We are hearing a lot about "sunsetting" this summer, a term used for the phasing out of programs and agencies typically by legislation passed for that purpose. Perhaps the most famous "sunset" was the elimination of the Medical Board of California's diversion program. This program was judged to be ineffective by an independent analysis and subsequently was phased out, effective June 30, 2008.
For those who were in the diversion program at the time of its sunset, they seem to have remained on diversion of a sort, under the auspices of the Board's enforcement personnel, or have been released from diversion in recognition of their substantial compliance. For those who would now elect to go into diversion, it would seem, at first blush, that they have missed the boat.
I can think of, however, many reasons why no one was happy with diversion. To those who think that the Medical Board should, in the name of public protection, create a damming public record about every physician subject to possible discipline, the diversion program swept these "bad" physicians under the rug, and kept their secrets to the detriment of all. From the point of view of those in diversion, the program was grueling, using as its primary compliance mechanism the maligned "EtG" drug and alcohol test, and tended to be a "one size fits all" program that seemed to last years without end. In constrast, drug addicition treatment in the criminal justice system (from Prop 36 to common judge-ordered treatment) relies upon less frequent but more reliable drug testing and typically entails three to nine months of treatment. Diversion remains alive and well for the other healthcare professions. Time will tell if it has really become unavailable, once and for all, for physicians.
This year, five California boards, the Dental Board, Speech-Language Pathology and Audiology Board, Vocational Nursing and Psychiatric Technicians, Court Reporters and Barbering and Cosmetology were "sunsetted." They expired without renewal, apparently because the political will did not exist to continue them. Licensees may see little effect, however, there is a difference - Boards tend to be comprised of the professionals regulated (largely), whereas the Bureaus that replace them are run by civil servants. A predictable result, despite the cost savings of eliminating a Board with members to be hosted, served and flown around the state, is the elimination of peer oversight that a Board provides. A Board can be replaced with an advisory committee to inject a certain amount of industry insight, although an advisory committee lacks the governing power of a Board.
Neither a Board nor a Bureau is very democratic, but a Board meets in public and permits public comment. A Board can withstand political pressure by doing right but unpopular things, and can use its specialty knowledge to govern a profession with skill and insight. I, for one, hope these Boards are reinstated, or at a minimum, that this trend does not continue. And those remaining Boards, approaching sunsets of their own, should work hard to prove their relevance, so that they enjoy the support and respect of the professions they regulate.
For those who were in the diversion program at the time of its sunset, they seem to have remained on diversion of a sort, under the auspices of the Board's enforcement personnel, or have been released from diversion in recognition of their substantial compliance. For those who would now elect to go into diversion, it would seem, at first blush, that they have missed the boat.
I can think of, however, many reasons why no one was happy with diversion. To those who think that the Medical Board should, in the name of public protection, create a damming public record about every physician subject to possible discipline, the diversion program swept these "bad" physicians under the rug, and kept their secrets to the detriment of all. From the point of view of those in diversion, the program was grueling, using as its primary compliance mechanism the maligned "EtG" drug and alcohol test, and tended to be a "one size fits all" program that seemed to last years without end. In constrast, drug addicition treatment in the criminal justice system (from Prop 36 to common judge-ordered treatment) relies upon less frequent but more reliable drug testing and typically entails three to nine months of treatment. Diversion remains alive and well for the other healthcare professions. Time will tell if it has really become unavailable, once and for all, for physicians.
This year, five California boards, the Dental Board, Speech-Language Pathology and Audiology Board, Vocational Nursing and Psychiatric Technicians, Court Reporters and Barbering and Cosmetology were "sunsetted." They expired without renewal, apparently because the political will did not exist to continue them. Licensees may see little effect, however, there is a difference - Boards tend to be comprised of the professionals regulated (largely), whereas the Bureaus that replace them are run by civil servants. A predictable result, despite the cost savings of eliminating a Board with members to be hosted, served and flown around the state, is the elimination of peer oversight that a Board provides. A Board can be replaced with an advisory committee to inject a certain amount of industry insight, although an advisory committee lacks the governing power of a Board.
Neither a Board nor a Bureau is very democratic, but a Board meets in public and permits public comment. A Board can withstand political pressure by doing right but unpopular things, and can use its specialty knowledge to govern a profession with skill and insight. I, for one, hope these Boards are reinstated, or at a minimum, that this trend does not continue. And those remaining Boards, approaching sunsets of their own, should work hard to prove their relevance, so that they enjoy the support and respect of the professions they regulate.
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