Troubled drug program for doctors shuts down

Dismissed as ineffective even by the state board that ran it, California's drug and alcohol diversion program for doctors has quietly ceased operation after 27 years.

On Tuesday, the program's final day, the plastic surgeon who operated on rapper Kanye West's mother just before she died pleaded not guilty in Solano County to drunken driving charges.

The surgeon, Jan Adams, was driving with a license that had been suspended because of a 2006 DUI conviction. He pleaded no contest in 2003 to another DUI charge.

When Donda West died last November, the California Medical Board was investigating Adams and considering revoking his medical license.

A Los Angeles County Coroner's Office probe did not fault surgical errors for West's death. But state Sen. Mark Ridley-Thomas said the case underscores why California needs an effective program to monitor doctors with drug and alcohol problems.

"(Adams) was in and out of the diversion program, which is an indication of its ineffectiveness – and the enforcement that, perhaps, should have taken place did not," said Ridley-Thomas.

The Los Angeles Democrat heads the panel that oversees licensing of health professionals in California. He is also the author of Senate Bill 1441, which would set uniform standards by January 2010 to monitor health professionals in treatment programs. The bill has cleared the Senate and is scheduled for a hearing in the Assembly Appropriations Committee this month.

The boards that license nurses, dentists, pharmacists, physical therapists, veterinarians, osteopaths and physician assistants set their own standards and contract with a private company, Maximus Inc., to run their programs.

The now-defunct program for physicians was operated by the California Medical Board, one of only three nationwide run by employees of a state medical licensing board.

While its demise leaves the state without a current alternative, Ridley-Thomas and other critics contend it largely failed to protect the public.

Of about 127,000 doctors licensed in California, experts estimate that up to 14,000 suffer from substance abuse during their career, according to Dr. Richard Fantozzi, a San Diego surgeon who is the medical board's president.

But only about 250 physicians were in the state program at any time, and more than 80 percent entered rather than have the board take enforcement action.

Experts say most doctors who seek treatment do so privately, without informing the medical board, because they fear losing their licenses.

And because of the state program's confidentiality, patients – including Donda West – had no way of knowing whether their doctor was in the program.

Candis Cohen, a spokeswoman for the medical board, said she could not comment on the board's probe of Adams because his case is pending.

But she conceded the board's program – which failed five audits – had not fulfilled its responsibility to protect the public.

"The board voted a year ago to allow its diversion program to sunset because it believed that, after failing repeated audits, the program was not consistent with its mission," Cohen said.

Because of the program's shortcomings, including inadequate staffing and resources, its funding was expected to end.

The final blow was a report, released a year ago by the California state auditor, finding that the medical board did not always require doctors to stop practicing immediately after testing positive for alcohol or drugs.

Participants agreed to a five-year monitoring period that included random testing for drugs and alcohol. But the audit found the program inconsistently monitored participants, with more than one in four urine tests not performed as randomly scheduled.

"Given the history of the problems with medical board's supervision – and oversight of the diversion program – it was high time we did something about it," Ridley-Thomas said.

The decision to end the program pitted the medical board against the 35,000-member California Medical Association, which argued the program could be strengthened.

"We believe in the underlying objective of the program, which was providing a pathway for physicians to get help," said Ned Wigglesworth, a spokesman for the association.

Julianne D'Angelo Fellmeth, who published an independent report in 2004 calling for major improvements in the program, said the medical board made the right decision.

"I would rather have no program than a fundamentally flawed program that does not work," said Fellmeth, administrative director of the Center for Public Interest Law based at the University of San Diego.

The CMA has not taken a position on SB 1441. The association is sponsoring a competing measure.

Assembly Bill 214 by Assemblyman Felipe Fuentes, D-Sylmar, would establish a program run by the Department of Public Health that would allow doctors to see patients while undergoing treatment.

If doctors voluntarily entered the program, their identities would not be disclosed to the public or medical board.

About the writer:

• Call Aurelio Rojas, Bee Capitol Bureau, (916) 326-5545.