By Emily Largent
California Proposition 46, the Medical Malpractice Lawsuits Cap and Drug Testing Doctors Initiative, is on the November 4, 2014 ballot. If approved by voters, the initiative would: increase the state’s cap on non-economic damages that can be assessed in medical negligence lawsuits; require hospitals to test certain physicians for drugs and alcohol; and require healthcare providers to check a statewide prescription drug database before prescribing or dispensing certain drugs to a patient for the first time.
The debate over Proposition 46 has been framed as a battle between doctors and lawyers. See also here or here. It’s not hard to see why. Attorneys have contributed the vast majority of the “yes” campaign‘s $9 million fund. By contrast, nearly three-fourths of the “no” campaign‘s $57 million has come from six insurance companies; other big backers include the state medical and dental associations. (It is the most expensive campaign in California this year.) While the two sides have made a variety of arguments for and against Proposition 46′s various provisions, I want to focus on the putative costs and cost-savings:
First, Proposition 46 would increase California’s current $250,000 limit on non-economic awards (which dates to the Medical Injury Compensation Reform Act of 1975) to $1.1 million, and provide for annual adjustment for inflation going forward. The non-partisan Legislative Analyst’s Office estimates that increased state and local government health care costs from raising the cap likely range from the tens of millions of dollars to several hundred million dollars annually. On the other hand, a RAND study of EDs in three states with strict malpractice limits found the caps had little effect on the cost of care.
Second, the California Department of Justice already has a prescription drug monitoring program system which allows registered users, including licensed prescribers, to access information on a patient’s controlled substance history. Proposition 46 would make it mandatory for doctors to consult the database, and California would become one of only nine states to require doctors to check before prescribing painkillers to first-time patients. The Legislative Analyst’s Office said that the savings from proscription drug monitoring were “uncertain, but potentially significant.” Use of the database could result in savings by reducing the amount of drugs prescribed and/or reducing costs associated with drug treatment, rehab, and law enforcement.
Third, Proposition 46 would require drug and alcohol testing of doctors and reporting of positive tests to the California Medical Board. It would give the state Medical Board one year to set up a system to test doctors–both randomly and within 12 hours after an unexpected patient death or serious injury. Because there is no other drug-testing law in the country, it’s unclear that such a policy would decrease costs.
Early polls showed strong support for the measures, but that support is rapidly waning. How would you vote?