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California Proposition 46, Medical Malpractice Lawsuit Cap and Drug Testing of Doctors Initiative (2014)

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California Proposition 46
Flag of California.png
Election date
November 4, 2014
Topic
Healthcare and Tort law
Status
Defeatedd Defeated
Type
State statute		Origin
Citizens


California Proposition 46 was on the ballot as an initiated state statute in California on November 4, 2014. It was defeated.

A "yes" vote supported increasing the state's cap on non-economic damages that can be assessed in medical malpractice lawsuits to over $1 million from the existing cap of $250,000 and requiring positive drug and alcohol tests of doctors to be reported to the California Medical Board.

A "no" vote opposed increasing the state's cap on non-economic damages that can be assessed in medical malpractice lawsuits to over $1 million from the existing cap of $250,000 and requiring positive drug and alcohol tests of doctors to be reported to the California Medical Board.


Election results

California Proposition 46

Result Votes Percentage
Yes 2,376,817 33.24%

Defeated No

4,774,364 66.76%
Results are officially certified.
Source


Overview

The initiative would have:[1]

  • 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.[2]

The measure would have created the first law in the United States to require the random drug testing of physicians.[3]


Text of measure

Ballot title

The ballot title for Proposition 46 was as follows:

“

Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute.

”

Ballot summary

The ballot summary for this measure was:

“

• Requires drug and alcohol testing of doctors and reporting of positive test to the California Medical Board.

• Requires Board to suspend doctor pending investigation of positive test and take disciplinary action if doctor was impaired while on duty.

• Requires doctors to report any other doctor suspected of drug or alcohol impairment or medical negligence.

• Requires health care practitioners to consult state prescription drug history database before prescribing certain controlled substances.

• Increases $250,000 cap on pain and suffering damages in medical negligence lawsuits to account for inflation.		”

Full Text

The full text of this measure is available here.

Fiscal impact statement

Note: The fiscal impact statement for a California ballot initiative authorized for circulation is jointly prepared by the state's legislative analyst and its director of finance.

“
  • Increased state and local government health care costs from raising the cap on medical malpractice damages, likely ranging from the tens of millions of dollars to several hundred million dollars annually.
  • Uncertain, but potentially significant, state and local government savings from new requirements on health care providers, such as provisions related to prescription drug monitoring and alcohol and drug testing of physicians. These savings would offset to some extent the health care costs noted above.[4]
 ”

Noteworthy events

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."[5]

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.)”[6]-->

Support

California Yes on 46 2014.png

The organization that led the campaign in support of the measure was known as Yes on 46.[7]

Political consultant Chris Lehane was hired to advise supporters.[1] He had previously served as a special assistant counsel to President Bill Clinton (D).[8]

Supporters

Officials

Organizations

Individuals

  • Candace Lightner, founder of Mothers Against Drunk Driving[13]
  • Erin Brockovich, consumer advocate[14]

Arguments

Yes on 46 made the following arguments in an FAQ:

“ Will indexing the cap raise health care costs on patients?
  • Medical malpractice costs (payments and insurance) represent only a very small fraction of health care costs. In fact, California’s medical malpractice cap has not reduced health care costs; indexing the cap will not raise costs because malpractice-related costs are such an infinitesimally small portion of health care costs. The CBO has found that the package of limitations on liability advocated by the AMA cannot possibly reduce healthcare costs by more than ½ of 1%. In contrast, the Affordable Care Act contains several reforms that are already reducing healthcare costs by more than that amount: Accountable Care Organizations, Patient-Centered Medical Homes, pay for performance initiatives, and bundled payments.

Will medical malpractice insurance rates skyrocket if the cap is raised, resulting in doctors fleeing California and a reduction in access to care?

  • This is simply false; medical malpractice insurers in California have consistently had such high profits that they would continue to make above-average profits even if the MICRA cap were indexed to inflation. The insurance industry earned a 6.5% return on net worth during the last ten years. California medical malpractice insurers, however, earned a 16.7% return – more than 250% of the industry average. Moreover, in each of the last eight years California malpractice insurers had loss ratios of 38% or less – meaning that they always had at least 62 cents of each premium dollar, plus all investment income, left over for expenses and profit.
  • Proposition 103 gave the California State Insurance Commissioner the power to regulate many types of insurance rates, including medical malpractice insurance. Indeed, in 2012, the Insurance Commissioner found that California’s medical malpractice insurers were charging doctors too much in premiums and he slashed their rates, saving California’s doctors over $52 million in premiums. California already has an effective and successful system to regulate medical malpractice insurance premiums – a system that won’t change because of an adjustment of the cap.

Will raising the cap lead to the closure of community health centers?

  • Indexing the cap for inflation will NOT increase the malpractice insurance costs of community health centers because health centers and free clinics are both protected by the Federal Tort Claims Act. Under the FTCA, individuals injured by the negligent acts of federal employees may seek and receive compensation from the federal government. Health centers and free clinics are therefore no longer liable for medical malpractice, and have no need to buy medical malpractice insurance.

Isn’t it true that the Pack Act isn’t about patient safety, but profits for attorneys?

  • A Harvard University study found that medical malpractice causes 300,000 injuries annually in hospitals alone. The deterrent effect of patient protection laws can save the health care system from these human and financial losses.
  • Medical malpractice litigation deters physicians and hospitals from committing medical errors and encourages them to gather and analyze information about past errors, thereby reducing the future costs associated with such errors. Without strong financial repercussions for malpractice, there is no incentive for doctors and hospitals to fix bad behavior.
  • MICRA’s original strict attorneys fee structure is left entirely in place by the Pack Act.

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?

  • Economic damages are limited to wage loss and future medical bills. In cases where the victim doesn’t have wages (children, the disabled, the elderly, stay-at-home moms) or where the victim dies (and therefore there are no future medical bills to pay), there are zero economic damages. This means that the most vulnerable among us can recover at most $250,000, while those with higher incomes have other avenues for financial redress.

[4]

”
—Yes on 46[15]

Consumer Watchdog issued a flyer following the group's signature submission on March 24, 2014. The flyer made the following arguments:[16]

  • "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."

Official arguments

The official arguments in support of Proposition 46 for the 2014 General Election Voter Guide were submitted by Bob Pack, father of Troy and Alana Pack; Carmen Balber, executive director of Consumer Watchdog; and Henry L. “Hank” Lacayo, state president of Congress of California Seniors:[17]

“ PROPOSITION 46 WILL SAVE LIVES.

Preventable medical errors kill up to 440,000 people each year, making medical negligence the third leading cause of death in this country behind only heart disease and cancer. Bob Pack is sponsoring Proposition 46 because a drugged driver killed Bob’s children after multiple doctors recklessly prescribed narcotics to her. Bob wants to prevent such a tragedy from happening to other families. Proposition 46 will save lives in three ways:

1. PROPOSITION 46 WILL DETER NEGLIGENCE BY HOLDING DOCTORS ACCOUNTABLE FOR MEDICAL ERRORS.

  • It holds doctors accountable when they commit negligence, including while impaired by drugs or alcohol, by adjusting for inflation the current cap of $250,000 on pain and suffering damages for victims of medical negligence like Troy and Alana Pack.
  • The Legislature set the cap in 1975 and has never adjusted it for inflation. While the cost of everything else has increased significantly since then, the value of a life has not increased one penny in 39 years.
  • Proposition 46 retains the current limit on attorneys’ fees in medical negligence cases.

2. PROPOSITION 46 WILL SAVE LIVES BY CRACKING DOWN ON PRESCRIPTION DRUG ABUSE.

  • A recent LA Times investigation showed that drugs prescribed by doctors caused or contributed to nearly half of the accidental prescription overdose deaths in four Southern California counties.
  • Proposition 46 requires doctors to check the existing statewide database before prescribing addictive painkillers and other narcotics to a first time patient.

3. PROPOSITION 46 WILL SAVE LIVES BY PROTECTING PATIENTS FROM IMPAIRED DOCTORS.

  • The California Medical Board reported that experts estimate nearly one in five health professionals suffers from substance abuse during their lifetimes.
  • Doctors under the influence of drugs and alcohol cause medical errors, but most substance abuse goes undetected because doctors are not tested.

PROPOSITION 46 REQUIRES:

  • Random drug and alcohol testing of doctors using the same proven federal testing program that works with pilots.
  • Suspension of a doctor who tests positive and disciplinary action if the doctor was impaired on duty.

THE FACTS:

  • Millions of Californians are drug tested at work yet California doesn’t require doctors to be tested.
  • Drug testing is required for pilots, bus drivers, and other safety workers—but not doctors.
  • Drug testing can save lives. That’s why random drug testing of doctors is supported by leading medical safety experts, consumer advocates, the Inspector General of the federal agency responsible for overseeing health care, and by doctors who themselves have abused drugs.
  • Dr. Stephen Loyd, an internist who practiced medicine while abusing drugs and who is now recovering, said: 'I

worked impaired every day; looking back, it scares me to death, what I could have done. My patients and my colleagues never knew I was using.'

Join Bob Pack, consumer groups, health care professionals and victims of medical negligence in voting YES on Proposition 46 (www.yeson46.org) so we can improve patient safety, hold doctors accountable, and save lives by making sure no one has an intoxicated doctor treating them or a loved one.[4]

”


Campaign advertisements

See also: California Proposition 46 (2014) campaign advertisements

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.

Opposition

California No On 46 2014 update.png

No on 46 led the campaign in opposition to the initiative.[18]

Democratic political consultant Gale Kaufman was hired by a coalition of insurers, hospitals and doctors to oppose the measure.[1] Kaufman served as the primary consultant for No on Proposition 6 and 9 in 2008.[19]

Opponents

See also: A full list of opponents

Organizations

The following are health and healthcare-related organizations that opposed the initiative:[20]

  • California Hospital Association[21]
  • California Dental Association[20]
  • California Medical Association[20]
  • American College of Emergency Physicians, California Chapter[20]
  • American Congress of Obstetricians & Gynecologists[20]
  • Medical Oncology Association of Southern California[20]
  • California Academy of Eye Physicians and Surgeons[20]
  • California Ambulance Association[20]
  • California Association of Health Facilities[20]
  • California Academy of Physician Assistants[20]
  • California Ambulatory Surgery Association[20]
  • American Nurses Association, California[20]
  • California Assisted Living Association[20]
  • California Academy of Cosmetic Surgery[20]
  • California Rheumatology Alliance[20]
  • California Society of Periodontists[20]
  • California Dialysis Council[20]
  • Association of Orthopedic Technologists of California[20]
  • Association of California Healthcare Districts[20]
  • California Association of Marriage and Family Therapists[20]
  • California Association of Oral and Maxillofacial Surgeons[20]
  • California Association for Health Services at Home[20]
  • California Association of Psychiatric Mental Health Nurses in Advanced Practice[20]
  • California Nurse-Midwives Association[20]
  • California Society of Plastic Surgeons[20]
  • California Orthotic & Prosthetic Association[20]
  • California Podiatric Medical Association[20]
  • California Psychiatric Association[20]
  • California Society of Addiction Medicine[20]
  • California Society of Pathologists[20]
  • California Society of Pediatric Dentistry[20]
  • California State Oriental Medical Association[20]
  • California Clinical Laboratory Association[20]
  • NORCAP[20]
  • American Osteopathic Association[20]
  • Operating Room Nursing Council of California[20]
  • Osteopathic Physicians & Surgeons of California[20]
  • Partnership HealthPlan of California[20]
  • California Family Health Council[20]
  • California Association of Physician Groups[20]
  • Infectious Disease Association of California[20]
  • California Orthopaedic Association[20]
  • California Pharmacists Association[20]
  • California Society of Anesthesiologists[20]
  • California Chapter of the American College of Cardiology[20]
  • California Neurology Society[20]
  • California Academy of Family Physicians[20]
  • California Association for Nurse Practitioners[20]
  • California Academy of Preventive Medicine[20]
  • California Society of Health-System Pharmacists[20]
  • Northern CA Chapter of the American College of Surgeons[20]
  • American College of Surgeons-Southern CA Chapter[20]
  • San Diego Chapter of the American College of Surgeons[20]
  • California Association of Nurse Anesthetists[20]
  • California Urological Association[20]
  • California Radiological Society[20]
  • California Thoracic Society[20]
  • California Society of Dermatology & Dermatologic Surgery[20]
  • Society of OB/GYN Hospitalists (SOGH)[20]
  • American Academy of Orthopaedic Surgeons[20]
  • CA Association of Neurological Surgeons[20]
  • CA Association of Oral and Maxillofacial Surgeons[20]
  • California Optometric Association[20]
  • California Otolaryngology Society[20]
  • California Society of Anesthesiologists[20]
  • California Orthotic & Prosthetic Association[20]
  • Association of Northern California Oncologists[20]
  • Hemophilia Council of California[20]
  • American College of Physicians California Services[20]
  • Chinese Community Health Care Association[20]
  • CA Chiropractic Association[20]
  • Southern California HMO Podiatric Medical Society[20]
  • American Academy of Pediatrics, California[20]
  • National Association of Social Workers–CA[20]
  • Children’s Specialty Care Coalition[20]
  • California Children’s Hospital Association[20]
  • Children’s Physicians Medical Group[20]
  • A New PATH (Parents for Addiction Treatment & Healing)[20]

The following are other organizations that opposed the initiative:[20]

Unions

  • California State Building & Construction Trades Council[25]
  • Service Employees International Union (SEIU) California[20]
  • SEIU United Long Term Care Workers (ULTCW)[20]
  • SEIU-USWW (United Security Workers West)[20]
  • SEIU 1000[20]
  • SEIU - Committee of Interns and Residents[20]
  • AFSCME California PEOPLE[20]
  • Union of American Physicians and Dentists (AFSCME Local 206)[20]
  • IBEW Ninth District[20]
  • IBEW Local 11[20]
  • IBEW Local Union 441[20]
  • IBEW Local Union 477[20]
  • IBEW Local Union 551[20]
  • Southern California Pipe Trades Health & Welfare Fund[20]
  • Plumbers & Pipefitters Local Union 228[20]
  • Plumbers & Steamfitters Local Union 398[20]
  • Plumbers and Pipefitters UA Local Union 442[20]
  • Plumbers & Pipefitters Local 447[20]
  • Southern CA Pipe Trades DC 16[20]
  • Plumbers, Pipe and Refrigeration Fitters UA Local 246[20]
  • International Brotherhood of Boilermakers[20]
  • Boilermakers Local 92[20]
  • Boilermakers Local 1998[20]
  • Sheet Metal, Air, Rail and Transportation Workers (SMART), Sheet Metal Workers’ Local Union No. 104[20]
  • Sprinkler Fitters UA Local 483[20]

Arguments


Vote No on 46's "The Truth About Proposition 46" video.

The following were arguments on Vote No on 46 campaign website:

“
OPPOSE THE “MICRA” BALLOT MEASURE
A costly threat to your personal privacy Californians can’t afford.

Costly for Consumers

  • Trial lawyers drafted a November 2014 ballot measure seeking to change current law to file more medical lawsuits against health care providers.
  • If they get their way, medical lawsuits and payouts will skyrocket. Someone will have to pay those costs. And that someone…is you.

Threatens People’s Personal Privacy

  • Money isn’t the only thing this ballot measure will cost you. It could cost you your personal privacy, and the doctors you trust and depend on.
  • This measure 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 your 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.

Jeopardizes People’s Access to their Trusted Doctors

  • If California’s medical liability cap goes up, you could also lose your trusted doctor. It’s true. Many doctors will be forced to leave California to practice in states where medical liability insurance is more affordable.
  • Even 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.

Increased costs. Losing your doctor. Threatening your privacy.
Exactly what happens when trial lawyers play doctor.

  • That’s why a diverse and growing coalition of trusted doctors, community health clinics, hospitals, family-planning organizations, local leaders, public safety officials, businesses and working men and women urge Californians to oppose the “MICRA” ballot measure.

[4]

”
—Stop Higher Health Care Costs - No On 46![28]

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.”[24]
  • 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.”[29]
  • 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."[30]

Official arguments

The official arguments in opposition to Proposition 46 for the 2014 General Election Voter Guide were submitted by Donna Emanuele, RN, president of California Association of Nurse Practitioners; Ann-Louise Kuhns, president of the California Children’s Hospital Association; and Stuart Cohen, MD, chair of the American Academy of Pediatrics, California:[17]

“ California special interests have a history of qualifying ballot propositions that appear to be about one thing but are really about another. Here’s another one. 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.

This measure does three things:

  • Quadruples the limit on medical malpractice awards in California, which will cost taxpayers hundreds of millions of dollars every year, and cause many doctors and other medical care professionals to quit their practice or move to places with lower medical malpractice insurance premiums.
  • 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.

Vote No on Prop. 46

This measure is not on the ballot because someone thinks we need to drug test doctors. Prop. 46 was written and paid for exclusively by trial lawyers who will profit from its passage. If they get their way, malpractice lawsuits and trial attorney awards will skyrocket. And we will pay the costs.

Raising the Limit on Medical Malpractice Awards

Lawyers want to quadruple the limit of awards that the state allows for medical malpractice lawsuits. Here are the consequences:

  • Increased Health Insurance Costs: If medical malpractice awards go up, health insurance companies will raise their rates to cover their increased costs. When health care insurance companies raise their rates, we all pay more in health care premiums.
  • Increased Taxes and Fees: State and county hospitals pay their own medical malpractice insurance premiums. When health insurance companies raise their rates, state and county governments will have to find a way to cover the new costs. They will either cut services or raise taxes and fees. In fact, the independent Legislative Analyst estimates the increased state and local costs to be 'hundreds of millions of dollars . . ..' We will pay either way.
  • Access to Health Care Reduced: If California raises their cap, many doctors and other health care professionals will move to states with lower malpractice insurance rates. Some will give up their practice. This could cause you to lose your doctor. Which is why the California Association of Rural Health Clinics opposes Prop. 46.

Prescription Drug Database Prop. 46 mandates that doctors consult an online database of Californians’ personal prescription drug history. This database is controlled by the state government in an age when it’s already too easy for government to violate our privacy. Government websites, including the DMV and the Pentagon, have a history of being hacked. Vote No to prevent reliance on another computer database that no one can assure will be secure.

In Summary

The consequences of Prop. 46 far outweigh any benefits: higher costs of health care, higher taxes, lost access to doctors, loss of privacy, and risking that our personal prescription drug history will be compromised and made available for anyone to see. Please vote no[4]

”


Campaign advertisements

See also: California Proposition 46 (2014) campaign advertisements

All campaign advertisements for campaigns in opposition of the measure can be found here.

No on 46 issued an advertisement video titled "Risk."[31]


No on 46's "Risk."

No on 46's "Risk" in Spanish.

Campaign finance

See also: Ballot measure campaign finance, 2014
The campaign finance information on this page reflects the most recent scheduled reports that Ballotpedia has processed, which covered through December 31, 2014.


Ballotpedia identified four committees registered to support Proposition 46 and three committees registered in opposition to Proposition 46.[32]

Cash Contributions In-Kind Contributions Total Contributions Cash Expenditures Total Expenditures
Support $11,110,856.24 $81,008.52 $11,191,864.76 $11,117,742.86 $11,198,751.38
Oppose $90,744,524.42 $814,538.15 $91,559,062.57 $57,899,588.44 $58,714,126.59
Total $101,855,380.66 $895,546.67 $102,750,927.33 $69,017,331.30 $69,912,877.97

Support

The following table includes contribution and expenditure totals for the committees in support of the measure.[32]

Committees in support of Proposition 46
Committee Cash Contributions In-Kind Contributions Total Contributions Cash Expenditures Total Expenditures
Yes on Prop 46, Your Neighbors for Patient Safety $10,582,506.32 $55,900.48 $10,638,406.80 $10,570,792.07 $10,626,692.55
Consumer Watchdog Campaign - Yes on 45 & 46 $425,135.00 $0.00 $425,135.00 $449,792.48 $449,792.48
Consumer Watchdog Campaign - Yes on 46 $65,000.00 $25,108.04 $90,108.04 $58,943.39 $84,051.43
Yes on Prop 46, Families for Patient Safety $38,214.92 $0.00 $38,214.92 $38,214.92 $38,214.92
Total $11,110,856.24 $81,008.52 $11,191,864.76 $11,117,742.86 $11,198,751.38

Donors

The following were the top donors who contributed to the support committees.

Donor Cash Contributions In-Kind Contributions Total Contributions
Consumer Attorneys of California Initiative Defense Political Action Committee $1,290,000.00 $0.00 $1,290,000.00
Consumer Attorneys Issue PAC $1,000,000.00 $54.95 $1,000,054.95
Consumer Watchdog Campaign $440,000.00 $55,177.77 $495,177.77
Robinson Calcagnie Robinson Shapiro Davis, Inc. $275,000.00 $0.00 $275,000.00
Kabateck, Brown, Kellner, LLP $260,000.00 $0.00 $260,000.00

Opposition

The following table includes contribution and expenditure totals for the committees in opposition to the measure.[32]

Committees in opposition to Proposition 46
Committee Cash Contributions In-Kind Contributions Total Contributions Cash Expenditures Total Expenditures
No on 46 - Patients, Providers, and Healthcare Insurers $90,523,594.97 $811,271.23 $91,334,866.20 $57,731,273.53 $58,542,544.76
Californians Allied for Patient Protection Ballot Measure Committee $118,214.91 $3,266.92 $121,481.83 $118,214.91 $121,481.83
California Association of Health Facilities, Defend MICRA on the November Ballot Committee, No on 46 $102,714.54 $0.00 $102,714.54 $50,100.00 $50,100.00
Total $90,744,524.42 $814,538.15 $91,559,062.57 $57,899,588.44 $58,714,126.59

Donors

The following were the top donors who contributed to the opposition committees.[32]

Donor Cash Contributions In-Kind Contributions Total Contributions
NorCal Mutual Insurance Company $16,000,000.00 $0.00 $16,000,000.00
The Doctors Company $15,500,000.00 $1,200.00 $15,501,200.00
California Medical Association Physicians' Issues $10,000,000.00 $301,251.78 $10,301,251.78
Cooperative of American Physicians $10,000,000.00 $0.00 $10,000,000.00
Medical Insurance Exchange of California $7,500,000.00 $0.00 $7,500,000.00

Methodology

To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.

Media editorial positions

See also: Endorsements of California ballot measures, 2014

Support

Ballotpedia did not identify any media editorial positions taken in support of Proposition 46.

Opposition

  • 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."[33]
  • 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."[34]
  • 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."[35]
  • 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."[36]
  • Los Angeles Times: "But the methods proposed by Proposition 46 to solve those problems have too many potential drawbacks to be worth the risk."[37]
  • 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."[38]
  • 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."[39]
  • 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."[40]
  • 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."[41]
  • 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."[42]


  • 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."[43]

Polls

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.[44]
  • 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.[45]
  • 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.[46]
California Proposition 46 (2014)
Poll Support OpposeUndecidedMargin of errorSample size
USC Dornsife/Los Angeles Times Poll
10/22/2014 - 10/29/2014		 42.0%42.0%14.0%+/-2.91,537
The Field Poll
10/15/2014 - 10/28/2014		 32.0%49.0%19.0%+/-3.41,536
Hoover Institute Golden State Poll
10/3/2014 - 10/17/2014		 34.0%37.0%30.0%+/-3.651,273
The Field Poll
8/14/2014 - 8/28/2014		 34.0%37.0%29.0%+/-4.8467
The Field Poll
6/26/2014 - 7/19/2014		 58.0%30.0%12.0%+/-2.61,535
AVERAGES 40% 39% 20.8% +/-3.47 1,269.6
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 editor@ballotpedia.org.


Background

MICRA

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 tied to inflation, the noneconomic cap would have been set at $1.1 million in 2014. The 2014 noneconomic cap of $250,000 would have been $57,600 in 1975.[2] Under MICRA, there is no cap on economic damages, such as compensation for medical bills or lost wages.[47]

Path to the ballot

See also: Signature requirements for ballot measures in California

In California, the number of signatures required for an initiated state statute is equal to 5 percent of the votes cast at the preceding gubernatorial election. For initiated statutes filed in 2013, at least 504,760 valid signatures were required.

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.

See also: California ballot initiative petition signature costs

See also

2014 Measures

California

News and analysis


External links

Basic information

Support

Opposition

Additional reading

Footnotes

  1. ↑ 1.0 1.1 1.2 Los Angeles Times, "Special interest groups look to shape 2014 California ballot," December 7, 2013
  2. ↑ 2.0 2.1 Washington Post, "The most expensive race of 2014 could be this California ballot measure," March 25, 2014
  3. ↑ PR Newswire, "California Ballot Initiative Will Enact Nation's First Law Requiring Random Drug Testing Of Physicians, says Consumer Watchdog Campaign," April 16, 2014
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
  5. ↑ San Diego Union-Tribune, "Malpractice ballot measure: Shame on AG Kamala Harris," March 29, 2014
  6. ↑ San Francisco Chronicle, "Poorly crafted state Proposition 46 puts doctors on defense," September 13, 2014
  7. ↑ Yes on 46, "Homepage," accessed August 25, 2014
  8. ↑ Politico, "Arena Profile: Chris Lehane," accessed August 25, 2014
  9. ↑ Reuters, "California measure to raise malpractice cap gets high-profile backer," March 31, 2014
  10. ↑ 10.0 10.1 10.2 10.3 Yes on 46, "Consumer Federation of California Endorses Proposition 46," July 14, 2014
  11. ↑ Yes on 46, "Congress of California Seniors Endorses Proposition 46 To Protect Patient Safety And Save Lives," July 10, 2014
  12. ↑ Yes on 46, "Teamsters, Transit Workers Back Prop 46 Campaign To Protect Patient Safety," July 29, 2014
  13. ↑ 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
  14. ↑ Yes on 46, "Consumer Advocate Erin Brockovich Endorses Proposition 46 Campaign To Protect Patient Safety," July 21, 2014
  15. ↑ Yes on 46, "Frequently Asked Questions," accessed August 25, 2014
  16. ↑ Consumer Watchdog, "The Problem: Medical Negligence Kills 440,000 Americans Every Year," March 24, 2014
  17. ↑ 17.0 17.1 University California - Hastings, "2014 General Election Voter Guide," accessed February 9, 2021
  18. ↑ No on 46, "Homepage," accessed July 3, 2014
  19. ↑ Kaufman Campaigns, "Gale R. Kaufman," accessed August 25, 2014
  20. ↑ 20.000 20.001 20.002 20.003 20.004 20.005 20.006 20.007 20.008 20.009 20.010 20.011 20.012 20.013 20.014 20.015 20.016 20.017 20.018 20.019 20.020 20.021 20.022 20.023 20.024 20.025 20.026 20.027 20.028 20.029 20.030 20.031 20.032 20.033 20.034 20.035 20.036 20.037 20.038 20.039 20.040 20.041 20.042 20.043 20.044 20.045 20.046 20.047 20.048 20.049 20.050 20.051 20.052 20.053 20.054 20.055 20.056 20.057 20.058 20.059 20.060 20.061 20.062 20.063 20.064 20.065 20.066 20.067 20.068 20.069 20.070 20.071 20.072 20.073 20.074 20.075 20.076 20.077 20.078 20.079 20.080 20.081 20.082 20.083 20.084 20.085 20.086 20.087 20.088 20.089 20.090 20.091 20.092 20.093 20.094 20.095 20.096 20.097 20.098 20.099 20.100 20.101 20.102 20.103 20.104 20.105 20.106 20.107 20.108 20.109 20.110 20.111 20.112 20.113 Stop Higher Health Care Costs, "Who We Are, accessed July 3, 2014
  21. ↑ 21.0 21.1 The Sacramento Bee, "Medical malpractice initiative qualifies for California ballot," May 15, 2014
  22. ↑ California Republican Party, "Party Endorsements," accessed September 10, 2014
  23. ↑ Washington Post, "California’s counties weigh in on a $64 million ballot fight," September 11, 2014
  24. ↑ 24.0 24.1 24.2 Legal Newsline Legal Journal, "Damage cap battle could be most expensive ballot initiative ever in Calif., observer says," January 31, 2014
  25. ↑ 25.0 25.1 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
  26. ↑ The Howard Jarvis Taxpayers Association, "November 4, 2014, Ballot Recommendations for Taxpayers," accessed September 26, 2014
  27. ↑ California Medical Association, "Los Angeles County Democratic Party comes out in opposition to Prop. 46," August 22, 2014
  28. ↑ Vote No on 46, "Oppose the “MICRA” Ballot Measure," accessed July 7, 2014
  29. ↑ Legal Newsline, "Calif. advocacy groups decry ballot measure to increase med-mal cap," May 20, 2014
  30. ↑ Los Angeles Times, "Backers of malpractice cap ballot measure submit signatures," March 24, 2014
  31. ↑ The Troy and Alana Pack Patient Safety Act, "Homepage," accessed July 7, 2014 (dead link)
  32. ↑ 32.0 32.1 32.2 32.3 Cal-Access, "2014 Propositions," accessed April 24, 2025
  33. ↑ "Chico Enterprise-Record", "Editorial: State propositions warrant much skepticism", October 6, 2014
  34. ↑ Contra Costa Times, "Contra Costa Times editorial: Proposition 46 goes too far, we urge a no vote," August 7, 2014
  35. ↑ "East Bay Express", "Vote Butt, Young, Nosakhare, and Padilla ", October 1, 2014
  36. ↑ "Los Angeles Daily News", "Prop. 46 not the way to boost patient health," October 2, 2014
  37. ↑ "Los Angeles Times", "No on Proposition 46", October 6, 2014
  38. ↑ Marin Independent Journal, "Editorial: IJ's stands on Nov. 4 state propositions," October 15, 2014
  39. ↑ "Monterey Herald", "Editorial: Vote no on Proposition 46", September 24, 2014
  40. ↑ Paradise Post, "Post urges a "No" vote on Proposition", September 9, 2014
  41. ↑ Sacramento Bee, "Endorsement: Proposition 46 is no cure-all," August 31, 2014
  42. ↑ San Diego Union-Tribune, "Prop. 46: Trial lawyers’ pathetic scam," September 22, 2014
  43. ↑ Santa Cruz Sentinel, "Editorial: Vote no on Proposition 46," September 24, 2014 (dead link)
  44. ↑ The Field Poll, "2014 TCWF-Field Health Policy Poll - Part 2," August 20, 2014
  45. ↑ The Field Poll, "Voter Support Diminishing for Two Health-Related Ballot Measures, Propositions 45 and 46," September 11, 2014
  46. ↑ USCDornsife, "USC Dornsife/LA Times Poll: Support for Prop. 46 Drops Steeply as Voters Hear Initiative Details," accessed February 9, 2021
  47. ↑ Los Angeles Times, "Voters may decide medical malpractice cap," February 18, 2014
  48. ↑ Larkspur-CorteMadera Patch, "Would You Support California Measure Raising Damages in Medical Malpractice Lawsuits?" March 24, 2014
  49. ↑ California Secretary of State, "Qualified Statewide Ballot Measures," accessed May 16, 2014
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