Does the Medical Practice Act, which bars California hospitals from hiring doctors, violate the 14th Amendment, the one that guarantees equal protection under the law?
Welcome to the latest argument in the campaign by California's hospitals to recruit and retain primary care providers and specialists by hiring them and offering them benefits.
Just like county hospitals and academic medical centers, as well as hospitals in nearly all other states get to do.
Pamela Ott, executive director of the 49-bed Sierra Kings District Hospital in the farm community of Reedley, 25 miles southeast of Fresno, thinks the law most certainly does violate the constitution. She's having trouble recruiting another obstetrician, really needs a general surgeon, and is looking for a cardiologist to set up practice in her underserved area.
Alexzandra Hollingworth, MD, a young, board certified general surgeon fears she may not be able to continue her practice in the San Joaquin Valley because "the payer mix does not provide enough money to make a living as a doctor.
"I'm not talking about a decent living," said Hollingworth, 38. "I'm talking about any living at all. I'm talking about being able to pay the rent." She also wants to work in a setting with benefits, like health insurance, as many of her friends in Virginia and New York enjoy.
Tom Petersen, a director with the Association of California Healthcare Districts, also says California's Medical Practice Act is unconstitutional. The Sacramento-based group is pushing for passage of legislation that would lift the prohibition for hospitals operating in rural areas as well as hospitals operated by special health districts as long as they serve a medically underserved population.
"The majority of the people who are harmed because of this existing law are people who are black, brown or poor, or two of those three," says Petersen. This is about people who have no one to advocate for their healthcare, and that means they're treated unequally under the law."
Other organizations and state agencies that support change include the California Hospital Association, the Medical Board of California, the Regional Council of Rural Counties, the California Alliance of Retired Americans, and many other groups.
Even Dolores Huerta, cofounder of the National Farm Workers Association with Cesar Chávez, has joined the campaign, saying she knows the scarcity of physicians in rural and impoverished parts of the state disproportionately harms patients because doctors aren't always there in emergencies, and because they have to travel much farther to get the care they need.
Unfortunately for their cause, the influential California Medical Association, which represents a large share of the state's physicians, vehemently disagrees and has defeated two of three bills that would have lifted the ban.
The remaining bill, SB 726, was heavily amended to include some of the provisions in the defeated bills.
However, as amended, the bill allows only two physicians instead of 10 to be hired per hospital, with another three allowed only if the hospital can show in a public hearing the need for additional hires.
Additionally, other provisions in SB 726 would limit its application only to hospitals in medically underserved areas and only those which can prove that they tried unsuccessfully for at least 12 continuous months to recruit physicians.
As it stands, it passed a key committee with a 15 to 2 vote in August. And is expected to be approved by the Assembly.
But the CMA may kill this bill too when it goes before the state Senate in coming weeks.