EDITORIAL
Drug-impaired doctors need better policing

Serious drug and alcohol addiction can be said to afflict roughly 10 percent of the general population, and it's reasonable to suppose that a similar proportion of physicians is similarly impaired.

Yet Hawai'i ranks last among states in enforcement efforts against physicians, taking just 0.8 serious actions for every 1,000 doctors, according to a survey Public Citizen, a national nonprofit public interest organization.

It would appear, then, that many physicians with a drug or alcohol problem, many of whom may be apparent to colleagues and family, are not being recognized officially and dealt with through intervention and enforcement efforts.

That's a pretty scary thought to those of us who may be relying on such a doctor for appropriate treatment or accurate diagnosis in a very complex and high-tech business that often means the difference between life and death.

We're not advocating some sort of quota system for weeding out addicted doctors, but we should be grateful to the Hawai'i Medical Service Association for pointing out the apparently serious under- enforcement in Hawai'i.

But while HMSA's concerns are legitimate, we have our doubts about the association's proposed solution: That HMSA, in effect, take over enforcement — at least for its participating doctors.

The insurance cooperative has proposed that it gain access to the medical records of "its" doctors — those physicians whose claims are paid by HMSA. The theory, apparently, is that since the existing system for identifying and dealing with addiction problems is not working, the insurer must step in.

A far better solution would be to fix the existing system, which works through the state and the Board of Medical Examiners. HMSA should use its clout and concern (it covers about 96 percent of Hawai'i physicians) to get the system fixed if indeed it is broken.

In addition to the privacy issues this raises, there are practical problems:

• What would happen with doctors who are not participating members of HMSA? Who will watch them?
• Might this not simply drive some doctors away from HMSA and its insurance coverage? That would hurt patients more than anyone else.
• If doctors knew that the insurance company had access to their personal medical records, they might be inclined simply to avoid seeking treatment or help for their problem so nothing shows up on their record. Who would be helped then?