The fight continues
Although Prop 46 was defeated,
the fight isn’t over. Surgeons
are moving forward with the
next steps to protect MICRA,
which include the following:
•California ACS chapters intend
to educate state lawmakers
about the need to maintain
medical liability protections and
to begin considering passage of
other meaningful reforms and
alternatives to the tort system for
resolving liability claims, such
as development of health courts,
enterprise liability, safe harbors,
and “disclose and offer” programs.
•It is likely that the proponents of
Prop 46 will continue to try to
enact measures that reflect the
intent of this ballot initiative.
Members of the coalition that
opposed Prop 46 are closely
monitoring whether a repeat
ballot measure will be filed.
Prop 46 used physician drug
testing as a hook to draw public
support. Since it polls well with
voters, this tactic could be used
again in a future initiative.
•A secondary intent of Prop 46
sought to require California
physicians to use the state’s
Controlled Substance Utilization
Review and Evaluation System
(CURES) database that is still
under development before
prescribing narcotics to patients.
Proponents of Prop 46 used
the story of Troy and Alana
Pack, children who were struck
and killed by an automobile
driver addicted to alcohol and
prescription pain medications,
to gain support. The driver had
not disclosed to her treating
physicians that she had sought
multiple narcotic prescription
refills from different providers.
In 2015, Governor Brown signed
legislation to extend the deadline
for health care providers to
register to use the CURES
database, as issues related to
adequacy of funding and ensuring
patient confidentiality for the
database continue to be evaluated.
The coalition against Prop 46 will
explore alternate ways of fulfilling
this provision in the initiative.
Ultimately, the defeat of
Prop 46 was a team effort and is
a testament to the importance
and value of physician and
surgeon advocacy. Perhaps the
most constructive next step is
to work legislatively and at the
negotiating table to better meet
the needs of society by reforming
the medical liability system. ♦
JAN 2016 BULLETIN American College of Surgeons
FROM RESIDENCY TO RETIREMENT
California ACS chapters intend to educate state
lawmakers about the need to maintain medical
liability protections, and to begin considering passage
of other meaningful reforms and alternatives to the
tort system for resolving liability claims, such as
development of health courts, enterprise liability,
safe harbors, and “disclose and offer” programs.
1. California Legislative Analyst’s
Office. Proposition 46 Drug and
Alcohol Testing of Doctors. Medical
Negligence Lawsuits. Initiative Statute.
July 17, 2014. Available at: www.lao.
Accessed December 1, 2015.
2. California Medical Association.
MICRA: A brief history. Available
November 29, 2015.
3. California Medical Association.
Trial lawyers’ money grab threatens
to overturn MICRA. Available
November 29, 2015.
4. Maviglio S. Intervenor fees:
Consumer Watchdog’s self interested
provision in Prop 45. Available
Accessed November 29, 2015.
5. Maa J, Sutton J. Preserving MICRA
and patient access to surgical care
in California. Bull Am Coll Surg.
2014;99( 10): 60-61. Available at:
November 5, 2015.
6. Hiltzik M. The battle between
doctors and trial lawyers grows more
infantile. Los Angeles Times. December
10, 2013. Available at: http://articles.
November 3, 2015.