After Troy and Alana Pack were killed by an impaired driver, their father became an advocate for change, ultimately writing Prop. 46 on November's ballot. (Photo Courtesy: Bob Pack)
After Troy and Alana Pack were killed by an impaired driver, their father became an advocate for change, ultimately writing Prop. 46 on November’s ballot. (Photo Courtesyof Bob Pack)

Troy and Alana Pack had spent the day at their neighborhood Halloween party in Danville. Ten-year-old Troy went as a baseball player, and 7-year-old Alana was a good witch. In the afternoon, they changed out of their costumes and set out for a walk with their mother down Camino Tassajara. Destination: Baskin Robbins 31 Flavors.

“Alana, she liked anything with chocolate,” says their father, Bob Pack. “Troy, for sure, bubble gum ice cream, ’cause he liked counting the bubble gums that he would get.”

Bob Pack stayed home to rest. His family made it only half a mile down the road before his phone rang: “I received a call from a neighbor screaming there’d been an accident. And I raced down there,” he says.

An impaired driver had veered off the road and hit Troy and Alana head-on. Pack was doing CPR on Troy when the paramedics arrived.

“I remember telling them I love them, and hang on. Just praying that they could hang on,” he says

Troy and Alana were pronounced dead at the hospital. In the months after their death, Pack’s wife, Carmen, retreated into her Catholic faith. Bob Pack was angry.

“I think, for me to get through, I needed action,” he says, “and I needed to take action for justice for Troy and Alana, and also for doing something that I thought maybe I could change to benefit others in the future.”

That was nearly 11 years ago. Pack quit his tech job to become an advocate. Over the last decade, he has helped write seven bills in California’s Legislature and has evolved into a savvy political player. None of his efforts have been bigger than the one he’s working on for the November election: Proposition 46, the patient safety initiative. It’s complex and has three distinct proposals.

Requires Doctors to Check Prescription Database

The first one, aimed at addressing “doctor shopping,” became a pet issue of Pack’s after the accident. Investigators found the driver who killed his kids was abusing prescription narcotics.

“She had gone to numerous doctors, saying that she was under different pain, neck pain, back pain, leg pain, elbow pain,” he says. “They, in my view, recklessly wrote prescriptions for her, for thousands of pills.”

Pack set out to help the state build a database where doctors can see how many times a patient has been prescribed serious narcotics, like Vicodin or Oxycontin. The result is the CURES database, or the Controlled Substance Utilization Review and Evaluation System.

Prop. 46 would make it mandatory for doctors to consult the database. California would become one of nine states requiring doctors to check before prescribing painkillers to first-time patients.

After passing similar laws, both Tennessee and New York saw a significant reduction in the number of narcotics prescriptions written. Studies have verified the correlation, but acknowledge that some of the reduction may be due to drug abusers turning to alternative sources or street drugs, like heroin.

Many doctors in California like the database. Some have called it “indispensable.” But they don’t like being told how to practice medicine.

“The problem with the current way the ballot measure is written is it makes it mandatory, to have that database checked,” says Dr. Richard Thorp, president of the California Medical Association (CMA), adding technical glitches have made the database unreliable.

Lifts Cap on Malpractice Awards

Doctors are also unhappy about another big piece of Prop 46: the proposed change to the cap on “pain and suffering” awards in medical malpractice lawsuits.

After his kids died, Bob Pack wanted to sue the doctors that prescribed drugs to the driver.

“I set out and talked to about eight lawyers,” he says.

They all turned him down. They told him a 1975 state law limited the malpractice award he could get to $250,000. That meant puny attorneys’ fees. The lawyers said it simply wasn’t cost effective for them to take his case.

“My reaction was ‘What?!’ That’s not democratic. That’s not America,” Pack says. “We all have the right to the court system.”

The law that set the cap is called MICRA, the Medical Injury Compensation Reform Act of 1975, passed with the intention of keeping medical liability insurance costs low. Several other states followed suit. California’s law caps only non-economic damages, or pain and suffering awards. Economic damages –- money that accounts for medical expenses, or lost wages when a person can no longer work because of a medical mistake –- are not capped.

But economic damages were no help in a case like Pack’s. His children had no jobs and therefore no lost wages. And they were dead, so they had no ongoing medical bills.

A study from Emory University shows that medical malpractice caps limit access to legal representation for up to 95 percent of victims. Children, the elderly and other people with no or very low incomes who cannot claim economic damages are the most affected.

“So the victim gets victimized a second time, not only by the harm or the loss of a loved one, but then they get no accountability or justice through the legal system,” Pack says.

That’s why some states have ruled such caps on pain and suffering awards unconstitutional.

Pack thinks California’s non-economic malpractice award should at least be adjusted for inflation, so lawyers would be more willing to take legitimate cases. Prop. 46 would raise the cap from $250,000 to $1.1 million and provide an annual adjustment for inflation going forward.

But the CMA’s Richard Thorp sees a big problem. “That will encourage additional lawsuits in the system.” He argues more lawsuits will cause malpractice insurance premiums to go up, and those costs could drive doctors out of California.

“You’ll start to see it become more difficult to recruit doctors to California,” he says. “And you’ll see doctors in the middle of their career start to look at it and say, ‘Maybe I can find a practice someplace else in another state where it will be more financially viable and I wouldn’t have to worry about the same number of malpractice cases as I’m going to have to face in California.’ ”

About a dozen other states have caps on pain and suffering awards similar to California’s.

In a review of studies from the 1970s to the early 2000s, researchers writing for the Milbank Quarterly found that damage caps do reduce malpractice insurance premiums, but to what degree is a matter of debate, with study results ranging from 6 to 25 percent.

No evidence was found that this savings gets passed on to consumers in the form of lower health insurance premiums, partly because malpractice insurance constitutes such a small percentage –- less than 2 –- of overall health care costs.

The same review highlighted a study from the U.S. Department of Health and Human Services that found a link between doctor supply and non-economic damage caps. Specifically, rural counties in states where caps were set at $250,000 –- like California -– had 5.5 percent more surgeons and 5.4 percent more obstetricians/gynecologists, compared with states with a higher cap.

Studies were inconclusive on whether doctors practice more “defensive medicine” in states with caps -– ordering more tests and procedures to avoid making mistakes and being sued.

County governments are especially concerned about the potential costs associated with Prop. 46.

Twelve counties, including Los Angeles and San Francisco, operate their own hospital systems and would have to use taxpayer dollars to cover the costs of additional malpractice lawsuits. The state’s independent legislative analyst estimates that cost could be between tens of millions and hundreds of millions of dollars a year.

The LAO reports says some of that could be offset by savings from other parts of the measure, the prescription database and the most controversial piece of Prop. 46: doctor drug testing.

Mandates Drug & Alcohol Testing for Doctors

This has been the centerpiece of the “Yes on Prop. 46” campaign, inspiring campy ads of airline pilots and police officers dancing through the stalls of a public restroom.

“All…of…the….pilots do it. Astronauts do it. Even the school bus drivers do it,” the ad goes. “Let’s do it. Let’s pee in a cup.”

Adding doctors to that list seemed like an easy sell. Early polls indicated voters strongly favored the idea -– many thought it was already law. In fact, if Prop. 46 passes, California would be the first state in the country to require drug testing of doctors.

“We’re the only profession I know of that are charged to police ourselves,” says Stephen Loyd, a Tennessee physician who thinks California should lead the way in passing Prop. 46. For years, he says he practiced medicine while grappling with an addiction to painkillers. At his worst, he was taking 100 Vicodin pills a day.

“Here’s the scariest thing about it. I thought I was a better doctor. I thought I was sharper. Thought I didn’t need to sleep, thought I didn’t need to eat, I could go longer, I could see more patients,” he says. “But I wasn’t better, I was worse.”

Loyd’s father ultimately caught him using and forced him to go to rehab.

Prop. 46 would give the Medical Board of California a year to set up a system to test doctors for drug and alcohol use, both randomly and within 12 hours after an unexpected patient death or serious injury at the hospital.

Doctors groups say that goes too far.

“This approach is too heavy-handed and too inappropriate,” says CMA’s Thorp. He says hospitals already have systems in place to suspend doctors who show up to work intoxicated.

“There’s very little tolerance for anyone to come in either acting or smelling or having any kind of sign of being under the influence,” he says.

But do doctors really snitch on each other? Loyd says no one ever reported him for being high.

“My colleagues all knew something was wrong. But nobody said anything,” he says. “They didn’t want to hurt my livelihood. They didn’t want to damage my reputation; they didn’t want to damage my practice.”

The two campaigns have fought back and forth over just how much of a problem there is with impaired doctors.

Prop. 46 backers cite estimates that, at any point in time, 1 to 2 percent of doctors are abusing drugs or alcohol. But they admit there are no firm data.

Regardless, Prop. 46 author Pack says, not enough is being done.

“The medical board has no authority and no mandate to be able to find out who these guys are, and weed them out or get them help,” he says.

Pack admits that drug testing was never part of his original plan for Prop 46. Increasing awards for victims of medical malpractice was his main goal. He says it was medical experts from the East Coast who caught wind of Prop. 46 and pushed the committee to add doctor drug testing.

“At first I had a mixed feeling, partially because my father-in-law is a doctor,” he says.

But he says the more research he did, the more he felt like drug testing was a core piece of patient safety.

Studies of workplace drug testing programs are actually inconclusive on whether testing deters employee drug use or reduces workplace accidents. A review of 23 studies in the upcoming issue of Accident Analysis and Prevention concluded: “The evidence base for the effectiveness of testing in improving workplace safety is at best tenuous.”

But the focus groups revealing voter support for the idea of doctor drug testing were convincing. That has opponents calling the provision nothing more than a political gimmick.

“The only reason that was added to the proposition is because it polled well with voters,” says Thorp. “They’re just hiding the fact that they’re trying to increase the cap on non-economic damages so that the payouts to trial attorneys can increase.”

But doctors and insurance companies are the big spenders in this campaign, amassing $57 million and making this the most expensive campaign of the fall election. They’re outspending lawyers 10 to 1 on ads aimed at swaying voters toward a no vote. None of them even mentions doctor drug testing.

“Proposition 46. What’s the real story? Well, start with the trial lawyers,” goes one opponent radio ad. “They wrote and paid for Prop. 46. And just as you might have guessed, they did it for money.”

These ads are everywhere. And it appears the blitz might be working. Early polls showed strong support for the measure during the summer – 58 percent. But that support is waning rapidly, dropping to 34 percent support in mid-September. Twenty-nine percent of voters said they hadn’t yet decided.

Prop. 46, Inspired By Tragedy, Pits Doctors Against Lawyers 30 September,2014April Dembosky

  • Dennis

    The cap is plenty high at $250k. This guy probably only wanted to sue the doctors because the driver probably didn’t have assets worth suing for. How is any amount of money (beyond funeral costs) going to make up for the loss of the children?

    Checking the drug database is a good idea. Why is it tied to the stupid idea above that is only meant to make liars (whoops I guess it’s spelled “lawyers”) richer?

    Doctors probably should be subject to drug testing as they have such easy access. But again, why is it tied to making liars richer?

    It’s too bad. The two good ideas here are tied to one so blatantly stupid that it is going to doom them to defeat.

    • Imollyq

      You obviously do not have anyone you know who has suffered from medical malpractice. Lawyers take 33-40% fee and that barely gives survivors much. If you are in a car wreck with a drunk driver and your life is ruined and you are in horrible pain you can get millions of dollars for pain and suffering, but if a doctor chops off the wrong leg when you are in surgery for cancer, so you ultimately lose both your legs-yes this really happened- pain and suffering was capped at $250,000. Really? The cap was okay in 1975, but my home was 1/10 of its current value in 1975. Having a reasonable cap that goes with inflation is fair. Doctors love the weather and other benefits of California life, so they will not leave because their malpractice payments go up. It is only 2% of medical costs for malpractice insurance. The billion dollar insurance companies are doing a great job with their ads making lawyers the bad guys and scaring people into thinking they will pay much more for medical care, which is not true. This is a good prop and will likely lose thanks to insurance company money an dads.

      • juan323

        Thank you for saying it, but will anyone listen?

      • Paul J. Molinaro, M.D., J.D.

        33-40%? Nope… MICRA and California law limit attorney fees… Under Section 6146 of the California Business and Professions Code: “An attorney shall not contract for or collect a contingency fee for representing any person seeking damages in connection with an action for injury or damage against a health care provider based upon such person’s alleged professional negligence in excess of the following limits: (1) Forty percent of the first fifty thousand dollars ($50,000) recovered. (2) Thirty-three and one-third percent of the next fifty thousand dollars ($50,000) recovered. (3) Twenty-five percent of the next five hundred thousand dollars ($500,000) recovered. (4) Fifteen percent of any amount on which the recovery exceeds six hundred thousand dollars ($600,000). The limitations shall apply regardless of whether the recovery is by settlement, arbitration, or judgment, or whether the person for whom the recovery is made is a responsible adult, an infant, or a person of unsound mind.”

        • Imollyq

          Yes, you are correct. MICRA limits the attorney’s fee amount to much less as the recovery increases. Reminder, attorneys generally advance many thousands of dollars in costs , which are not paid back until teh end of tehcase. Expert witness fees alone can be backbreaking, sometimes $1,000/ hour. That is why Prop. 46 is necessary.

        • Wake Up California

          Wow, those are huge fees! I know plenty of doctors who are lucky to make $100-150,000/year on a salary or squeak by in their own small private practice and still pay their staff, rent, malpractice insurance, return phone calls that aren’t billable, make insurance calls for prior authorizations that aren’t billable, write chart notes and review medical records that are billable but never reimbursed… So to get that kind of money in one case,….whoohoo! No wonder you abandoned family medicine and became a medical malpractice lawyer! And no wonder you support this proposition.

  • Fredsky

    Puny attorney fees? So the law should lift the cap huh? Alternative idea: the laws should forbid lawyers to refuse cases bringing “puny attorney fees” so people like this poor guy can have their day in court.

    • Imollyq

      Drug testing good idea, sure, then do it for every office job. Doctors have your life in their hands, and you can die right there if they make a mistake. Will someone die if an attorney files something late or makes a mistake in a case? No, except death penalty cases, and the lawyer can be sued for malpractice and the defendant can get a new trial, not so if a drunk doctor kills you. My son told me a cute joke Lawyers are like handguns. No one wants one until they need one. Attorney’s fees are capped by law in medical malpractice cases to specific limits of dollar amounts, and the lawyers only get paid if they win. Lawyers in these cases have huge expenses paying expert witnesses, investigators, months and years of work, so if the fee is low, they cannot afford to take the case. They have employees, offices, families, and malpractice insurance of their own to pay.

      • Fredsky

        My heart is overflowing with sadness about poor poor lawyers having employees, offices, families and malpractice insurance fees. As we all know medical offices practically run themselves for free. So I have another solution: just to be as carefree and easy to run as medical offices, lawyers should be forced to join panels, bill insurances, have formularies as to what defenses they can use, have joyful preauthorization forms to fill out, the law ins cos should change formularies in the middle of a lawsuit, claims should be denied for a decimal point being put at the wrong spot on a claim form. Fees are puny? Why, see more clients in an hour, just like those happy, carefree, filthy rich docs reeking from vodka. And of course all this should be done to the lawyers by a horde doctors, all these rules and regulations should be written for them by doctors who really have no idea how to do law but hey, if lawyers want to have as much fun doing law as doctors doing medicine, why, let them be treated the same way.

        • Sam Canas

          Right on!

        • Imollyq

          I must wonder if you know or woerk for a Physician who has committed malpractice.

          • Wake Up California

            lmollyq; I must wonder if you work for a trial attorney who discriminates against cases based on dollar signs to line his pockets?

        • Sad dad

          I get your point… but you are missing a simple point. There are gross mistakes made by Dr. that directly or indirectly take the lives of people that they are intrusted to care for. Sadly there are a lot of cases that are frivolous, and this takes away from the need to compensate for those that are deserving. `My son had a heart condition that was not diagnosed for four years. After he died we found out that the Dr. did have the results of the potentially fatal condition in his file. Yet he never saw it. it sat in his file while he tried to guess what was wrong. He had the results already! my sons condition had a 98 % success rate for a cure if the procedure had been preformed. So this seems like a cut and dry case right! wrong, you see if you are a child you have no loss wages, and if you claim future loss wages for your child, it is the rebutted by the future cost of raising your child, the cost of schooling etc… we were told our child was a debt not an asset!

          We called 3 different medical malpractice attorneys who told us we had no case! This was not true, we just did not have a big enough loss to make it affordable to take to trial court. You see, the Dr,s have prepaid attorneys, and in fact at one point they had six attorneys sitting across the table from us. It is hard for a malpractice lawyer to fight these odds for several years in some cases, when they can only charge 30% of the cap… The insurance companies will spend far more on paying to fight the case than you could ever win for taking them to court. It is an unfair balance of justice.

          If you feel a cap is justified, then set a cap that the insurance lawyers can spend on defending these cases. It is a lopsided fight from the beginning to the end. There is not enough money in the cap rate of 250k to take these cases to court, you can not compete against mega rich insurance companies, who have full time lawyers on payroll to drag you through hell and back. Six lawyer! they had six lawyers, at $300.00 per hour each minimum. They were spending roughly $2000.00 an hour. Our one lawyer, who only took the case because he saw the gross negligence, and had a kid the same age as ours who died.

          Did our case go to court! no they settled out of court. They had no defense, they had my sons diagnoses in there file for a year before he died. They let my son walk around with a time bomb ready to go off and it did!.

          And for this dad, and for his mom, we got $75,000 k each!

          But only after being dragged through hours of depositions, insulted by an offer of 25K and told we had no case.

          No we had a case, but when your child dies, they have no value, there is no more pain and suffering. Your pain and suffering as a parent is not counted!

          You are lucky if you can find a lawyer to take the case, because they cant spend the same amount of money that the insurance companies can to fight the suit. Its simple math. At today’s cost to try a case, the cap falls short.

          • watson

            This is horrible, and any normal person would ache for Sad Dad for his awful experience, loss and heart wrenching hardship. But prop 46 is NOT the way to address this. It puts too many people at risk because it was badly written. A well written proposition about patient safety must have doctor input, and this did not. It was written by trial lawyers to make more money, pure and simple. This is proven by the fact that only trial lawyers funded this, –and “Consumer Watchdog” which is a euphemism for “Trial Lawyers”. Why else would every major group protecting patient safety be opposed to this? Why else would so many groups, large groups, like Planned Parenthood, for example, oppose this? Please, Sad Dad, realize that Prop 46 is the wrong way to seek a right solution for you.

        • Wake Up California

          Right on!

    • Darkie One

      Doctors do see patient for puny fees ie medical insurance. Even for free! Many times over. Do lawyers take a case for free? when I say free, I mean FREE. NO FEE AT ALL. Lose or win! Never head one. Ha! Ha!

  • juan323

    I support 46 and I’m not shilling for the trial attorneys, but Californians who deserve a decent settlement for medical malpractice. 1975 is nearly 40 years ago and here are some prices for 1975:
    Cost of a new home: $42,600.00
    Median Household Income: $11,800.00
    Cost of a first-class stamp: $0.10 ($0.13 as of 12/31/75)
    Cost of a gallon of regular gas: $0.57
    Cost of a dozen eggs: $0.77
    Cost of a gallon of Milk: $1.57

    It is time for the cap to be raised to reflect the changes in valuations. Attorneys can’t work for free and to ask them to invest their time and money in cases that are taken on contingency fee at the present cap does not serve justice.

    • Wake Up California

      Juan 323….you forgot that there is NO LIMIT to MALPRACTICE SETTLEMENTS in CA!! This proposition is about the PAIN AND SUFFERING CAP!! If an attorney sees that there is a case, THEY WILL TAKE IT!! ATTORNEYS take most of the settlement from the victims. THAT NEEDS TO CHANGE! Doctors in private practice in CA (I know, I am one) make $200/hr from contracted insurances (down from $275/hr…thank you Mr. Obama and Ms. Pelosi). I pay my staff, overhead, rent, loans, etc, etc. etc with that. But ATTORNEYS get a raise because of cost of living in my same town….hmmm….Silicon Valley attorneys charge $575/hr and by the minute. They certainly do not work for free! If you email them a question…you get a bill. Somehow, I don’t see why the attorney is a more valuable person than the doctor to have that type of wage discrepancy. This proposition is designed specifically to line the pockets of the attorneys and the other decoys added to it are distractions from the real goal. Why not address each of their points in separate propositions? If you vote for Prop 46 because of one part, you’ve just voted for it all. Kind of like the healthcare bill and those famous words….”you will find out what is in it after it is passed”. (N. Pelosi)

    • Wake Up California

      Here you go. Straight from regarding Malpractice settlements

      Damage Caps in California Malpractice Cases

      The money a patient seeks when filing a lawsuit against a medical provider for medical malpractice is known as damages. In medical malpractice cases, there are several types of damages available to an injured party. California malpractice law does place limits on some of these damages.

      The first type of compensation is known as compensatory damages, which are also sometimes referred to as actual or economic damages. These compensate the victim for costs such as medical bills and lost wages due to missed days at work. California places no cap on this type of damages.

      The next type of compensation is known as non-economic damages. These damages compensate the victim for things like pain, suffering, inconvenience, disfigurement, and physical impairment. In California, such damages are limited to $250,000. This means that the maximum a court can award an injured patient in a medical malpractice case for pain and suffering is $250,000.

      Finally, patients may also seek punitive damages in certain situations. Punitive damages are awarded as a way to punish a medical provider for reckless behavior. Oftentimes, patients and their attorneys must prove that the healthcare professional actions involved malice or fraud in order to receive punitive damages. California does not place caps on punitive damages for most medical malpractice claims.


      • juan323

        Actually, your argument is based of the false assumption that those types of damages are sufficient to cover the damages caused by doctors who commit malpractice. Also, pain and suffering ARE punitive damages and capping them ENCOURAGES malpractice because doctors know that attorneys won’t file law suits if they can’t paid for their legal work. I have PERSONAL EXPERIENCE dealing with a hospital who committed a wrongful death but due to the cap they couldn’t economically litigate. It is time for Californians to have justice, not give unprofessional doctors who cause hurt passes.

        Lastly, judging by your comment name I bet you are shilling for those trying to stop this common sense change in the law that has been overdue.

        • Wake Up California

          Juan 323

          Read the current law in the provided link. THERE IS NO CAP on PUNITIVE DAMAGES OR ECONOMIC DAMAGES! if you have a case, you win….and sky is the limit!! You lose your case if you can’t prove malpractice. Now, if you win your case, and you are not getting enough, perhaps you need to go after the attorneys that take 40-90% of the settlement! Their rates are astronomical and they are victimizing you. The common sense here is that the decoy in the proposition is drug testing of doctors and the mandatory pharmaceutical database on all Californians. If you vote because you think one of these is a good idea, then you’ve voted the whole thing in. This is not a good democratic process to assess each individual point, but a blanket law. We all know what that is like; think of the Affordable Care Act and those famous words “You will find out what is in the law after it is passed”!! As much as you may agree with one point in this proposition, you are voting for the WHOLE ENCHILADA! Now, Mr. Pack sadly lost his two children to a drunk driver who abused her medications. He has been looking for someone to pay for it, someone to blame. This is the incident that inspired this law. Somehow, they made a connection between the abuser of drugs and alcohol who drove a vehicle into two children, and the prescribing doctor calling it a preventable case of medical malpractice……What????? So now you are no longer responsible for your idiotic decisions. Your prescribing doctor is responsible for how you take your medications and when you take your medications. That means if you are on blood pressure pills or take diabetes medications and if you take too much and have a syncopal spell and lose consciousness while driving and have an accident, the doctor is on the hook. That means doctors are going to change how they practice. Perhaps they will only give you a one week supply of your regular medications for fear you screw up and come after them for their mistakes. Perhaps your medical marijuana card that you and many Californians so enjoy becomes something no one will be willing to write for given the potential for abuse and accidents. Perhaps if you strain your back and are in pain, you only walk out with 1 pill and no refills because, you may screw up and take too many. You see, we have stripped the individual from personal responsibility because we have turned them into a victim, a puppet of their prescribing doctor. This is a really big deal. If you keep bullying your doctors, you won’t have one. You will spend more on office visits to get your prescriptions. The whole proposition is incongruent from the beginning of the 3 bullet points and the disconnection between them.

          • Paul J. Molinaro, M.D., J.D.

            There is plenty of accurate information on the Internet about MICRA and medical malpractice in California… unfortunately, many of the posts in this thread are not such a source. Punitive damages are allowed to punish intentional or reckless tortfeasors… and such is NOT the case in medical malpractice cases which are a form of the tort of negligence. I can, and probably more than I should, lecture on this topic… and my opinion is based on years and years of experience in medicine and law. YES on 46 would benefit Californians, well, those that are not in the business of insuring doctors anyway… the current system not only harms truly injured patients but protects the really bad doctors. Time for a change.

          • Wake Up California

            Well, since you gave up medicine to become a malpractice trial attorney, you have quite the incentive to have this pass. But, attacking a medical profession for your financial benefit is, well, a bit disconcerting. Ultimately, the majority of ethical, well meaning, respected physicians will simply incorporate more of a “defensive medicine” stance and limit the number of prescriptions written for everyone. If a connection can be made by Mr. Pack’s unfortunate experience of the loss of his children by a drunk and drug abusing driver to the physician who wrote the prescription, then we are lifting patient’s from their own individual responsibility and transferring that fully to the doctor. That will transpire to only a few days of some medications at a time, with no refills, and more requirements for everyone to visit their doctor more often. That means an increase in healthcare costs which is coming from the patient’s copay, coinsurance or the unmet deductible which has increased! As you know, doctor, if someone takes their blood pressure or diabetes medication incorrectly, a syncopal spell while driving is life threatening, and now the good doctor is on the hook for that. California has been there and done that before and voted NO on this before. So, NO, this is not the change we need. NO on 46!

      • Chris

        Punitive damages are so rare in medical malpractice cases that they barely exists. Secondly, the economic damages only pay back the victim of medical malpractice for out of pocket losses, like lost earnings and medical bills. What is more, attorneys fees are capped under MICRA – by law on any settlement or judgments over 600,000 the attorney can only collect a 15% fee after costs are deducted. Attorneys are not getting rich here and they won’t after passage of 46. It is shameful. Medical Malpractice insurance companies are funding this opposition to the tune of 60 million dollars.

        • watson

          If this isn’t about the attorneys, then why is this ENTIRELY funded by trial lawyers. Nice try, Chris, but this is ALL about attorneys and the money-grab. So sad that victims are being used by the attorneys here. Malpractice companies recognize that doctors can’t afford to keep working when their rates increase if 46 passes. 46 hurts patients by making medicine unaffordable to the very people who are trying to help patients.

          • Chris

            On the other side, it is entirely funded by Medical Malpractice insurance companies.

        • Wake Up California

          You are simply wrong. Punitive damages ARE malpractice damages. Punitive = past, current AND FUTURE costs related to the impacts of the malpractice. If you have a case, you get PUNITIVE DAMAGES! If you don’t have a case, you won’t get either. So don’t expect that if you are not awarded PUNITIVE DAMAGES that you WILL be awarded non-punitive damages. CALIFORNIANS are given false hopes here that by going after pain and suffering, they will get something even if they are not awarded punitive. And, I took math in school, 15% of a minimum of $600,000 is $90,000, which is a hefty paycheck for any attorney or firm if they have a case. And 40% OF $50,000 IS $20,000 ALSO a big payout. In Mr. Pack’s case, he had two children and he is claiming he couldn’t get an attorney to take the case because $250,000 wasn’t enough? $250,000 x 2= $500,000 with HUGE attorney payouts for the case!! ATTORNEYS didn’t take the case because he didn’t have one! He’s going after the prescribing doctor when it’s clearly the drunk and drug abusing woman who ran over these kids with her car! So, if we are going to vote to say that we will make a connection between the doctor and the person who makes stupid decisions, then doctors will LOGICALLY conclude that ANY prescription they write for, including your insomnia, pain, blood pressure and diabetes medications,….what about that medical marijuana card…..can be misused by a patient, cause an accident on the road, on the job, etc., and now you won’t get more than a few days of it at a time. Forget the 90 day supply with a year of refills. Just ask your own doctor what he/she will do with your prescriptions…the discussion is already happening in the medical community…

          • Chris

            Wake Up, You are the one who is wrong. In California in order to prove negligence you need to prove by the preponderance of the evidence (more like true than not true) that the doctor breached the Standard of Care. However, to obtain punitive damages, the plaintiff must prove by clear and convincing evidence that the doctor acted with malice, fraud or oppression. Punitive damages do not get awarded in medical malpractice cases. What is more, they are not covered claims, so they are often not pursued. With respect to your 15% is a big payday. In order to advance a medical malpractice case, a Plaintiff’s lawyer often has to advance $50,000 or more to prove the claim, this is primarily expert costs. What is more, it takes years to get to trial, these cases typically do not settle until after expert discovery (on the eve of trial). Hundreds of hours of time and work goes into the preparation of the case. We have staff, payroll, insurance, overhead (rent, phones, etc.), the funds do not just go to one attorney after a few measly hours of work. By the way, the defense attorneys fees are not limited at all in medical malpractice cases, just the Plaintiff’s attorney. And, unlike the Plaintiff’s attorney – the insurance companies advance all costs for the doctors. So the restraint on trade is one-sided. We are not asking this be changed. We only want our clients to receive a shot in court, for a jury to hear the evidence and determine what is just and fair. You are ranting about a subject you know nothing about – or alternatively, you are deliberately lying. Either way, shame on you. What is wrong with providing just compensation to an individual harmed by medical negligence? Do you have a problem with all law suits or just ones against doctors?

          • Wake Up California

            Slow down….hold the insults…Chris, thank you for explaining that you are a malpractice attorney and why you would support an increase in attorney settlements. At least you said it like it is. Everyone needs to be protected from malpractice, whether from a doctor, an attorney, or any licensed professional. I don’t claim to be an attorney. I am a Californian and a parent, and I research issues. I, like many parents, want the best for my kids. We have chosen excellent physicians for our family and we have a respected patient-doctor relationship with them. Because of that example, I dream of my children being doctors one day, but with this climate, I have to discourage them from the healthcare field. What a sad statement to make. The problems here are many. First, the premise of this proposition shows the example of Mr. Pack. As a parent, I can only imagine this man’s heartache. He is clearly in pain, still suffering a decade later, and looking for someone to pay. However, I believe in individual responsibility. I do not believe that a patient who abuses prescription medications and alcohol or other drugs should NOT be responsible for their actions. I do not believe that the prescribing doctor should be responsible for the individual’s behavior. It does not make sense. This lack of logic sets the stage for the tone of cases to be filed. More cases will be filed, and malpractice insurers will be involved, and physician and therefore healthcare costs will increase. If what you wanted was to raise the cap for some other logical reason, that should have been said, but your organization used a case, that of Mr. Pack, that really scares me as a citizen. Because I disagree with at least one part of the 3 parts of this proposition, I logically cannot vote for it because I would be voting for all three parts by default even if I only agreed with part of it. The truth is, I don’t think drug testing doctors is going to be any more protective than drug testing lawyers or congressmen, or senators, or any elected official or profession who has the power to propose laws, control people or affect people’s lives. How is drug testing a doctor 12 hours after an adverse event going to prove anything? So they had a glass of wine with dinner when they are called to be tested? And the doctor in the Pro 46 commercial is from Tennessee, he’s not even a California doctor. Finally, the CURES data base is already up and running and doctors all have to register by January 2016. Once a doctor is registered and has been educated on the process and the reason for it, don’t you think they will use it? Doctors have already been trained in defensive medicine and passage of this proposition will add to doctors restricting medications to patients who otherwise need a 30 or 90 day supply but the doctor simply won’t feel comfortable allowing that because they could get sued if someone misuses it. Your organization needed to present a better case for your true goal, more money, without the smoke signals of drug testing or the data base or a really bad example of malpractice. Try again next time, but separate them out. I am a Californian, a voter, and this is my opinion. No on 46!

    • Watson

      Then let’s put this in writing that all extra payments for “non-economic damages” go exclusively and entirely to the victim. This is not about the victim, this is about the attorney.

      • juan323

        Guess f’ing what…it takes money to run a law office. Go find out what the litigation costs are for the attorney instead of looking at the sizes of damage awards. Victims of medical malpractice won’t get to see a day in court unless the law is changed. Yes on 46, yes to justice!

        • Darkie One

          yo, doctors do see patient for free. many times over. Do lawyers take a case for free? when I say free, I mean FREE. NO FEE AT ALL. Lose or win! Never head one. Ha! Ha!

  • Sam Canas

    the simple fact is that this so called “impaired” driver was a multiple convicted drunk driver high on alcohol and pills. The true crime is that she was still on the road driving when she should have been in jail. This has nothing to do with medical malpractice. This Mr. Pack is so misguided and being taken advantage of by lawyers. The reason why $250,000 doesn’t interest lawyers is because their fees are so high. $400 an hr? come on. This is a lawyer safety act masquerading as patient safety.

    • Darkie One

      Doctors only get paid $80.00 for a consult by medical. And worse, USC County insurance pays $25.00 for a consult, and $10.00 for a follow up.
      Yet trial lawyers complain $400.00 an hour as too little?

  • PeaceIsPossible14

    According to a recent study in the Journal of Patient Safety up to 440,000 Americans die yearly as the result of medical negligence.

    If a drunk driver crashed into you killing your child and you later discovered that a state law now blocks you from obtaining an attorney to take legal action against the driver wouldn’t you be outraged? And if you later discovered that the driver did not have to stop at DUI checkpoints wouldn’t you be further infuriated?

    In 1975 malpractice insurance companies backed the MICRA law that capped non-economic “pain and suffering” damages to $250K without inflation adjustment. Except in a rare punitive damage award this is the only award that can be paid in a wrongful death malpractice case for nearly 20 million Californians who do not have any job income(children, retirees, disabled, unemployed, ect).

    Attorneys will not take these cases because the MICRA cap limits the attorney award to about 30%(BPC 6146) or $75K of any maximum $250K award and attorney and medical expert costs in a malpractice case quickly exceed $75K, search on “caps harm California” and “protectconsumerjustice org how micra came to be”.

    The MICRA cap and low non-economic damage caps in other states have enabled malpractice insurance companies to earn billions in profits by eliminating their monetary liability in these cases. It’s no wonder insurance companies have spent tens of millions to defeat Prop 46 which doesn’t even eliminate the cap, only adjusts it for inflation.

    22 other states do not have a non-economic damage cap and medical insurance rates are not any higher in those states nor are there shortages of physicians in those states.

    Prop 46 also includes testing doctors for drug and alcohol which is done in other occupations such as in the transportation industry and military to increase public safety.

    And Prop 46 requires physicians to check the state’s existing and secure DOJ CURES prescription drug database before prescribing narcotics and other addictive drugs to curb doctor-shopping drug abusers, to prevent over-dose deaths and to reduce harmful behavior, search on “prnewswire prop 46 requiring physicians to check statewide prescription drug database”.

    PLEASE VOTE YES ON PROPOSITION 46 for Patient Safety and Patient Justice.

    • Sam Canas

      Attorney costs? Maybe they shouldn’t bill $500 a hour. That’s a ton of money. I don’t think that the desire of a lawyer to win enough money to buy an estate should be enough to raise costs on everyone. Lower the billing rate to $150 an hour!

      • Chris

        Really? Why don’t we become a communist country then? Let’s cap attorneys’ fees, doctors’ fees, CEO fees, NFL player fees? Should we also cap what can be charged for goods as well as services? Should we cap what you can make? That is the silliest argument I have ever heard and will do nothing to advance patient safety. If where not for these lawyers that you hate so much, we would not have seatbelts in our cars; we would not have regulations for drugs; you could discriminate based up race, religion and gender. Is that the kind of free market economy that you want to live in? And, by the way, Plaintiff’s lawyers do not bill by the hour! We work for free and don’t get paid unless there is a settlement or judgment. This is a considerable risk. Prop 46 does three things to advance patient safety – 1) it requires drug screening for doctors (1 and 5 doctors are addicted to drugs, higher than the general population); 2) it requires doctors to check a database which already exists to make sure that the patient is not doctor shopping, saving Californians millions of dollars a year in medical payouts; and 3) adjust the cap to the current rate of inflation, holding doctors who do harm to pay what a jury tells them they should pay.

    • concernedtaxpayer

      I am voting NO on Prop 46, and the following is my reasons why.

      Peaceispossible14 clearly does not understand prop 46, nor it’s true implications, or she/he is paid by the trial attorneys…or is a trial attorney to write what she/he just said. The TRUE agenda behind Prop 46 is increasing payment, which Peaceispossible14 discusses. The FALSE agenda behind Prop 46 that it safely addresses issues of drug testing doctors and that it properly insures use of the CURES database to find and stop drug abusers. The FALSE agenda behind Prop 46 is that it was written to help victims of horrendous malpractice cases.

      Let’s explore what I just stated:

      A well written proposition is an HONEST proposition, and it is clear that I just implied that it is NOT well written, and that it is NOT honest. Consumer Watchdog is a front organization for the Trial Attorneys. Remember, the trial attorneys have written and paid for the Prop 46 ballot measure.

      Trial attorneys make their money by winning trials. They make a percentage of their earnings, so the bigger the settlement, the bigger the payment to them. Limits on that payment exist in different cases, but to imply that if Prop 46 passes, that these poor attorneys won’t get a large piece of the pie is dishonest. So, it doesn’t take much to recognize that this is paid for by people who get a financial reward if it passes. Much more honest if this was paid for by someone that doesn’t benefit financially. Trial attorneys know that they can win jury trials by appealing to people’s sympathy. So it doesn’t take much of a jump to recognize that they can twist the public to support their cause by putting forth a sad story, like one of a child that died. They also know that they can twist the public to support their cause by making sure that drug over-users are caught and stopped. Finally, they know that everyone wants drug-abusing doctors caught and pulled from circulation. I used the word “twist” deliberately, because people who are sucked into supporting this bill are being “twisted away” from the purpose behind it, namely a “money-grab”. The manipulatively sad use of pained families of dead children, the “stick-it-to-’em” bit about drug testing of doctors, and the catching of drug over-users using CURES are deliberate, and quite deceptive, smokescreens.

      Malpractice lawsuits became out-of-hand in the 1970’s, causing the costs of malpractice insurance to skyrocket such that doctors could not afford to practice medicine, and MICRA was passed to NOT limit payment for patient care costs, but to limit payouts to the increasing trend of lawyers seeking payment for things that have nothing to do with patient care, AKA “Non-Economic Damages”. Remember, every large settlement cost is passed on to all the people who buy health insurance. As a good result of MICRA, doctors remained working and patients remained receiving care. Safety measures have grown with each decade to heavily protect patient safety and patient rights. Most people who object to MICRA today are people who believe a financial “punishment” is needed for a malpractice cases where death results. This is a different matter, not addressed by MICRA and not addressed by Prop 46.

      The CURES database holds a record of every patient’s prescriptions, and a doctor can contact this database to find out if a patient is seeking narcotics from multiple doctors. Many people don’t want every prescription they have ever received to be sitting on a government database for the world to see. To some, however, it sounds good, but let’s look at the facts. The database barely works, and sometimes doesn’t work. Doctors will go online or sit on hold on the phone for hours just to get a prescription “authorized”. Sometimes, the database is down and no authorization is received. It is run by one person who works on it half-time. It gets 50,000 calls/database hits a year. So, after November 5, if Prop 46 passes, it will increase to 4,500,000 calls/database hits a year. So tell me how that is going to pan out with a broken system? Before passing a law requiring all doctors to use this for their patients who are in pain, or school kids on Ritalin, doesn’t it make sense to fix the problems with the system? Does this mean that people in pain won’t get their prescriptions? That kids with ADD won’t get their medicine? Does this mean that the truly sick will be delayed or miss out on care for pain? What about people in surgery getting anesthesia that contains narcotics? What about moms after a cesarean section? What about cancer patients?

      Before requiring by law that all doctors comply with this database, let’s make sure that CURES works. Regardless of what anyone thinks about Prop 46, this single issue puts patients at risk, it shouldn’t have been put in the proposition, but it makes great copy to get people who don’t understand it to support the overall proposition. It’s really sad.

      Drug testing doctors. The statistics here are always manipulated. They stretch to nationwide statistics or local statistics, wherever the largest number can be pulled. The truth is that very few doctors are drug addicts, drug abusing doctors are caught and punished, like all professions, and drug addicted doctors lose their licenses. Simply listing untested statistics about drug use and doctors serves to vilify a noble profession and plays to public skepticism about physicians.

      The WAY that Prop 46 requires testing is the issue here, not the testing itself.

      Again, badly written to get buy-in from under-informed voters. No one wants a drunk airline pilot, heavy-machinery operator or a surgeon. But imagine requiring drug testing of a pilot whenever turbulence hits. To stop flying and go to the restroom and pee in a cup. Imagine having your entire construction crew stop working and go to a testing facility for drug testing if someone falls off a roof. No one supports any person driving drunk or intoxicated on a drug. So laws requiring drug testing sound good on the surface. But testing a physician for every bad outcome within 12 hours seems strange. Doesn’t it seem like drug testing depends on what went wrong and how the doctor was involved? Shouldn’t an intelligent application to testing requirements be put into effect. What determines a “bad outcome”? Why is every union in California opposed to this? Is it because it suggests a violation of civil rights? What if the doctor ate a bagel with poppy seeds on it? What if the doctor is home and “not on call” drinking a glass of wine when she is called to get tested?

      Drug testing is an important topic, but this is not what Prop 46 is truly about, and it presents an assumption of guilt about drugs for every problem, which is unrealistic to apply across the board to all professions.

      Finally, the true issue, cost of healthcare. The reality is that malpractice insurance is expensive. Being a doctor requires hundreds of thousands, possibly millions of dollars to be paid in malpractice insurance over one’s career. Current assessments from malpractice companies suggest that these costs will double if Prop 46 passes. Most doctors don’t make the money to afford doubling their malpractice, this is just a reality. Contrary to popular opinion that doctors are all rich fat cats, the rise in HMO’s in medicine combined with the poor reimbursements for Medicaid have led to a medical crisis that has decreased working doctors to crisis levels in California. Thus, the result is less doctors able to work. For those who still work, their cost will have to go up. This passes the cost to all of us who pay for healthcare. Current studies suggest up to $1000 per working family of four. Today, with healthcare uncertainties and higher costs, no one can simply afford to give Trial Lawyers this luxury money-grab at this time. Perhaps when medicine is affordable, trial lawyers can ask for more money at that time.

      For now, I am voting NO on prop 46.

      • Wake Up California

        Wonderful, intelligent, logical argument. So refreshing to read an analysis of someone who takes their vote seriously.

  • Lisa

    I don’t like how there are really THREE different issues here, lumped together into one proposition. This sort of law making creates unnecessary confusion about laws, what’s at stake, and allows obscure ‘pork barrel’ add-ons to piggyback their way into existence.
    I would love to see a proposition that requires a ‘plain talk’ single issue requirement for propositions put before voters!

    • mocarbgoode

      I completely agree! In fact, I thought propositions had to be about only one topic. Adding the doctor drug testing to get votes is just not good lawmaking.

  • Wake Up California

    This is a deceitful proposition. Just looking at the drug testing proposition, for instance. 1) The California Medical Board already oversees the punishments of doctors who break the law or abuse drugs and alcohol. 2) The doctor the Pro 46’rs have in their commercial who claims to have abused drugs and put 1000’s of patients at risk is from…..TENNESSEE!! He is not even a California doctor. You’d think that they would at least have a California physician in their commercial!! 3) the parents who sadly lost their two children in Danville indicate that their lives were lost due to preventable malpractice. Well, it’s not hard to find out that their children were killed by a drunk driver who abused her prescription medications. The physician had nothing to do with the case! Isn’t the drunk driver on prescription drugs the responsible party here? Where is the individual responsibility here? 4) They cite that pilots, police, bus drivers, etc are drug tested. Yes, they are transporting 100’s or thousands of people in a course of a month. Police are on the road driving and interacting with 100’s of people in a day. One bad move, and dozens or hundreds of people’s lives are at risk in one swoop! You doctor, though, is seeing you and only you for your visit, your procedure, your surgery, etc. Nurses and other medical staff are around them at every turn. They are working in a doctor-patient relationship and you are not a victim in this relationship. You are a voluntary participant. However, we don’t choose the pilot, we don’t choose the bus or train operator, we don’t choose the officer whom we may interact with. They are in a role to directly impact the PUBLIC’s lives and many are PUBLIC employees. So, if this proposition is considered as a reasonable proposition by any Californian, consider this. Consider a proposition that all ELECTED PUBLIC OFFICIALS, APPOINTED JUDGES, and TRIAL ATTORNEYS must be DRUG TESTED! I mean, they make the laws, right? So a drunk or high or elected official will make laws that EFFECT us ALL! That makes more sense, doesn’t it? Now, to tackle the malpractice limit. They want to raise the cap on the PAIN AND SUFFERING limit! Jerry Brown capped it in the 70’s because huge malpractice premiums were driving doctors out of California! Well, here we go again! They don’t mention that THERE IS NO LIMIT TO MALPRACTICE Acts, ex. BODILY HARM! I empathize with a suffering parent who loses their child to an accident. But in this case, the driver is wholly responsible. That is why there is a law to require liability CAR insurance. So, the greedy attorneys are going after the PAIN AND SUFFERING limit. Why not, hey? Other states have it, so why not CA? Well, kiss your doctor bye-bye as they cross a state line to practice where they are not being bullied. I mean, if you quadruple a malpractice limit, what do you think will happen to the doctor’s premium? Ummmm….maybe QUADRUPLE? What do you think will happen to the filing of frivolous law suits?????? I rest my case…

    • Lily

      Who else would have access to the database? Police, judges, city officials, Insurance companies etc,
      A speeding ticket could turn into a D.U. I. (Influence) after they check the data base. Or maybe you wouldn’t be able to drive if your in the database
      Judicial system: Lawyers, Judges, District attorneys, Juries.
      Insurance companies: It could affect the cost of Auto insurance, Business insurance, Life insurance, and many more.
      Even if it is a “secure” database, is it a private database? It can be read by any doctor, nurse? medical assistant? or some else the doctor delegates to check the information. I think It’s mandatory if this bill passes.
      Eventually this information would be in the hands of Government Agencies, Human resources (hiring), Landlords. They can already check your credit rating.

    • Imollyq

      Medical malpractice was dispensing the drugs to teh driver without monitoring how many drugs were dispensed, etc.

      • Wake Up California

        The abuser is responsible for their actions and choices, not the physician. Let’s go after every bartender who serves alcohol to a patron, then the patron leaves and has an accident. Truly, is it the bartender’s fault? And what about all those patients that cross state lines and are not in the California data base? We will still blame the doctor! If doctor’s need to babysit all the prescriptions they write, then we are adding to the defensive medicine already being practiced. You doctor will refuse to prescribe a 30 or 90 day supply of blood pressure or diabetes medications, or sleep medication,…etc because of the possibility of you taking it incorrectly, l,os consciousness, and suffer an accident. So, if you want to give up your healthcare altogether, keep this war of lawyer vs. doctor going.

  • M

    I’d like to know why this proposition is one the ballot considering that propositions must be limited to a single subject and this one has three (medical malpractice cap, the requirement to check the prescription database, and the testing of doctors).

  • MG

    If this were such a great proposal why do they mask the real reason for it under “drug testing for doctors” when it’s really to try to increase caps for pain and suffering i.e. ambulance chasing

  • Aaron

    As a person who lost a child to medical negligence, I can sit here and explain all the ways the medical system lies and conspires to prevent accountability, and resurface a lot of pain…or I can tell you about the basic economics of our situation. After two years in a lawsuit, we were told by our lawyer that it would cost $150,000 to go to trial, with our best case scenario of a $250,000 reward due to the MICRA cap. Doing the math: $250,000 – $150,000 – lawyer’s fees = close to zero. The risk versus reward potential was (understandably) too much for our lawyer and he had to drop our case.

    In California, in order for the Medical Board to even consider punishment against a doctor, there needs to be at least a $30,000 settlement on record. The doctors knew it would be expensive for us to go to trial, so they held out. When we were forced to drop the case, we couldn’t even successfully report them to the medical board. Therefore….no accountability in even the most basic sense, and no reason for the doctors to be discouraged from practicing poor healthcare moving forward.

    I don’t know about you, but I can get fired on the spot if I have a bad day on the job. Doctors can recklessly take lives and go back to business as usual with the current laws in place. Should you find yourself in such a tragic situation of losing a loved one, you will find you have virtually no legal protection on your side.

    People who have no direct experience with medical negligence can sit around and demonize trial lawyers all they want, but the fact of the matter is, lawyers have caps on what they can earn. If the plaintiff earns a higher amount (extremely unlikely, as punitive damages are rare), the fee drops to 15%:

    I am not a lawyer, and I am not a healthcare provider. But damn did my lawyer work hard for us before he had to drop our case.

    Lastly I would like to show you the more than 10x discrepancy in campaign contributions, disproportionately coming from the ‘No’ side. Tell me if you think this is a fair fight. I can tell you from going through medical malpractice process: it is not.

  • Darkie One

    “All…of…the….pilots do it. Astronauts do it. Even the school bus drivers do it,” the ad goes. “Let’s do it. Let’s pee in a cup.”
    What about trial lawyers? are they required to have drug test?
    Frankly, I don’t care about the drug test. It’s the malpractice trial lawyers tried to sneak in. It will only flood the ER with more patient who lost their doctors.


April Dembosky

April Dembosky is the health reporter for The California Report and KQED News. She covers health policy and public health, and has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, mental health and end-of-life issues.

Her work is regularly rebroadcast on NPR and has been recognized with awards from the Society for Professional Journalists (for sports reporting), and the Association of Health Care Journalists (for a story about pediatric hospice). Her hour-long radio documentary about home funerals won the Best New Artist award from the Third Coast International Audio Festival in 2009.

April occasionally moonlights on the arts beat, covering music and dance. Her story about the first symphony orchestra at Burning Man won the award for Best Use of Sound from the Public Radio News Directors Inc.

Before joining KQED in 2013, April covered technology and Silicon Valley for The Financial Times, and freelanced for Marketplace and The New York Times. She is a graduate of the University of California at Berkeley Graduate School of Journalism and Smith College.

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