Most physicians wake up every day intending to do the best possible job and help their patients. They work long hours, sacrifice a normal family life, and don’t always receive a thank-you note.
Digest the following hypothetical.
You and your partner are the only neurosurgeons for a small community of 50,000 people. The draw area is larger, say 250,000. The closest major metro area is 80 miles away. And that city has a medical school, teaching hospitals, and full service trauma treatment.
You and your partner alternate call for both the practice and the ER.
Your partner is on call.
You’ve had a long week, and are ready to kick back. In anticipation of the weekend, you just finished a large glass of Cabernet. Yum.
The ER calls and you pick up the phone. You didn’t have to. But you did.
There was a 3 car pile-up on the highway and the ER is full. You partner has already taken the most serious injury, a patient with a subdural hematoma, to the operating room. He’s not expected out of the operating room for some time.
The patient with the next most serious injury just returned from CT. He has a large epidural hematoma – and his neurological status is deteriorating quickly. The rest of his scan looks fine. And was awake and talking just prior to going to the CT suite.
The ER knows you’re not on call, but they hope you will help. They know that calling for the helicopter to transfer the patient to the adjacent metro area will take time. Even in the best of circumstances, the delay will cost a lot of neurons; and perhaps the patient’s life.
What do you do?
Most doctors I know will say, “I’ll be in shortly. Please help get the OR team in place.” The reason: They know they can save a life and preserve function. The procedure isn’t technically demanding. It will not take long.
OK. Now I want to change one fact.
A new law has just been passed. Here are just some of the details.
Requires Hospitals to Conduct Alcohol and Drug Testing on Physicians. This measure requires hospitals to conduct testing for drugs and alcohol on physicians as follows:
- Following an adverse event, tests on physicians who were responsible for the care and treatment of a patient or prescribed medication to a patient within 24 hours prior to the adverse event. Physicians would be required to make themselves available for drug testing as soon as possible after the adverse event occurs. Failure to submit to drug testing within 12 hours after the physician learns of the adverse event can be cause for suspension of the physician’s license.
The hospital would be required to bill the physician for the cost of the test. The hospital would also be required to report any positive test results, or the willful failure or refusal of a physician to submit to the test, to the Board which must do the following:
- Refer the matter to the Attorney General’s Health Quality Enforcement Section for investigation and enforcement.
- Temporarily suspend the physician’s license pending the Board’s investigation and hearing on the matter.
- Notify the physician and each of the health facilities at which the physician practices that the physician’s license has been temporarily suspended.
Back to our hypothetical. You just finished a glass of wine. The ER calls. You’re not on call. Your partner is tied up in the OR. You can save a life quickly rather than allowing the patient to be transferred to distant city for treatment, risking injury via delay.
If that law were in place, I know what most physicians would do. They say they’d like to help. But, they just had a glass of wine. Can’t put their license at risk. Sorry.
While the vignette was hypothetical, the law most certainly is not. If the Troy and Alana Pack Safety Act passes in California by referendum this November, this will be the new landscape. “Sorry, I’d like to help. And I’m sure I could save the life. But, I can’t come in. Just had a glass of wine.”