Questions and Answers About Prop. 46 A costly threat to people s personal privacy Californians can t afford.

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1 Questions and Answers About Prop. 46 A costly threat to people s personal privacy Californians can t afford. What will Prop. 46 do? Prop 46 does three things: Quadruples the limit on medical malpractice awards in California, which will cost consumers and taxpayers hundreds of millions of dollars every year in higher health care costs, and cause many doctors and other medical care professionals to quit their practice or move to places with lower medical malpractice insurance premiums reducing access to care. Threatens your privacy by requiring a massive expansion of the use of a personal prescription drug database. Requires alcohol and drug testing of doctors, which was only added to this initiative to distract from the main purpose. Proposition 46 uses alcohol and drug testing of doctors to disguise the real intent to increase a limit on the amount of medical malpractice lawsuit awards. Who opposes Prop. 46? Thousands of organizations and individuals representing doctors, nurses, community clinics, local governments, labor unions, business groups, education groups, taxpayer groups, hospitals, community groups and many others oppose Prop. 46 because it will lead to more lawsuits, higher health care costs, threaten people s access to their trusted doctor or clinic, and jeopardize people s personal prescription drug information. Who supports Prop. 46? One hundred percent of the reported contributions to pay for signature gathering to place this on the ballot in November 2014 came from trial lawyers and their allies.

2 How will Prop. 46 increase health care costs? There is no question that more lawsuits against health care providers will increase costs, and someone has to pay. And that someone is consumers and taxpayers. California s former Legislative Analyst found Prop. 46 would increase health costs for consumers and the state by about $9.9 billion annually. This translates to more than $1,000/year in higher health care costs for a family of four. California s current independent, non- partisan Legislative Analyst Office (LAO) said impacts to state and local governments (i.e. taxpayers) would be several hundred million dollars annually. In its evaluation, the LAO warned even a small percentage change in health care costs could have a significant effect on government health care spending. How does this affect taxpayers? State and local governments pay for current and retired government employee health benefits and they provide health care safety net services directly through Medi- Cal, state and county hospitals and community clinics, and other local programs. If lawsuits increase and health care costs go up, state and local governments pay these out of the budgets they receive from taxpayers. Increased health costs to state and local governments could force cuts to other vital services like education, public safety and social safety net programs. Or, state and local governments may decide to make up that additional cost by raising revenues, and that will come from taxpayers. What about access to health care? How will that be affected by Prop. 46? If California s medical liability cap goes up, people could lose the ability to see their trusted doctors. Many community clinics operate on slim margins. Any significant increase in their costs will force them to reduce or eliminate services for patients. Many doctors will be forced to leave California to practice in states where medical liability insurance is more affordable. Respected community clinics, including Planned Parenthood, warn that specialists like OB- GYNs will have no choice but to reduce or eliminate vital services, especially for women and families in underserved areas. Why are community clinics so strongly opposed to Prop. 46? Community clinics, like Planned Parenthood Affiliates of California, Community Clinic Association of Los Angeles County, and the California Association of Rural Health Clinics and hundreds of others say Prop. 46 will raise costs that will cause specialists, like OBGYNs, to reduce or eliminate services to their patients. Many clinics struggle financially, particularly community clinics that serve low- income, uninsured and rural patients. Anything that increases costs could jeopardize access to care for those patients most in need.

3 How will Prop. 46 threaten people s personal privacy? Prop. 46 forces doctors and pharmacists to use a massive statewide database filled with Californians personal medical prescription information. A mandate government will find impossible to implement, and a database with no increased security standards to protect personal prescription information from hacking and theft none. And who controls the database? The government in an age when government already has too many tools for violating your privacy. What is wrong with the provision mandating use of the CURES database? This database sounds simple, but it s not. While the CURES database is already in existence, Prop. 46 would require an immediate ramp up (the day after the election, on November 5, 2014), and will force the CURES database to respond to tens of millions of inquiries each year something the database simply cannot do in its current form or functionality. In fact, in evaluating Prop. 46 the LAO noted, Currently CURES does not have sufficient capacity to handle the higher level of use that is expected to occur when providers are required to register beginning in This poses two problems: Jeopardizes patient access to their prescriptions. Prop. 46 will force the CURES database to respond to tens of millions of inquiries each year something the database simply cannot do in its current form or functionality. A non- functioning database system will put physicians and pharmacists in the untenable position of having to break the law to treat their patients, or break their oath by refusing needed medications to patients. Significantly puts at risk patients private medical information. Prop. 46 contains no provisions and no funding to upgrade the database with increased security standards to protect personal prescription information from government misuse, hacking, theft or improper access by non- medical professionals. Shouldn t doctors be drug tested? The physician community and all health care providers are always looking for ways to improve patient safety. But don t be fooled by Prop 46. The drug testing provision was included for political, not policy reasons. The lawyers who wrote and funded getting Prop. 46 on the ballot have never gone to the state legislature to propose drug testing of doctors. In fact, the consultant for Prop 46, Jamie Court, cynically told the LA Times on December 10, 2013, that drug testing of doctors was the ultimate sweetener, designed to deceive voters from the real reason behind the initiative, to make lawsuits easier and more lucrative for the lawyers who wrote and funded Prop 46.

4 Are the drug testing provisions in Prop. 46 the same as what the FAA and Department of Transportation require of pilots and airline personnel? No. In fact, Prop. 46 cherry picks portions of the FAA procedure for pilots, but excludes other important provisions that ensure due process and fairness. For instance: Prop. 46 imposes a presumption of negligence immediately upon a positive test or if a physician is unable to take the test within the mandated 12 hour timeframe. This is not part of the FAA/Department of Transportation regulatory framework. Anyone (disgruntled patient, co- worker, family member) could make a claim that a physician is impaired. In fact, Prop. 46 grants immunity to anyone who reports any information that appears to show that a physician "may" be impaired. The FAA and Department of Transportation s drug testing policies are designed to identify and respond to impairment that directly places passengers at risk. In contrast, Prop. 46 focuses on identifying and imposing sanctions for physician substance use during an arbitrary time period, regardless of whether there is any evidence that it places patient safety at risk. Are patients only entitled to $250,000 in the event of a medical liability case? No. MICRA was set up to ensure patients received fair compensation if they were injured. Under MICRA, patients receive: UNLIMITED economic damages for any and all past and future medical costs. UNLIMITED economic damages for lost wages and lifetime earning potential. UNLIMITED punitive damages - punishment awarded for malicious or willful misconduct. Up to $250,000 for speculative non- economic damages, often called pain and suffering. The $250,000 cap reduces incentives to file meritless lawsuits, while at the same time ensures that legitimate claims can move forward.

5 What about children, seniors, and low- income Californians and the $250,000 MICRA cap? Those who will be most hurt by Prop. 46 and the higher health care costs are the very people who are most vulnerable and least able to absorb higher costs: children, seniors, families and low- income Californians. More lawsuits, like those that will result from Prop. 46, will increase costs for those who can least afford them. And it will reduce patient access to care. The bottom line is that Prop. 46 will make it harder for all of California s patients, including children, seniors, and low- income families to receive quality care. That s why groups like the American Academy of Pediatrics California, California Children s Hospital Association, Children's Specialty Care Coalition and senior advocates like those at Curry Senior Center oppose this measure. Won t Prop. 46 help improve quality by holding doctors more accountable? Even one medical error is too many and that s why the entire health care community is always looking for ways to improve patient safety. But don t be fooled by this measure. Increasing lawsuits is not the answer and will do absolutely nothing to improve health care quality. Worse, the resulting higher health care costs will put health care services even more out of reach for people who already suffer from lack of access. Community clinics, rural practitioners and safety net providers are the most vulnerable to cost increases and could be forced to cut back services.

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