SACRAMENTO, CA — To have earned a title like "The Man Who Cracked Enron," Joe Dunn must be persistent.

So it’s no surprise that the former Orange County senator is
still trying to save the state’s diversion program, which allows
doctors to see patients while secretly being treated for drug or
alcohol abuse.

I first wrote about diversion in July, when Dunn was leading an
effort to defend the program as president and CEO of the California
Medical Association. At the time I introduced you to Tina Minasian, who
says she was "physically deformed" by a plastic surgeon who she never
knew was monitored for alcohol abuse.

Dunn wouldn’t talk to me then about why he had staked his
reputation on protecting the little guy but now supports a program that
some say endangers Californians. But after denying my request again
this week, I finally spoke with him Thursday.

"There’s no conflict whatsoever. Our No. 1 goal is patient
safety," said Dunn, a consumer attorney who led the state’s inquiry
into Enron. "The inescapable fact in eliminating this program is it
raises the risk of patient
safety. Eliminating this program means that doctors with substance
abuse problems may remain in secret about them until the ticking time
bomb explodes. When it explodes, the results will be harm to patients."

Last summer, the Medical Board of California voted to end the
diversion program in June 2008 after months of bad media coverage and
the program’s fifth negative audit in its 27-year history. Among the
California State Auditor’s most damning findings was that the "program
has not always required a physician to immediately stop practicing
medicine after testing positive for alcohol" or drugs.

"Public protection is the medical board’s highest priority,"
board President Richard Fantozzi wrote in the board’s November
newsletter. "The operation of a diversion program which demonstrably
does not adequately monitor substance abusing physicians, while
concealing their participation from patients, is obviously inconsistent
with that mission."

But Dunn and the 35,000 doctors he represents aren’t giving up.
They insist the state needs a program that allows doctors to
confidentially seek rehab without damaging their reputations. Without
it, they say, doctors will hide their addictions and no one will know
until a patient is hurt.

"The only thing this program is about is patient safety," Dunn
said. "If we agree on the goal of patient safety as the only goal, then
we have to maintain this program. It’s been successful in California.
We have to correct the deficiencies. It’s been successful in 40-some
other states. And returning to a time when substance abuse remains in
the shadows is not acceptable to public safety."

In November, the medical association surprised the state
medical board by presenting the framework for a proposed Public
Protection and Physician Health Program to take the place of diversion
when the state ends it in June.

The proposal, drafted with the California Psychiatric
Association and the California Society of Addiction Medicine, imagines
some sort of collaboration by the board, Legislature and the medical
community to continue the basic services of diversion.

David Pating, president of the California Society of Addiction
Medicine, described it to the board as "an alternative, diversionlike
program." In fact, the framework includes the two very things critics
hate about diversion: that it allows monitored doctors to continue
seeing patients and that it keeps patients in the dark about their
doctors.

"The risk is too great," said Minasian, when I told her about
the proposal. "There’s a chance they could hurt patients if they’re
still practicing while in rehab."

The medical association and its partners fleshed out their
proposal Thursday at a diversion summit, sponsored by the medical
board, in Sacramento. The summit was called to address the problem
after the diversion program ends, and the association presented its
vision for an independent, nonprofit that would manage diversion.

Their ideas were echoed and endorsed by several other speakers
from the state medical community, who called diversion essential to the
welfare of patients and doctors.

"The program that was established by California 27 years ago,
by design, was very, very good," Dunn said. "If we could correct the
deficiencies and remain true to the original design, we’d have a very
effective program in California, similar to other states. So the vision
is to remain true to the original design… It means budgetary fixes,
resource allocations, those things that unfortunately haven’t been done
over the past few years."

And don’t think Dunn and the medical association don’t have the
influence to pull this off. In just the first half of 2007, the
association gave more than $240,000 to 81 of the Legislature’s 120
lawmakers.

At the same meeting where the framework was unveiled, the
association successfully lobbied the medical board to approve a
$500,000 contribution to a struggling loan repayment program named in
honor of a late association executive — even though the association
itself has never given a dime to it.

"In years past, CMA has been able to use a lot of muscle on the
Capitol," said political watchdog Doug Heller of the Foundation for
Taxpayers and Consumer Rights. "It can’t be ignored that they’ve held
off reform of the medical malpractice laws for years and they’re
desperately in need of reform… They’re obviously able to pretty
effectively fight off accountability reforms, and that’s dangerous —
quite literally in this case."

PERSISTENCE:Former Orange County state senator Joe Dunn is
continuing his crusade to save the state’s medical diversion program,
which monitors doctors being treated for alcohol or substance abuse but
allows them to practice at the same time.
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Brian Joseph covers Capitol issues for the Register. His Capitol
Watchdog column focuses on government practices. To reach him, call
916-449-6046 or e-mail [email protected]