California Proposition 46, Medical Malpractice Lawsuits Cap and Drug Testing of Doctors (2014)
- 1 Election results
- 2 Text of measure
- 3 Background
- 4 Support
- 5 Opposition
- 6 Media editorial positions
- 7 Polls
- 8 Path to the ballot
- 9 See also
- 10 External links
- 11 Additional reading
- 12 References
California Proposition 46, the Medical Malpractice Lawsuits Cap and Drug Testing of Doctors Initiative, was on the November 4, 2014 ballot in California as an initiated state statute. The measure was defeated.
The initiative would have:
- Increased the state's cap on non-economic damages that can be assessed in medical negligence lawsuits to over $1 million from the current cap of $250,000.
- Required drug and alcohol testing of doctors and reporting of positive tests to the California Medical Board.
- Required the California Medical Board to suspend doctors pending investigation of positive tests and take disciplinary action if the doctor was found impaired while on duty.
- Required health care practitioners to report any doctor suspected of drug or alcohol impairment or medical negligence.
- Required health care practitioners to consult the state prescription drug history database before prescribing certain controlled substances.
Supporters of the initiative refered to it as the Troy and Alana Pack Patient Safety Act of 2014, after two children who were killed by a driver under the influence of alcohol and abused prescription drugs.
The measure would have created the first law in the United States to require the random drug testing of physicians.
Supporters of Proposition 46 argued that medical negligence is too common and pain and suffering damage awards are too low. Opponents said the initiative wasn't about protecting patients, but increasing medical lawsuit payouts to trial lawyers.
|California Proposition 46|
Election results via: California Secretary of State
Text of measure
The long-form summary read:
Fiscal impact statement:
The San Diego Union-Tribune argued that the first sentence of the ballot title - "Drug and alcohol testing of doctors." - was intentionally placed first by Attorney General Kamala Harris (D). The editorial board continued, "That’s right — Attorney General Kamala Harris intentionally deceived ballot signers by highlighting one of the fig leaves that trial lawyers attached to the measure to hide their real intent. It’s in keeping with her long history of using misleading ballot titles and summaries to help measures her allies like and hurt measures they don’t."
The San Francisco Chronicle’s editorial board also took issue with Harris’ title and summary. The board stated, “Voters should not be fooled by the title and summary put together by Attorney General Kamala Harris’ office that focuses on the testing as if it were the centerpiece of the measure. It is not. (Harris has been a less-than-stellar steward of ballot titles and summaries throughout her term, often skewing them with loaded language for political effect. Her descriptions of everything from pension reforms to tax increases have been so egregiously unfair that they raise the question of whether the responsibility should rest with a less-partisan officeholder. We’ll save elaboration on that issue for another day.)”
The Medical Injury Compensation Reform Act (MICRA) was signed in 1975 by Gov. Jerry Brown (D). MICRA capped noneconomic pain and suffering damages, as a result of medical malpractice, at $250,000. He did so in response to doctors who complained about medical malpractice awards being too high. If MICRA was pegged to inflation, the noneconomic cap would now be set at $1.1 million. The 2014 noneconomic cap of $250,000 would have been $57,600 in 1975. Under MICRA, there is no cap on economic damages, such as compensation for medical bills or lost wages.
The organization that led the campaign in support of the measure was known as Yes on 46.
- Candace Lightner, founder of Mothers Against Drunk Driving
- Erin Brockovich, consumer advocate
Yes on 46 made the following arguments in an FAQ:
|“|| Will indexing the cap raise health care costs on patients?
Will medical malpractice insurance rates skyrocket if the cap is raised, resulting in doctors fleeing California and a reduction in access to care?
Will raising the cap lead to the closure of community health centers?
Isn’t it true that the Pack Act isn’t about patient safety, but profits for attorneys?
Isn’t it true that, since current law allows unlimited economic damages, there’s no need for a higher cap on non-economic “pain and suffering” damages?
—Yes on 46
- "According to a study published in the Journal of Patient Safety, medical negligence is the third leading cause of death in the country behind only heart disease and cancer. As many as 440,000 people die each year from preventable medical negligence. That’s like a 747 crashing every 10 hours."
- "The California Medical Board estimates that almost one-in-five doctors (18%) suffer from drug and/or alcohol abuse at some point during their careers – and leading medical safety experts have called for random drug testing to curb substance abuse and ensure patient safety."
- "The Journal of the American Medical Association found that doctors are the biggest suppliers for chronic prescription drug abusers, and called for the mandatory usage of state prescription drug databases... A 2012 Los Angeles Times investigation found that drugs prescribed by doctors caused or contributed to nearly half of recent prescription overdose deaths in Southern California."
| Total campaign cash |
as of October 27, 2014
Four ballot measure campaign committees were registered in support of the initiative as of October 27, 2014:
- Note: Consumer Watchdog Campaign - Yes on 45 and 46, A Coalition of Consumer Advocates, Attorneys and Nurses supported Proposition 46 and Proposition 45.
|Committee||Amount raised||Amount spent|
|Consumer Watchdog Campaign - Yes on 45 and 46, A Coalition of Consumer Advocates, Attorneys and Nurses||$2,362,442||$2,089,245|
|Consumer Watchdog Campaign - Yes on 46||$100,108||$72,241|
|Families for Patient Safety||$33,215||$1,272|
|Yes on Prop. 46, Your Neighbors for Patient Safety||$9,897,003||$7,399,857|
- Note: Of the $9,897,003 raised by Yes on Prop. 46, Your Neighbors for Patient Safety, $1,235,000 or 12.5 percent is held as unpaid or unforgiven loans.
The following are the donors who contributed $100,000 or more to the campaign supporting the initiative as of October 27, 2014:
- Note: Some of these donors gave their money to a committee that was simultaneously supporting more than one ballot measure. When that is the case, it is not generally possible to break down how much of that donor's money specifically was spent on the campaign for a particular proposition. Those contributions are listed below with shading; readers should not assume that all or even most of a donation to a multi-purpose committee was used for expenditures related to this particular proposition.
|Consumer Attorneys Issue PAC||$1,108,000|
|Consumer Attorneys of California Initiative Defense PAC||$1,000,000|
|Kabateck, Brown, Kellner, LLP||$259,000|
|Robinson, Calcagnie, Robinson, Shapiro, Davis, Inc.||$259,000|
|Greene Broillet & Wheeler, LLP||$175,000|
|Girardia / Keese||$150,000|
|Shernoff, Bidart, Echeverria, Bentley, LLP||$150,000|
|Law Offices of Walkup, Melodia, Kelly & Schoenberger||$150,000|
|Panish, Shea & Boyle, LLP||$125,000|
|Bisnar/Chase Personal Injury Attorneys, LLP||$125,000|
|Bruce G. Fagel, A Law Corporation||$110,000|
|Kazan, McClain, Satterley, Lyons, Greenwood & Oberman||$100,000|
|Lieff, Canraser, Heimann & Berstein, LLP||$100,000|
All campaign advertisements for campaigns in favor of the measure can be found here.
U.S. Sen. Barbara Boxer: Yes On California Prop 46
Dr. Stephen Loyd: Yes on California Prop 46
Bob Pack: Yes on Prop 46.
No on 46 led the campaign in opposition to the initiative.
Democratic political consultant Gale Kaufman was hired by a coalition of insurers, hospitals and doctors to oppose the measure. Kaufman served as the primary consultant for No on Proposition 6 and 9 in 2008.
- See also: A full list of opponents
The following are health and healthcare-related organizations that opposed the initiative:
- California Hospital Association
- California Dental Association
- California Medical Association
- American College of Emergency Physicians, California Chapter
- American Congress of Obstetricians & Gynecologists
- Medical Oncology Association of Southern California
- California Academy of Eye Physicians and Surgeons
- California Ambulance Association
- California Association of Health Facilities
- California Academy of Physician Assistants
- California Ambulatory Surgery Association
- American Nurses Association, California
- California Assisted Living Association
- California Academy of Cosmetic Surgery
- California Rheumatology Alliance
- California Society of Periodontists
- California Dialysis Council
- Association of Orthopedic Technologists of California
- Association of California Healthcare Districts
- California Association of Marriage and Family Therapists
- California Association of Oral and Maxillofacial Surgeons
- California Association for Health Services at Home
- California Association of Psychiatric Mental Health Nurses in Advanced Practice
- California Nurse-Midwives Association
- California Society of Plastic Surgeons
- California Orthotic & Prosthetic Association
- California Podiatric Medical Association
- California Psychiatric Association
- California Society of Addiction Medicine
- California Society of Pathologists
- California Society of Pediatric Dentistry
- California State Oriental Medical Association
- California Clinical Laboratory Association
- American Osteopathic Association
- Operating Room Nursing Council of California
- Osteopathic Physicians & Surgeons of California
- Partnership HealthPlan of California
- California Family Health Council
- California Association of Physician Groups
- Infectious Disease Association of California
- California Orthopaedic Association
- California Pharmacists Association
- California Society of Anesthesiologists
- California Chapter of the American College of Cardiology
- California Neurology Society
- California Academy of Family Physicians
- California Association for Nurse Practitioners
- California Academy of Preventive Medicine
- California Society of Health-System Pharmacists
- Northern CA Chapter of the American College of Surgeons
- American College of Surgeons-Southern CA Chapter
- San Diego Chapter of the American College of Surgeons
- California Association of Nurse Anesthetists
- California Urological Association
- California Radiological Society
- California Thoracic Society
- California Society of Dermatology & Dermatologic Surgery
- Society of OB/GYN Hospitalists (SOGH)
- American Academy of Orthopaedic Surgeons
- CA Association of Neurological Surgeons
- CA Association of Oral and Maxillofacial Surgeons
- California Optometric Association
- California Otolaryngology Society
- California Society of Anesthesiologists
- California Orthotic & Prosthetic Association
- Association of Northern California Oncologists
- Hemophilia Council of California
- American College of Physicians California Services
- Chinese Community Health Care Association
- CA Chiropractic Association
- Southern California HMO Podiatric Medical Society
- American Academy of Pediatrics, California
- National Association of Social Workers–CA
- Children’s Specialty Care Coalition
- California Children’s Hospital Association
- Children’s Physicians Medical Group
- A New PATH (Parents for Addiction Treatment & Healing)
The following are other organizations that opposed the initiative:
- California Republican Party
- California State Association of Counties
- Civil Justice Association of California
- California Citizens Against Lawsuit Abuse
- California Chamber of Commerce
- California NAACP
- Bay Area Council
- Valley Industry & Commerce Association
- Howard Jarvis Taxpayers Association
- American Civil Liberties Union of California
- American Civil Liberties Union, Northern California
- American Civil Liberties Union of Southern California
- American Civil Liberties Union of San Diego and Imperial Counties
- California Teachers Association
- California School Boards Association
- California Association of School Business Officials
- California School-Based Health Alliance
- Small School Districts’ Association
- Los Angeles County Democratic Party
- California State Building & Construction Trades Council
- Service Employees International Union (SEIU) California
- SEIU United Long Term Care Workers (ULTCW)
- SEIU-USWW (United Security Workers West)
- SEIU 1000
- SEIU - Committee of Interns and Residents
- AFSCME California PEOPLE
- Union of American Physicians and Dentists (AFSCME Local 206)
- IBEW Ninth District
- IBEW Local 11
- IBEW Local Union 441
- IBEW Local Union 477
- IBEW Local Union 551
- Southern California Pipe Trades Health & Welfare Fund
- Plumbers & Pipefitters Local Union 228
- Plumbers & Steamfitters Local Union 398
- Plumbers and Pipefitters UA Local Union 442
- Plumbers & Pipefitters Local 447
- Southern CA Pipe Trades DC 16
- Plumbers, Pipe and Refrigeration Fitters UA Local 246
- International Brotherhood of Boilermakers
- Boilermakers Local 92
- Boilermakers Local 1998
- Sheet Metal, Air, Rail and Transportation Workers (SMART), Sheet Metal Workers’ Local Union No. 104
- Sprinkler Fitters UA Local 483
Vote No on 46's "The Truth About Proposition 46" video.
Vote No on 46 issued an abundance of critiques of Proposition 46 on their website. The following were their basic "Why Voters Should Oppose" arguments:
Costly for Consumers
Threatens People’s Personal Privacy
Jeopardizes People’s Access to their Trusted Doctors
Increased costs. Losing your doctor. Threatening your privacy.
—Stop Higher Health Care Costs - No On 46!
Other arguments against the initiative included:
- Kimberly Stone, president of the Civil Justice Association of California, said, “If you’re a highly-paid doctor in Los Angeles or San Francisco, it would be OK. You could pass those costs on to your patients. But if you’re an anesthesiologist or an OBGYN in a rural area or a low-income area, a dramatic increase in your medical malpractice insurance premiums could make a big difference to your ability to practice.”
- Tom Scott, executive director of California Citizens Against Lawsuit Abuse, said, “Trial lawyers have one goal in mind with this initiative: they want to file more lawsuits against more doctors and make more money doing it. If this initiative passes, trial lawyers will profit wildly, and California consumers will be the ones left holding the bag. A recent study found that this initiative will increase health care costs by $9.9 billion annually – or more than $1,000/year in higher health costs for a family of four.”
- Dr. Richard Thorp, president of the California Medical Association, argued, "A ballot measure that is certain to generate more medical lawsuits and drive up costs for every health consumer in California is the worst possible idea at the worst possible time. This initiative is bad for patients, bad for taxpayers and bad for California’s entire system of healthcare delivery."
Three ballot measure campaign committees were registered in opposition to the initiative as of October 27, 2014:
|Committee||Amount raised||Amount spent|
|California Association of Health Facilities, Defend MICRA on the November Ballot Committee||$102,715||$50,120|
|No on 46 - Patients, Providers and Healthcare Insurers to Protect Access and Contain Health Costs||$57,611,516||$53,468,646|
|Californians Allied for Patient Protection Ballot Measure Committee||$121,482||$121,482|
The following were the donors who contributed $1,000,000 or more to the campaign opposing the initiative as of October 27, 2014:
|The Doctors Company||$10,000,000|
|Norcal Mutual Insurance Company||$10,000,000|
|California Medical Association Physicians' Issues Committee||$5,272,695|
|Cooperative of American Physicians Independent Expenditure Committee||$5,000,000|
|Medical Insurance Exchange of California||$5,000,000|
|Kaiser Foundation Health Plan, Inc.||$5,000,000|
|California Hospitals Committee on Issues||$2,750,000|
|California Association of Hospitals & Health Systems||$2,500,000|
|California Dental Association||$2,052,709|
|The Dentists Insurance Company||$1,590,000|
|The Mutual Risk Retention Group Inc.||$1,000,000|
All campaign advertisements for campaigns in opposition of the measure can be found here.
No on 46 issued an advertisement video titled "Risk."
No on 46's "Risk."
No on 46's "Risk" in Spanish.
Media editorial positions
- Chico Enterprise-Record: "Lawyers want to increase the cap on malpractice awards from $250,000 to about $1.1 million. Since the cap hasn't been raised since 1975, you could make a good argument for that. But the provision that requires random drug testing of all doctors with hospital privileges sounds like not only an overreach, but also potentially illegal. Vote no on this flawed measure."
- Contra Costa Times: "The initiative doesn't specify what levels of alcohol or drugs, ranging from opiates to marijuana, would constitute a positive test. But a positive finding would require suspension of a doctor's license -- and, effectively, income -- until the state Medical Board rules. It could be months or years. That's a drastic measure that requires more thought and supporting data. We urge a no vote on Prop. 46."
- East Bay Express: "There are aspects of Prop 46 that we really like: namely, that it would help fight the prescription drug epidemic in California and would assist low-income victims of medical malpractice. But the proposition contains a poison pill that makes it impossible for us to support it: It would require all doctors in California to undergo random drug testing. The measure's backers admit that they included this provision because it polled well in focus groups. But we view it as an unwarranted intrusion on people's privacy rights."
- Los Angeles Daily News: "No one wants to be treated by a doctor who’s high. But random drug testing of doctors gets into some sticky legal areas. Generally, courts have upheld such invasions of privacy only for occupations such as bus and truck drivers. There’s a safety component in the work of doctors too, of course, but there’s no widespread evidence that substance-abusing doctors are the ones who most often harm patients. It’s a solution in search of a demonstrated problem, and an unwise and potentially expensive policy."
- Los Angeles Times: "But the methods proposed by Proposition 46 to solve those problems have too many potential drawbacks to be worth the risk."
- Marin Independent Journal: "But these are issues that should be studied, addressed and debated by the state Legislature, not by voters who are barraged by TV commercials."
- Monterey Herald: "Proponents of Proposition 46 are trying to trick voters into raising malpractice awards. It should be noted that state Attorney General Kamala Harris joined in with the sleight of hand when she wrote the title of the measure to focus on the drug and alcohol testing and not specifying that the measure is about raising noneconomic malpractice damages. We strongly encourage voters to reject Proposition 46."
- Paradise Post: "All in all, this proposition is not for the people, but is for drug enforcement watchdogs and attorneys. A NO vote is recommended."
- Sacramento Bee: "If doctors are drug-addled, other doctors and nurses have a duty to report them. If doctors make horrible mistakes during surgery, there might be cause for testing. But Proposition 46 would impose the insulting requirement of random testing on all doctors who have hospital privileges, and require that the Medical Board of California discipline any doctors whose tests are dirty. In its propaganda, Consumer Watchdog jokes about privacy concerns in a lowest-common-denominator video showing that other professionals must provide urine samples. Simply because laws allow for testing of some workers doesn’t mean physicians’ privacy should be trampled."
- San Diego Union-Tribune: "Plainly, the doctor drug-testing provision is “the ultimate sweetener” designed to make this foul brew go down better. It wasn’t a critic who used that term. It was Jamie Court, president of Consumer Watchdog, in an interview with The Los Angeles Times. Such an openly cynical attempt to manipulate voters shouldn’t be rewarded. Vote no on Proposition 46."
- San Francisco Chronicle: "Again, it’s an appealing issue, but a poorly drafted solution. The problem with this measure is that the statewide database is nowhere close to ready, and the requirement to check an incomplete and sometimes unresponsive system would expose medical professionals to liability in the meantime. The Legislature should consider such a law after the system is determined to be fully operational."
- Santa Cruz Sentinel: "Proponents of Proposition 46 are trying to trick voters into raising malpractice awards. It should be noted that state Attorney General Kamala Harris joined in with the sleight-of-hand when she wrote the title of the measure to focus on the drug and alcohol testing and not specifying that the measure is about raising non-economic malpractice damages."
- See also: Polls, 2014 ballot measures
- The Field Poll conducted a survey related to ballot initiatives between June 26, 2014, and July 19, 2014. They found that about 58 percent of total registered voters supported Proposition 46. Democrats supported the proposal by 62 percent, while Republicans approved of it by 58 percent. Voters not affiliated with either party supported it by 52 percent.
- The Field Poll's August 14 through August 28, 2014, poll showed a sharp drop in support for Proposition 46. The only subgroup in which the proposition was supported by 50 percent or more was people between the ages of 18 and 39. The subgroup least likely to support the initiative was people with incomes over $100,000, with 24 percent support. People living in the San Francisco Bay Area were the second least likely subgroup to support Proposition 46, with 28 percent support.
- The USC Dornsife/LA Times’ September 2 through 8, 2014 poll found that support for Prop 46 dropped significantly–to just 39 percent–when those polled were presented with arguments for and against the measure.
|California Proposition 46 (2014)|
|Poll||Support||Oppose||Undecided||Margin of Error||Sample Size|
|The Field Poll|
6/26/2014 - 7/19/2014
|The Field Poll|
8/14/2014 - 8/28/2014
|Hoover Institute Golden State Poll|
10/3/2014 - 10/17/2014
|The Field Poll|
10/15/2014 - 10/28/2014
|USC Dornsife/Los Angeles Times Poll|
10/22/2014 - 10/29/2014
|Note: The polls above may not reflect all polls that have been conducted in this race. Those displayed are a random sampling chosen by Ballotpedia staff. If you would like to nominate another poll for inclusion in the table, send an email to|
Path to the ballot
- Robert S. Pack submitted a letter requesting a ballot title for Version #13-0011 on July 24, 2013.
- Robert S. Pack submitted a letter requesting a ballot title for Version #13-0016 on August 30, 2013.
- A ballot title and summary were issued by the Attorney General of California's office for Version #13-0011 on September 13, 2013.
- A ballot title and summary were issued by the Attorney General of California's office for Version #13-0016 on October 24, 2013.
- 504,760 valid signatures were required for qualification purposes.
- The 150-day circulation deadline for #13-0011 was February 10, 2014.
- The 150-day circulation deadline for #13-0016 was March 24, 2014.
- Version #13-0011 failed to qualify for the ballot on February 24, 2014.
- About 830,000 signatures were filed with election officials for Version #13-0016 on March 24, 2014.
- The measure was certified for the ballot on May 15, 2014.
Cost of signature collection:
The cost of collecting the signatures to qualify the initiative for the ballot came to $1,692,673. That is equivalent to $3.35 per signature.
The signature vendor was Kimball Petition Management.
- California 2014 ballot propositions
- 2014 ballot measures
- Laws governing the initiative process in California
- Letter requesting a ballot title for Initiative 13-0011
- Letter requesting a ballot title for Initiative 13-0016
- League of Women Voters Guide to Proposition 46
- Voter's Edge Guide to Proposition 46
- New York Times, "California Asks: Should Doctors Face Drug Tests?," August 1, 2014
- Washington Post, "The most expensive race of 2014 could be this California ballot measure," March 25, 2014
- The Sacramento Bee, "Big California ballot battle looms over malpractice limit," March 24, 2014
- League of Women Voters of California Education Fund, "CAvotes.org Pro and Con for Proposition 46: Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits," September 4, 2014
- Los Angeles Times, "Special interest groups look to shape 2014 California ballot," December 7, 2013
- Washington Post, "The most expensive race of 2014 could be this California ballot measure," March 25, 2014
- PR Newswire, "California Ballot Initiative Will Enact Nation's First Law Requiring Random Drug Testing Of Physicians, says Consumer Watchdog Campaign," April 16, 2014
- California Official Voter Information Guide for the November 4, 2014, General Election, "Proposition 46 Official Title and Summary," accessed September 16, 2014
- Note: This text is quoted verbatim from the original source. Any inconsistencies are attributed to the original source.
- San Diego Union-Tribune, "Malpractice ballot measure: Shame on AG Kamala Harris," March 29, 2014
- San Francisco Chronicle, "Poorly crafted state Proposition 46 puts doctors on defense," September 13, 2014
- Los Angeles Times, "Voters may decide medical malpractice cap," February 18, 2014
- Yes on 46, "Homepage," accessed August 25, 2014
- Politico, "Arena Profile: Chris Lehane," accessed August 25, 2014
- Reuters, "California measure to raise malpractice cap gets high-profile backer," March 31, 2014
- Yes on 46, "Consumer Federation of California Endorses Proposition 46," July 14, 2014
- Yes on 46, "Congress of California Seniors Endorses Proposition 46 To Protect Patient Safety And Save Lives," July 10, 2014
- Yes on 46, "Teamsters, Transit Workers Back Prop 46 Campaign To Protect Patient Safety," July 29, 2014
- Yes on 46, "Candace Lightner, Founder of Mothers Against Drunk Driving, and President of WeSaveLives.org Endorses Proposition 46 To Protect Patient Safety, Require Random Drug and Alcohol Testing of Doctors," July 11, 2014
- Yes on 46, "Consumer Advocate Erin Brockovich Endorses Proposition 46 Campaign To Protect Patient Safety," July 21, 2014
- Yes on 46, "Frequently Asked Questions," accessed August 25, 2014
- Consumer Watchdog, "The Problem: Medical Negligence Kills 440,000 Americans Every Year," March 24, 2014
- California Secretary of State, "Campaign Finance," accessed June 9, 2014
- No on 46, "Homepage," accessed July 3, 2014
- Kaufman Campaigns, "Gale R. Kaufman," accessed August 25, 2014
- Stop Higher Health Care Costs, "Who We Are, accessed July 3, 2014
- The Sacramento Bee, "Medical malpractice initiative qualifies for California ballot," May 15, 2014
- California Republican Party, "Party Endorsements," accessed September 10, 2014
- Washington Post, "California’s counties weigh in on a $64 million ballot fight," September 11, 2014
- Legal Newsline Legal Journal, "Damage cap battle could be most expensive ballot initiative ever in Calif., observer says," January 31, 2014
- Stop Higher Health Care Costs, "CA Building Trades & CA NAACP Latest Groups to Oppose MICRA Measure and Join Newly-Numbered “No On 46” Campaign," July 7, 2014
- The Howard Jarvis Taxpayers Association, "November 4, 2014, Ballot Recommendations for Taxpayers," accessed September 26, 2014
- California Medical Association, "Los Angeles County Democratic Party comes out in opposition to Prop. 46," August 22, 2014
- Vote No on 46, "Oppose the “MICRA” Ballot Measure," accessed July 7, 2014
- Legal Newsline, "Calif. advocacy groups decry ballot measure to increase med-mal cap," May 20, 2014 (timed out)
- Los Angeles Times, "Backers of malpractice cap ballot measure submit signatures," March 24, 2014
- The Troy and Alana Pack Patient Safety Act, "Homepage," accessed July 7, 2014 (dead link)
- "Chico Enterprise-Record", "Editorial: State propositions warrant much skepticism", October 6, 2014
- Contra Costa Times, "Contra Costa Times editorial: Proposition 46 goes too far, we urge a no vote," August 7, 2014
- "East Bay Express", "Vote Butt, Young, Nosakhare, and Padilla ", October 1, 2014
- "Los Angeles Daily News", "Prop. 46 not the way to boost patient health," October 2, 2014
- "Los Angeles Times", "No on Proposition 46", October 6, 2014
- Marin Independent Journal, "Editorial: IJ's stands on Nov. 4 state propositions," October 15, 2014
- "Monterey Herald", "Editorial: Vote no on Proposition 46", September 24, 2014
- Paradise Post, "Post urges a "No" vote on Proposition", September 9, 2014
- Sacramento Bee, "Endorsement: Proposition 46 is no cure-all," August 31, 2014
- San Diego Union-Tribune, "Prop. 46: Trial lawyers’ pathetic scam," September 22, 2014
- Santa Cruz Sentinel, "Editorial: Vote no on Proposition 46," September 24, 2014 (dead link)
- The Field Poll, "2014 TCWF-Field Health Policy Poll - Part 2," August 20, 2014
- The Field Poll, "Voter Support Diminishing for Two Health-Related Ballot Measures, Propositions 45 and 46," September 11, 2014
- Larkspur-CorteMadera Patch, "Would You Support California Measure Raising Damages in Medical Malpractice Lawsuits?," March 24, 2014
- California Secretary of State, "Qualified Statewide Ballot Measures," accessed May 16, 2014
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