Medical Board and Physician Substance Abuse Charges
The Medical Board substance abuse program is disciplinary only. There is no formal substance abuse diversion program and the board has mandatory programs that severely restrict the ability of a physician to practice once that doctor is found to be involved in drug or alcohol abuse.
The Medical Board Has No Substance Abuse Diversion Program
The Medical Board of California is “talking” about establishing a program to help manage physician substance abuse outside of the disciplinary process but presently it is just a thought and no program exists.
As Kristen Hwang published in December, 2024 [A California recovery program keeps watch on addicted health workers — but not doctors]
“Only 141 physicians are on probation for abusing substances, according to the medical board.
‘They ought to have like 2,000 people in monitoring. They’re missing a lot of cases,’ based on the number of doctors in California, said Skipper, who ran Alabama’s physician health program for more than a decade.”
The point is that by the time the Medical Board of California has focused on a physician for substance abuse, the horse is out of the barn and the Board is focused almost completely on discipline.
How Do Allegations of Physician Substance Abuse Reach the Medical Board?
Drug or alcohol issues arise in two main contexts. The first are arrests (even without convictions) for drug or alcohol offenses. DUI’s (Drunk Driving) or simple possessions arrests are enough to trigger an inquiry. Patient care failures are the next area. This can range from anesthesiologists injecting Fentanyl in the OR or a lapse in record keeping that leads investigators to wonder whether the doctor is “tuning out” due to drug use. In other words, any patient care issue can trigger a drug inquiry.
A third danger area are civil lawsuits. As any physician civil lawyer knows, lawsuits for money (civil lawsuits) always include personal attacks on the litigants and witnesses. A civil business dispute, a civil car accident case and certainly a medical malpractice case can lead to a medical board filing against a doctor.
Medical Board Disciplinary Standards for Drug or Alcohol Abuse
Doctors disciplined by the Medical Board for unprofessional conduct involving the use of illegal drugs, the abuse of drugs and/or alcohol, or the use of another prohibited substance are presumed to have a “substance abuse problem”. (See: § 1361. Disciplinary Guidelines and Exceptions for Uniform Standards Related to Substance-Abusing Licensees)
This presumption and the ability under the law to make such an assumption is granted by Business & Professions Code section 315 which says:
B&P §315. (a) For the purpose of determining uniform standards that will be used by healing arts boards in dealing with substance-abusing licensees, there is established in the Department of Consumer Affairs the Substance Abuse Coordination Committee. ... The Director of Consumer Affairs shall chair the committee and may invite individuals or stakeholders who have particular expertise in the area of substance abuse to advise the committee.
What are the Mandatory Conditions for Physician’s Presumed to Have a Drug Problem?
It does not matter what you submit to the Board. Once these findings are made there are mandatory conditions. The disciplinary regulation is clear that these are always imposed.
“(c) The following probationary terms and conditions shall be used without deviation in
the case of a substance-abusing licensee”. In the law the term “shall” in unwavering in its application.
You can read all of the rules for Medical Board Discipline Here MEDICAL BOARD DISCIPLINARY STANDARDS but in summary form, here are the mandatory conditions in excerpt form.
(1) Clinical Diagnostic Evaluations and Reports; Temporary Removal From Practice.
(A) If the Board orders a licensee who is on probation due to a substance abuse problem to undergo a clinical diagnostic evaluation, the following applies:
...
4. The clinical diagnostic evaluation report shall set forth, in the evaluator’s opinion, whether the licensee has a substance abuse problem; whether the licensee is a threat to himself or herself or others; and recommendations for substance abuse treatment, practice restrictions, or other recommendations related to the licensee’s rehabilitation and ability to practice safely. If the evaluator determines during the evaluation process that a licensee is a threat to himself or
herself or others, the evaluator shall notify the Board within 24 hours of such a determination.
5. In formulating his or her opinion as to whether the licensee is safe to return to either part-time or full-time practice and what restrictions or recommendations should be imposed, including participation in an inpatient or outpatient treatment program, the evaluator shall consider the following factors:
a. License type;
b. Licensee’s history;
c. Documented length of sobriety/time that has elapsed since substance use;
d. Scope and pattern of substance abuse;
e. Treatment history;
f. Medical history;
g. Current medical condition;
h. Nature, duration, and severity of substance abuse problem; and
i. Whether the licensee is a threat to himself or herself or the public.
(B) Whenever the Board orders a licensee to undergo a clinical diagnostic evaluation, the
Board shall order the licensee to cease practice pending the results of the clinical diagnostic
evaluation and review by the Board.
(C) While awaiting the results of the clinical diagnostic evaluation, the licensee shall
undergo random biological fluid testing at least two (2) times per week.
(3) Biological Fluid Testing.
(A) The Board shall require biological fluid testing of substance-abusing licensees.
(B) For the purposes of this section, the terms “biological fluid testing” and “testing”
mean the acquisition and chemical analysis of a licensee’s urine, blood, breath, or hair.
What Are the Biotests for Alcohol & Drug Use?
We note that for alcohol use laboratory tests that can be ordered include ethyl glucuronide (EtG), and ethyl sulfate (EtS) tests. Carbohydrate-deficient transferrin (CDT) and phosphatidylethanol (Peth), Gamma glutamyl transpeptidase (GGT), Aspartate aminotransferase (AST) and whole blood–associated acetaldehyde (WBAA). You can Google them but bottom line is you can’t “fool” this array of tests. Chronic drug use lacks the same biomarkers and the board will stick to short term urine and blood tests and rely upon hair testing for longer term use.
Drug use will result more in an order for random testing as “(C) The Board may order a licensee to undergo a biological fluid test on any day, at any time, including weekends and holidays. Additionally, the licensee shall be subject to 52 - 104 random tests per year within the first year of probation, and 36 - 104 random tests per year during the second year of probation and for the duration of the probationary term, up to five (5) years.”
The Board Will Impose Additional, Case Specific Sanctions
In nearly every instance, the board will impose a range of additional sanctions, terms, and conditions beyond the initial penalties. These sanctions are tailored to the specific circumstances of the case and the individual physician involved. The scope and nature of these penalties are extensive, encompassing a wide array of measures that may include mandatory rehabilitation programs, probationary monitoring, continued education requirements, fines, or practice restrictions. The flexibility and breadth of the board’s authority ensure that each case is addressed uniquely, often resulting in a combination of penalties designed to address the specific issues at hand. The range of potential sanctions is vast, leaving almost no limit to the possible outcomes physicians may face.
Physicians - Get the Best Medical Defense
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