providers of health care, and employers who purchase health care insurance for both county employees and retirees. County hospitals and clinics employ health care providers in hospitals and clinics, often choosing to self-insure against the risk of medical malpractice claims. This means that any increase in costs for medical malpractice cases will be directly borne by self-insured counties. Further, for counties that purchase medical malpractice insurance, the increase in medical malpractice claims will drive increases in premiums. Counties anticipate that increasing the cap on noneconomic damages would increase any settlements or awards paid by counties. Additionally, the number of attorneys willing to litigate on noneconomic damages would likely increase, which also has the potential to increase settlements and awards. Counties will also bear the costs of additional medical malpractice suits and increases in noneconomic damages through rising health care insurance premiums associated with county employees and retirees.
At the August 25, 2014, meeting of the Board's Legislative Committee, the Committee recommended that the Board take an oppose position on Proposition 46. If the Board approves this recommendation, a letter will be sent to the "No on 46" campaign informing them of the Board's position.
OTHER AGENCY INVOLVEMENT
The CAO-Intergovernmental & Legislative Affairs Division prepared this report with information from the Official Voter Information Guide for the November election, the LAO's office, CSAC and the Health Department. Proposition 46 is opposed by CSAC, Rural County Representatives of California, Urban Counties Caucus, the medical community, numerous labor unions, public safety groups, and state and local Chambers of Commerce (including the Salinas Valley Chamber of Commerce), the Monterey County Medical Society, Natividad Medical Center, Community Hospital of the Monterey Peninsula, and many others.
FINANCING
Approval of this recommendation will not result in additional General Fund contributions.
Prepared by: Annette D'Adamo, Management Analyst III; ext. 3045
Approved by:
__________________________________________
Nicholas E. Chiulos
Assistant CAO/Interim Parks Department Director
Attachments:
· Exhibit A - Information from the Official Voter's Information Guide for the November 4, 2104 Election on Proposition 46
· Exhibit B - Proposition 46 Oppose Letter