• Bob Pack: The man behind California’s patient safety initiative Friday, August 16, 2013

    Never a quitter


    His children were killed when a doctor-shopping prescription drug addict ran them down on a neighborhood sidewalk. Then Bob Pack learned that an antiquated state law put a limit on the value of their life at $250,000. He won’t stop until MICRA is fixed.

    By Richard C. Paddock

    Bob Pack can still hear the voice of his daughter, Alana, telling him not to give up. “Don’t be a quitter, Daddy,” she would say when they were running in the park near their home in Danville, Calif.

    That was a decade ago, when Alana was 7, not long before she and her 10-year-old brother, Troy, were killed by a hit-and-run driver who was high on prescription pain pills. He has not forgotten her instruction.

    Bob and Carmen Pack with their children Troy and Alana

    Bob and Carmen Pack with their children Troy and Alana

    At first, Pack was overwhelmed by grief. But then he threw himself into one battle after another: A fight to see the killer punished, a drive to hold doctors accountable and a crusade to curb the rampant over-prescription of narcotics.

    Now he has taken on his biggest challenge: A bid to strip the medical profession of a 38-year-old special-interest law that shields doctors from having to face the full cost of their mistakes in court.

    Pack is taking on the Medical Injury Compensation Reform Act of 1975, known as MICRA, which placed a limit of $250,000 on pain and suffering damages in malpractice cases.

    MICRA has been on the books so long it was signed by Jerry Brown during his first stint as governor. The size of the cap has not been increased since the law was enacted. Adjusted for inflation, it would be more than $1 million today.

    “Since 1975, the cost of everything has gone up. Except the value of your life,” says Pack’s campaign website, 38 Is Too Late.

    Pack’s effort is supported by the Consumer Attorneys of California, the advocacy group Consumer Watchdog and a host of patient safety organizations. He says the campaign has raised about $2 million so far. A successful Internet entrepreneur, Pack says he has personally contributed a “substantial amount” to the effort.

    “Bob is amazing; he is the leader of this movement,” said Consumer Watchdog President Jamie Court. “He took what is the most unimaginable tragedy and he has turned it into a lifeline for other people who are unfortunate enough to walk in his steps. He is taking on the entire medical insurance establishment on their most holy of sacred cows.”

    Pack and his allies recently introduced an initiative – dubbed “The Troy and Alana Pack Patient Safety Act” – linking a MICRA fix to physician drug testing and a requirement they use an online database to prevent doctor shopping of prescription drugs.

    “The effort surrounding the prescription drug problem and the MICRA law is all about victims’ rights and keeping the public safe,” Pack said in an interview. “I feel like I am a good representative for these initiatives because I am not motivated by anything expect public safety and victims’ rights.”

    Pack, 57, who earned a business degree at the University of Southern California, has held management positions at several companies, including America Online. In 1998, he helped start the successful Internet service provider NetZero, which went public two years later. He stopped working in 2003 after the deaths of his children but recently founded Shop O’ Lot, a mobile shopping app.

    Alana Pack

    Alana Pack

    Before the tragedy, Pack and his Peruvian-born wife, Carmen, enjoyed a suburban life in Danville organized primarily around their children’s activities. Both children loved sports and did well in school. Troy hoped to follow in his father’s footsteps and attend USC. Alana’s softball coach called her a “quiet leader.”

    On Oct. 26, 2003, Carmen took Troy, Alana and two neighbor children to get ice cream. The kids were riding their bikes and scooters along the sidewalk on Camino Tassajara when a car traveling 45 miles an hour jumped the curb and headed straight towards them.

    Carmen shoved one neighbor child out of the way and the other dove to safety. But the car struck Troy, Alana and Carmen. Pack was called to the scene minutes later and helped try to revive the children, but both were dead within hours.

    The driver, later identified as Jimena Barreto, fled the scene on foot and evaded police for three days before she was caught. She was a nanny in the neighborhood and had been on her way to work. Minutes before the accident, neighbors saw her driving erratically on Camino Tassajara and nodding off when she stopped at a traffic light.

    Troy Pack

    Troy Pack

    Investigators later found that she had been taking large quantities of prescription pain pills she obtained from doctors at Kaiser Permanente. In the weeks before the accident, different doctors gave her 340 Vicodin, a narcotic painkiller, and 180 Flexeril, a muscle relaxant. When investigators found the bottles in her apartment, they were empty. She also had four previous arrests for driving under the influence.

    “When I learned about her prescription narcotic abuse and that these pills were given to her by Kaiser, I was furious,” Pack said.

    He also was upset when he learned that the district attorney was about to accept a plea from Barreto that would allow her to serve as little as four years in prison.

    The possibility that Barreto would receive a minimal sentence helped transform Pack into an activist. For months he waged a public campaign until the prosecutor relented and agreed to put Barreto on trial. She was convicted on two counts of second-degree murder and sentenced to 30 years to life in prison.

    Pack created the Troy and Alana Pack Foundation and worked with state legislators to tighten laws on repeat DUI offenders and the reporting of prescription narcotics. He also began using his Internet startup expertise to help create an online database to prevent the kind of doctor shopping that allowed Barreto to obtain so many pills.

    He paid $50,000 for a feasibility study that showed the idea could work. Then, working closely with the office of then-Attorney General Jerry Brown, he helped design a database that can tell doctors immediately when a patient is obtaining the same prescription from another doctor.

    Known as the Controlled Substance Utilization Review and Evaluation System, or CURES, it began operating in 2009. But poor participation by pharmacists and doctors and a lack of state funding have crippled the program.

    In 2011, Pack considered launching a ballot measure that would pay for CURES by levying a quarter-cent fee on prescription pain pills but he could not generate enough support. Pack’s CURES database is now part of his proposed initiative winding its way toward the November 2014 ballot.

    Apart from his work on CURES, Pack sought to sue Kaiser and its doctors for prescribing pain pills for Barreto. He approached at least nine law firms, he said, but all of them turned him down. The attorneys told him they could not afford to handle his case because of the MICRA limit on awards for pain and suffering. A suit of this sort could easily cost more than $250,000 in litigation costs, they said.

    Under state law, a victim of medical malpractice can receive compensation for economic damages, such as lost income or the cost of medical care. But in a case such as the death of a child, there is no lost income or future care needed. With a cap of $250,000 on emotional damages, there is little legal recourse. There is also no financial incentive for doctors to change their behavior, Pack said.

    Pack graveEventually Pack negotiated a settlement with Kaiser and received several hundred thousand dollars, which he gave to the Troy and Alana Pack Foundation to finance his effort to seek justice on their behalf.

    Pack said Kaiser never took disciplinary action against the doctors who prescribed the pills to Barreto. Kaiser spokesman Marc Brown said the company could not discuss details of the case because of the settlement agreement. He declined to say whether any of the doctors involved were disciplined.

    Pack said he turned to the initiative process this year because no state senator or Assembly member was willing to stand up to the medical and insurance industries, which are among the most powerful lobbies in Sacramento.

    The initiative introduced recently by Pack with the support of Santa Monica-based Consumer Watchdog has three main provisions. It would:

    •  Raise the $250,000 MICRA cap to reflect 38 years of inflation, which would boost it to nearly $1.1 million, and then adjust it thereafter to reflect the rise in cost of living.

    •  Require physicians who perform surgery or enjoy hospital privileges to undergo random drug testing as well as testing after adverse medical events.

    •  Require health care providers to consult the CURES database when prescribing drugs that are at risk of being abused.

    Pack said the Legislature could make one or more of these provisions unnecessary if it acts on them this summer.

    Molly Weedn, a spokeswoman for the California Medical Association (CMA), declined to comment for this article. In May, when asked about the proposed initiative, she told the San Francisco Chronicle that her organization “isn’t in the business of speculating on every hypothetical, ridiculous ballot measure that is floated.” She called the measure “nothing more than an ill-fated publicity stunt.’’

    The CMA website, however, tells a different story. It says the organization is preparing to defend MICRA, which it argues helps keep the cost of medical care from skyrocketing. Trial lawyers are waging an “aggressive campaign’’ against MICRA, the website says, and urges doctors to donate or sign up to speak in support of the $250,000 limit.

    “CMA has some of the best lobbyists, lawyers and other advocates in the Capitol, but the most powerful weapon in advancing the cause of physicians and their patients is you,” the post reads. “Hearing from a physician with experience from the frontlines of medicine can make all the difference for a legislator facing a complicated health care issue such as MICRA.”

    Pack and his allies, of course, take exception with the medical establishment’s arguments in support of MICRA.

    The medical industry has no academic study or demonstrable proof that a precipitous health care cost increase would be triggered by adjusting the MICRA cap to account for inflation, they say. In fact, the medical malpractice insurance industry is in robust fiscal health. It is among the most profitable lines of insurance in the state, with plenty of room to absorb any increases due to higher payouts, they say.

    Plus, with Proposition 103’s constitutional restrictions acting in tandem with the regulatory authority of the insurance commissioner, malpractice rate increases would be muted, as would any impact on health care prices.

    For Pack, of course, this is not about wading into one of the state’s longest running political feuds. It’s a personal cause. Win or lose this year, for him this battle isn’t over until change is made.

    If Troy were alive today, he would have just turned 20. Alana would be 16 and a junior in high school. After the accident, the Packs had another daughter, Noelle. She is now 7, the same age Alana was when she died.

    One source of continuing motivation for Pack is helping victims of medical malpractice who seek him out. And, following Alana’s directive, he has no intention of quitting.

    “It’s been a story of tragedy and blessing, too, for us,” Pack says. “It doesn’t end. I am committed to these causes. I have many years ahead and I will keep at it, and keep at it.”

    Rick Paddock is a freelance writer and former Los Angeles Times foreign correspondent.