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California doctors’ lobby group pushes agenda with swagger

California Medical Association won its seminal malpractice fight
Group’s self-confidence, money and connections give it influence
Now, it’s leading statewide effort to tax cigarettes $2 per pack

From left, California Medical Association general counsel Francisco Silva, CEO Dustin Corcoran and Janus Norman, senior vice president, talk at their Sacramento headquarters last week. Randall Benton


As large clocks around the office counted down to Election Day last year, leading physicians ditched their business meeting and marched downstairs to stuff envelopes with campaign pamphlets in a makeshift war room at the California Medical Association’s Sacramento headquarters.

No issue confronting voters threatened the pocketbooks and political prestige of physicians more than Proposition 46, the latest turn in the doctors’ epic battle with trial attorneys over a limit on medical malpractice awards. Polls showed the measure foundering, as physicians and allied insurance companies poured tens of millions into the campaign. Yet the doctors weren’t taking chances.

For Dustin Corcoran, the swaggering chief executive of the medical association, the race was the culmination of years of preparation. And as chair of the opposition campaign, Corcoran stressed to his young staff the fleeting nature of political races.

“There’s a day that it ends,” he recalled telling them. “And nothing you can do the day after that is going to change the outcome of what just happened.”

The doctors’ campaign, choreographed by Democratic consultant Gale Kaufman, won in a rout. As an encore, the CMA was instrumental in two of this year’s biggest legislative fights: vaccines and doctor-assisted death.

Now, it’s preparing for the next showdown, a $2-per-pack tax on cigarettes aiming for next year’s ballot, with some of the proceeds going to boost the reimbursement rates for doctors who take Medi-Cal patients. Tobacco companies are again readying to spend heavily to ensure its defeat.

“Tobacco is really good at running a ‘shiny object’ campaign – almost always pointing to something unrelated and minor in the grand scheme of things,” Corcoran said. “In this campaign, tobacco is going to face the strongest, most organized and well-funded effort that’s ever been mounted against them.”

Founded in 1856 as the Medical Society of California, the powerful association functions as a trade group for more than 40,000 doctors in all modes of practice. In the early days, the physicians sought to differentiate themselves from “irregular” members of the profession, or quacks.

The modern CMA, operating in the burgeoning health care industry, is guided by well-connected, politically savvy employees who help steer millions of dollars through the lobbying and campaign systems to advocate for the interests of doctors. Admirers say CMA attacks and overwhelms issues with manpower and money. But its elevated stature and shifting priorities sometimes make the group a target.


Jamie Court, the president of Consumer Watchdog

Jamie Court, the president of Consumer Watchdog and proponent of last year’s health rate-regulation measure opposed by CMA, accused it of selling out on its principles, and dismissed it as a “go-along to get-along country club organization that lacks the fortitude to go after the insurers” over patients’ rights.

“They are everywhere in these battles because all of these unpopular industries want to stand behind the white coat,” Court said. “And the medical association will rent out that coat cheaply to anyone in the medical industry who wants it.”

The CMA’s staff had long been characterized by its buttoned-up, conservative cast of characters. A turning point came with the hiring of Steven M. Thompson as vice president of government relations in 1992. A brilliant mind who helped shape health policy, Thompson had been chief of staff to former Assembly Speaker Willie Brown.

In 1998, after reading a Brown biography, Corcoran knew he wanted to work under Thompson, a fellow Democrat. In his first position at the CMA, Corcoran raised money for its political action committee. He looked on as Thompson dealt with the board and executive committee, and sat in when he made phone calls. “I was probably a pest at times because I would just sit and listen,” Corcoran said.

When he made junior lobbyist, Corcoran’s youth gave him an edge with legislative staff, while Thompson relied on his tight relationships with their bosses. Their arrangement ended in 2004, when Thompson died of cancer at 62. His passing devastated the CMA, which struggled with declining membership.

Meanwhile, the composition and focus of its doctors evolved. Since 2006, its percentage of solo and small-group practices with five or fewer physicians dropped from roughly 40 percent to about 22 percent. Large practices of 1,000 or more doctors increased to 35 percent of the organization from 20 percent.

“For a lot of years, they were lost in the middle trying to determine whether they represented the old-school doctors or the future of medicine,” said Charles Bacchi, president and chief executive of the California Association of Health Plans. “Any organization whose membership is dwindling has to figure out how to change that. One way to do it is to look at where the growth in the physician community was happening, and a lot of that is happening through the large groups.”

After leading its lobbying team, Corcoran was promoted to CEO in 2010. He hired new talent and helped forge what employees say is a collaborative culture at the association, which has a staff of about 70 and annual operating budget of $23 million. Membership rebounded as Corcoran kept focused on protecting the Medical Injury Compensation Reform Act of 1975. It established the $250,000 cap on pain and suffering damages in medical malpractice cases. Increasing the limit, which the attorneys view as outmoded and arbitrary, was the focus of Proposition 46.

Some lawyers believe the campaign shouldn’t have occurred. They maintain Corcoran and his medical industry allies abruptly walked away from a deal that would have raised the cap to $500,000, with no cost-of-living adjustment. Lea-Ann Tratten, political director for the Consumer Attorneys of California, said CMA expressed initial interest, then rejected the idea as the deadline to file signatures to place the matter on the ballot was about to expire.

Corcoran said there never was an agreement in place.

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