Jenny Spielman was found dead in a bathtub at a drug treatment facility in Bay Park a few hours after spending the evening with family, celebrating her 29th birthday.
"She was smart," Spielman's sister, Laura, told NBC 7 Investigates. "She was funny. She was beautiful. And she was taken away, way too soon."
Spielman battled serious mental illness and addiction to prescription drugs for a decade. It was a battle she and her loving family lost that April 2008 night in a group treatment home on Ottawa Street.
The San Diego County Medical Examiner determined Spielman's death was an accidental drowning, but a combination of powerful drugs - including the narcotics Fentanyl and Oxycodone - also contributed to her death, according to the report.
Some medical experts say tragedies, like the overdose death of Spielman and the dangerous and illegal self-prescribing of controlled substances by her then-doctor, would be reduced if voters approve Proposition 46 on Nov. 4.
Opponents of the ballot measure disagree and said if Proposition 46 passes it will require unnecessary drug and alcohol testing for doctors. They also claim the measure would increase lawsuit settlement payouts for trial lawyers and patients.
Spielman was prescribed the drugs by Dr. Jerry Rand, an addiction treatment specialist. His actions, according to the California State Medical Board, contributed to Spielman's death.
In a formal accusation, the Medical Board claimed Dr. Rand committed "gross negligence" and "repeated negligent acts" in her care, including a failure to "properly detoxify" and "closely monitor" Spielman, to "prevent (her) overdose and death." The Medical Board also criticized Rand for his alleged lack of a "coherent treatment plan" for her addictions.
According to that same accusation, Rand also illegally "self-prescribed" controlled substances and dangerous drugs, including sleeping pills, for his own personal use.
Rand is not the only local physician accused of abusing drugs or alcohol or over-prescribing powerful pharmaceuticals to patients. NBC 7 Investigates reviewed every petition for discipline, decision and settlement filed by the Medical Board against San Diego County doctors since January 2011.
The investigation revealed more than one-third of the 111 local doctors targeted by the Board were accused of — or admitted to — abusing powerful narcotics or other controlled substances, including alcohol, or over-prescribing dangerous drugs for their patients.
Prop 46: Possible Solution?
“The incidence of overdose deaths, emergency room visits and addiction problems related to prescription drugs is going up every year,” said Dr. Clark Smith, a psychiatrist and addiction treatment expert. “We need every tool available to us to try and control this."
According to the National Survey on Drug Use and Health, nearly one-third of people 12 and over who used drugs for the first time began by non-medically abusing a prescription drug.
Smith has counseled drug addicts and alcoholics for more than 30 years. He helps professionals from all walks of life, including other physicians. He said there is a need to reduce substance abuse and negligent prescribing of narcotics and dangerous drugs by doctors.
Proposition 46 calls for random drug and alcohol testing of California doctors who work at hospitals or have hospital admitting privileges. It would also require doctors to submit to substance abuse testing if a patient under their care suffers medical harm.
Click here to see the complete voters guide on Proposition 46 from California’s Secretary of State Office.
"If they are having a problem that's out of control, that means their patients are at risk that's out of control," Smith said.
Smith is bucking many of his fellow physicians — and the medical establishment — by supporting Proposition 46.
He compares the current random drug testing of airline pilots, truck drivers and school bus drivers — all occupations involving public safety — to the drug testing that would be required of doctors if the Proposition passes.
Dr. Ted Mazer, a leading opponent of Proposition 46, acknowledges the problem.
“We know there are issues of substance abuse by physicians and other healthcare personnel,” Mazer told NBC 7 Investigates.
Click here to check the status of your doctor’s license.
But Mazer said there's no study showing how often patients are actually harmed by their doctor’s potentially dangerous behavior. He said the hospital-based random drug and alcohol testing proposed is a “poorly designed gimmick” that would have no impact on thousands of doctors who see patients only at their offices.
"Where are the studies to support this, (that) somehow, randomly testing doctors who enter hospitals will address any particular issue?” Mazer said. “That's what we need to look at."
Smith said the testing is inconvenient because physicians already submit to tuberculosis testing, even though the disease is quite rare.
“We get (the TB test) because we don’t want to put our patients at risk,” he said. “That same logic, I think, should apply to drug and alcohol tests.”
Mazer argues requiring doctors to submit to testing after a patient has a bad outcome is bad policy. He said such testing might not happen for days, even weeks, after the patient has suffered an “adverse event” that might be only remotely connected to the doctor’s care.
He said the doctor might be on his day off, away on vacation, or even enjoying a beer at a ballgame when he’s summoned for the mandatory drug and alcohol test.
“It’s illogical,” Mazer said. “What I do today doesn’t mean what I was doing five days ago when I saw the patient.”
Under Proposition 46, the state attorney general would temporarily suspend the doctor’s license if he or she tests positive for drugs or alcohol. The doctor would then have to fight to get their license back.
“You’re presumed guilty, and you’ve got to plead your innocence,” Mazer said. “In which time period you can’t practice medicine or take care of your patients.”
What the files show
In the past four years, 38 local doctors were accused of — or admitted to — abusing powerful narcotics or other controlled substances, including alcohol, or over-prescribing dangerous drugs for their patients.
The Medical Board cited a handful of doctors for both violations: abusing dangerous substances, and over-prescribing or negligent prescribing of controlled substances for patients.
Some of those doctors investigated include:
Dr. Scott Greer, a local gastroenterologist, has a history of DUI arrests and convictions. The Medical Board said Greer left threatening voice mails on a friend’s phone and threatened to “split his head open with an axe.” His license was suspended for 30 days and he is on probation for seven years.
Dr. Jason Lane, with the Southern California Permanente Medical Group, went to work in October 2013 with a blood alcohol level almost five times the legal limit for driving, according to his attorney. Lane collapsed on the job, and was taken to a hospital emergency room, where he was treated for alcohol poisoning. He was later fired. In June of this year, Lane acknowledged that his alcohol addiction makes him a danger to the public, and he agreed to let the Medical Board suspend his license.
The Medical Board’s case against addiction treatment specialist Miles Stanich dates back more than 15 years, and blames him in part for the death of two patients. According to the Board’s accusation, Stanich committed “gross negligence, repeated negligent acts.” He was placed on three years’ probation in 2006, which he successfully completed. But last year, an administrative law judge revoked Stanich’s medical license, citing evidence Stanich had “committed repeated acts of negligence” from 2008-10 involving two additional patients.
Dr. Rand no longer practices addiction medicine in San Diego.
Having been repeatedly disciplined by the Medical Board — which placed him on strict probation three different times, for a total of 17 years during a 24-year period — Rand surrendered his medical license in 2012.
Neither Greer nor his lawyer responded to requests for comment for this story.
Lane’s attorney, David Rosenberg, told NBC 7 Investigates his client began abusing alcohol approximately three years ago, when he tried to “self-medicate” symptoms of PTSD related to his combat service in the Middle East.
Stanich declined to comment for this story, but his attorney, Robert Frank, told NBC 7 Investigates that his client was never accused of any personal drug or alcohol abuse. Frank said Stanich’s patients had “verified pain problems.”
Click here to read more about the accusations against the doctors and see the responses from them and their lawyers.
A tool to prevent “doctor shopping”
Proposition 46 also targets drug-abusing patients, some of whom visit multiple doctors every week — or even every day — to obtain prescriptions for powerful narcotics and controlled substances. If approved by voters, it would require doctors to consult a prescription drug database that tracks a patient's’ prescription history.
In the state database, a physician is able to see if a patient has been “doctor shopping” for dangerous drugs.
“Doctor shopping” is described as the practice of a patient requesting care from multiple physicians, often at the same time, without making efforts to coordinate care or informing the physicians of the multiple caregivers.
If a physician thinks a patient is “doctor shopping,” the doctor could refuse to write them a prescription and instead counsel them about possible addiction treatment.
Mazer said that’s a good theory, but one that fails in the real, work-a-day world of modern medicine.
He said the database is outdated, time consuming “and pretty much non-functional.” Doctors or their assistants must spend many hours online, just trying to sign-up for the system, he said.
“You’re in the emergency room, the doctors are busy taking care of you and other patients,” Mazer said. “Is the doctor going to wait around — or the nurse going to wait around — for a computer program?”
Right now, Smith said only about 9 percent of doctors use the database, called the California Prescription Drug Monitoring Program, CURES.
According to Mazer, California doctors have agreed to pay a special fee to update and improve the database. He said the upgrade will take about 18 months, at which time it might make sense to require all doctors to use the database.
“But if Prop. 46 passes, we have to use it now,” Mazer said. “It isn't ready. It means you (the patient) might not get the medication you need, when you need it. That's not the way we want to practice medicine."
Increase lawsuit payouts
For Proposition 46 opponents the most persuasive argument against the ballot measure is their claim the drug and alcohol testing and the required use of the prescription database are just shills that hide the real objective of the ballot measure, which would also raise the existing $250,000 cap on lawsuit awards for pain and suffering, to more than $1 million.
"The term is a ‘sweetener,’” Mazer said. “It's a deception.”
Mazer said proponents of Proposition 46 claim the ballot measure will improve patient safety and stop drug and alcohol abuse by doctors, but that’s not the case. “It's about masking what they're really after, which is to raise the cap,” on lawsuit awards.
According to Mazer and other opponents, Proposition 46 would result in:
Plaintiff lawyers filing more negligence and malpractice lawsuits against doctors and hospitals, because they can potentially win bigger verdicts and settlements.
Doctors and medical clinics paying more for malpractice insurance and passing at least some of those costs on to patients.
Doctors, especially those with “high-risk” specialties, including neurosurgery and obstetrics, leaving California, or retiring early.
The state of California’s independent legislative analyst said lifting the malpractice cap would increase health care costs for state and local governments anywhere from “the tens of millions of dollars to several hundred million dollars annually.”
But the analysis found those costs would be offset by savings from wider use of the prescription database and substance abuse tests for doctors.
According to the analysis, random drug and local alcohol testing “would deter some physicians from using alcohol or drugs while on duty, and, in turn, result in fewer medical errors. Fewer medical errors would decrease overall healthcare spending.”
It predicts the annual savings “is highly uncertain, but potentially significant. These savings would offset to some extent the increased governmental costs from raising the cap” on malpractice lawsuits.
Regardless of how voters decide on Proposition 46, Spielman’s family said they will continue talking about their daughter’s tragic death, and voicing their strong belief that random drug and alcohol screening for medical professionals and wider use of the prescription drug database can save lives.
“A doctor who’s impaired can kill someone,” said Spielman’s father, Chuck. “We just need to do more to ensure that the health care professionals who care of our loved ones are not on drugs themselves. It’s critical. It must happen.”
Click here to check the status of your doctor’s license.