California’s Proposition 46: A Wolf in Sheep’s Wool

Preventable harm is the third leading cause of death inhealth care (1). One third of physicians will have issues related to impairment in their ability to practice medicine during their career (that is, impairment from all causes, including substance use disorders) (2). Alcohol and drugs impair performance and, directly or indirectly, increase risks for error. Although we do not know the extent to which preventable harm and physician drug and alcohol use overlap, given the prevalence of both, they likely do. These facts make for a compelling argument for physician drug testing. We have previously described the key principles of a program for physician drug testing, which have been proven effective in health care and other industries. Such a program should 1) focus on identification and rehabilita-tion of physicians, rather than punishing and subjecting them to civil or criminal liability, although some behaviors should warrant sanctions; 2) be confidential and protected under the umbrella of quality assurance; 3) include man-datory testing before employment, appointment, or licen-sure; 4) include random testing; 5) include for-cause test-ing, perhaps for sentinel events leading to a patient’s death; and 6) initially be limited to the hospital setting, where the bylaws and infrastructure can support the program. Estab-lished physician health programs should be involved, tasked with early identification and assistance of physicians with impairment-related disorders. We recognize that widespread physician drug testing would be novel and could have unintended consequences. We have recom-mended that experience could be gained by starting in 1 department, hospital, or health system, enabling vetting of the logistics, risks, and benefits of such a program