Program keeps doctors' addictions secret

Former O.C. senator Joe Dunn is leading the California Medical Association, which is fighting to keep the program alive despite critical reviews.

By Brian Joseph
Capitol Watchdog column
The Orange County Register
July 13, 2007

SACRAMENTO - A former trial lawyer and state senator, Joe Dunn battled the greedy and unscrupulous on behalf of the little guy.

He stood up for children, participated in the national tobacco litigation settlement and investigated officials at Enron.

"Rarely is a wrong righted without someone forcing the truth to the surface," the Santa Ana Democrat once said. "Throughout my career, I have accepted the responsibility to be that someone… ."

Today, however, as executive vice president and CEO of the California Medical Association, Dunn finds himself leading an organization that's defending a secretive and controversial medical program that some say endangers patients.

Take Dr. Brian West, a plastic surgeon in Long Beach and Beverly Hills. West has been accused of horribly disfiguring several patients when he worked in Northern California a few years ago. He also twice was convicted of drunk driving.

The Medical Board of California has never been able to link West's substance abuse to the allegedly botched surgeries, but the graduate of UC Irvine's medical school was able to keep his alcoholism secret thanks to the board's Diversion Program.

Designed to help troubled doctors without ruining their careers, the Diversion Program diverts qualifying physicians from disciplinary proceedings and into rehab.

Diversion is largely confidential, so West's former patients never knew about his drinking problem until he failed out of the program. Board documents indicate West was kicked out because he couldn't attend inpatient treatment and that he made one of his employees falsify records about his participation in Alcoholics Anonymous.

His former attorney, Robert Sullivan, said West should not be "the poster boy for the Diversion Program's" problems, adding that West is a skilled surgeon and that the Diversion Program provides a vital service.

"I would have liked to have known … he was in diversion," said Tina Minasian of Sacramento, who says West performed a body lift on her in 2002, a year after he entered the program.

Today, Minasian says she is "physically deformed with huge gaps surrounding my abdominal area." She says is one of the anonymous patients referenced in a formal charge of wrongdoing filed against West by the attorney general.

"I feel extremely outraged, betrayed and misled," Minasian said.

Dunn's organization, which represents 35,000 California doctors, thinks the Diversion Program has merit, however. At two public hearings last month, representatives of the California Medical Association testified that the Diversion Program protects the public while helping doctors who are battling the disease of substance abuse.

They argued that the program is safe, that doctors will still suffer from substance abuse regardless of whether the program exists and that the program provides a valuable service for California physicians.

"I think you have an effective program," Sandra Bressler, association vice president of policy, said in a June 18 hearing. "This is not a scandal and a big catastrophe that has happened," she said.

The association's support comes despite mounting evidence that suggests West is just one example of a failed program. Since its inception 27 years ago, the Diversion Program has been the subject of five external audits, none of them complimentary.

The most recent, a June report by the California State Auditor, found that the "program has not always required a physician to immediately stop practicing medicine after testing positive for alcohol" or drugs, as required by policy, and has ruled doctors who tested positive for drugs have not relapsed "without providing any justification for such a determination."

The audit also found that the Diversion Program, which monitored 354 doctors in fiscal year 2005-06, does not adequately follow their progress or administer drug tests that are truly random.

The auditor reports that the Diversion Program should have received 51 reports from therapists but only obtained 17. The auditor also found 26 percent of drug tests were not completed on their randomly chosen dates – subjects avoided some of them by taking vacation days.

"It's a huge problem. There's an error rate of 25 percent because they're not performing drug tests randomly," said Assemblyman Jose Solorio, a Santa Ana Democrat who chairs the Assembly Public Safety Committee and represents many of the same neighborhoods Dunn once did. "It's definitely a public safety issue."

I wanted to ask Dunn about his organization's stance on the Diversion Program, but I couldn't get a hold of him. I left messages on his cell phone, at his association office and at his home in Orange County. I also tried to contact him through association spokeswoman Karen Nikos, but she refused to let me talk to him, saying Dunn doesn't speak about the group's policy positions.

As for the Diversion Program, its future is uncertain. Current law, enacted because of problems uncovered by a previous audit, terminates the program on July 1, 2008.

The medical board's executive committee recently voted down a plan to abandon the program, but the board is expected to address the issue again this month. Sen. Mark Ridley-Thomas, D-Los Angeles, is carrying a bill that would extend the sunset date for a year or two, but only if the program meets stringent performance standards.

Julianne D'Angelo Fellmeth, administrative director of the of the Center for Public Interest Law at the University of San Diego and the leader of the 2004 audit of the program, said the California Medical Association is working to protect its "sacred cow."

"It's very, very important to them," she said. "But I don't think it's defensible anymore."