What happens when the medical board of a major state begins reviewing fatal opioid overdoses with an eye to disciplining physicians who wrote the prescriptions?
According to this “How I Did It piece” from Cheryl Clark, depending on the perspective, it’s either a witch hunt, upending practices of physicians who legitimately tried to help patients manage pain, or a much-needed action to protect consumers from inappropriate, and perhaps deadly, prescribing.
Clark was surprised to find that the media had not reported on California’s efforts to deter excessive opioid prescribing, although apparently this program, which reviewed provider prescriptions against the records of deceased patients, had been active for several years. Perhaps even more surprising was that state and county medical associations had made little effort to publicize the board’s efforts to their members — some of whom may have directly or inadvertently contributed to patients’ deaths.
Clark actually learned about the “Death Certificate Project” from a neighbor that is a physician who received a letter from the California State Medical Board, which licenses the state’s 137,000 physicians. That scrutiny led to investigations of numerous doctors, nurses, and physician assistants whose patients had died within three years of being under their care. To Clark, the effort was troubling because the board was reaching back as far as 2009, long before the extent of the opioid crisis was known and before steps were taken to limit prescribing.
Several physicians spoke of their strong concerns over the medical board’s reach in asking them to produce patient records from years prior, and how these actions squared with a mandate of addressing patients’ complaints of pain; which was even tied to physician payment and overall ratings. And why were a quarter of all physicians under review based in and around San Diego?
To date, Clark has written five stories for MedPage Today about the Death Certificate Project, why many doctors are terrified, what it means for their practices, why ongoing prescriber education is vital and whether the state medical board is overreaching in its efforts to penalize doctors.