California Medical Board Abandons Replacement for Physician Diversion Program

$11 a year. That’s how much less California physicians will pay ($22 biannually) as a result of the abandonment of the Medical Board of California’s (MBC) decision to abandon its Diversion Program altogether. The MBC published its “Final Statement of Reasons” today, explaining further its decision not only to let the Diversion Program die, but also not to replace it with an alternative as many had expected.

The Diversion Program had served as an option for physicians struggling with chemical dependency/substance abuse or other mental health issues to “self-refer” and address their challenges in a confidential setting. In exchange for confidentiality, doctors were evaluated for their safety level and monitored for any drug use, participating in facilitated groups. In addition, the Board had referred physicians with these issues into the Diversion Program as a condition not to pursue disciplinary relief or as term of probation in disciplinary orders.

The death of the Diversion Program as of June 30, 2008 was a victory for advocates of a zero tolerance approach to substance abuse, who had identified shortcomings in the program which led to its suspension. Opponents, such as Julianne Fellmeth, made themselves heard at a January 2008 “summit” and succeeded in blocking an alternative.

The absence of the Diversion Program creates risks of which physicians struggling with chemical dependency or mental health issues need to be aware. There is no prospect of a “safe harbor” for physicians seeking treatment; if the MBC discovers the problem, it now takes a zero tolerance approach and has the right to institute a disciplinary action. A single incident, such as a DUI, may be sufficient to trigger a licensing action. Physicians should do their best to ensure that any treatment sought is kept strictly confidential. For physicians who are ordered to undergo biological fluid testing as a condition of probation, the prospect of a positive test is likely to result in a petition to revoke probation. Zero tolerance advocates may think the end result is better patient safety. It would be interesting to consider the extent to which the opposite may be true: physicians have more incentive than ever to keep chemical dependency and mental health issues secret.