A ghost of Prop. 46 eyed in the Capitol

California voters, confronted by a multimillion-dollar advertising blitz, overwhelmingly rejected Proposition 46, which would have raised the cap on pain-and-suffering damages in medical malpractices lawsuits.

But new legislation proposed in the Capitol targets a slice of Proposition 46, the part dealing with the state’s prescription drug database. And some rival forces that clashed over Proposition 46 may do battle again, although it’s too early to tell and negotiations over the provisions are under way.

Currently, consulting the CURES database is voluntary. But language to make it mandatory is proposed for the new legislation by Sen. Ricardo Lara, D-Bell Gardens.

In both the voting booth and campaign coffers, Proposition 46 was handily defeated, with insurers, doctors, hospitals, dentists and myriad others in the medical community opposing it.

Supporters included trial lawyers and some consumer advocates. Total spending in the campaign reached about $73 million, with some $59 million raised by foes and $13.6 million by supporters, led by Consumer Watchdog and its allies. The proposition lost at the polls by nearly 34 percentage points, or about 2.3 million votes out of more than 7.1 million ballots cast.

Much of the attention on Proposition 46 dealt with the measure’s mandatory drug testing for doctors and the lifting of the state’s 40-year-old malpractice cap in MICRA, the 1975 Medical Injury Compensation Reform Act.

But another provision would have required dispensary pharmacies and clinics to consult the state’s prescription drug database, known as CURES, before prescribing any controlled substances. CURES is bureaucratic shorthand for Controlled Substance Utilization Review and Evaluation System.

Currently, consulting the CURES database is voluntary on the part of the doctor.

But language to make it mandatory is being proposed in the new legislation, SB 482, authored by Sen. Ricardo Lara, D-Bell Gardens. The final language in the bill — known in the Capitol as a “spot bill” because it was introduced to meet deadlines but its contents have not been decided — currently is under negotiation.

Among other things, the proposal would require doctors to review a patient’s drug history upon writing the first prescription, and then review it again at least once annually, according to sources working on the bill language.

The issue is of deep importance to Pack because of a tragedy: A doctor-shopping driver – drunk and high on prescription drugs – struck and killed his two children with her vehicle.

Health care activist Bob Pack, who’s been advocating for the required use of CURES since before last year’s ballot fight over Proposition 46, also created the system currently being utilized by California doctors on a voluntary basis. But fewer than one in 10 doctors actually uses the system, which allows a registered user like a doctor to track a patient’s prescriptions that have a potential for abuse and also review that patient’s pharmaceutical drug history.

“The problem with it currently is it’s a voluntary system and we don’t have a very large base of doctors involved with the system,” Pack said. According to the state Department of Justice, only about 8% of eligible users had registered for the voluntary system as of 2013.

“It’s been available for several years now and not enough are enrolled and not enough are checking, so we need to mandate this – several other states have already mandated it, recently in the last year or two, and they are having tremendous success in reducing doctor shopping,” Pack added.

The issue is of deep importance to Pack because of a tragedy that that occurred in his family 12 years ago: A doctor-shopping driver – drunk and high on prescription drugs – struck and killed his two children with her vehicle.

Over the last decade, the CURES database has found a permanent home in the state’s DOJ building after its former location in the Bureau of Narcotics Enforcement was shut down by Gov. Brown in 2011.

Previous legislation has also enabled the system to improve its “efficiencies and functionality,” according to the DOJ. A new version of the CURES system, called CURES 2.0, launches in July.

In order not to conflict with that revamp, Pack said SB 482’s requirement on doctors to review CURES prior to writing a prescription would likely not go into effect until next year.

Why go the legislative route instead of back to the ballot? “I think the legislative way is the proper way to do it … I think there are multiple reasons why it didn’t go through on Prop. 46, but as a stand-alone bill I think it has a lot of chance.”

The California Medical Association, a key opponent of Proposition 46, has not taken a position on Lara’s bill, noting that the legislation as introduced is a “spot bill” and that it hasn’t seen the final language.

Pack said he hoped that the rival forces in Proposition 46 could unite on the need to curb prescription drug abuse.

“The best outcome is all of the parties work together because the benefit of this is safe prescribing of prescription narcotics. Doctors want that too,” Pack said.
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Ed’s Note: Fixes language 8th graf to show that spot bill’s contents are not final, changes “contained” to “proposed,” and notes that negotiations under way; edits to conform throughout.