On March 12, 1856, the Medical Society of the State of California held its first meeting at Pioneer Hall on “J” Street in what is now Old Town Sacramento. The society’s first president, Benjamin Franklin Keene, M.D.,—also a state senator representing El Dorado County—led the meeting of 75. The dynamic physicians who founded the Medical Society of the State of California were veterans in the fight against cholera, encephalitis, typhoid and smallpox – diseases that became prevalent in the newly minted lands of California after the Gold Rush of 1849. They dedicated their organization to “promote the science and art of medicine, protection of public health, and the betterment of the medical profession.”
Reflecting their mission, the group’s early accomplishments were many, and these built the foundation of many achievements to come. The CMA and its leaders:
- Started the state public health department in the 1870s;
- Made immunizations compulsory for school children in the 1880s;
- Began looking at ways to fund health care for the poor in the 1930s;
- Performed some of the first cornea transplants, and set up some of the first organ transplant guidelines in the country; and
- Started California’s first medical schools, which later became Stanford and University of California.
A deadly cholera epidemic struck Sacramento in October 1850. Despite their unfamiliarity with these diseases, physicians remained committed to helping their patients. About 5,000 people in Sacramento and the surrounding areas died of cholera, and thousands of others deserted the area in fear of the disease.
John Frederick Morse, M.D., a historian and journal editor for the medical society who would form some of the first disciplinary and licensing terms for state physicians, noted physicians’ remarkable commitment: “…Not one educated physician turned his back upon the city in its distress and threatened destruction.” The dead in the cholera epidemic included seventeen physicians, a third of the physician population of California. They are memorialized in a plaque at the historic Sacramento City Cemetery, with only one of them buried in a marked grave.
The surviving physicians became close colleagues and friends, and began to found county medical societies. The first were founded in Sacramento and San Francisco. Each society kept in contact, and society secretaries Thomas Logan, M.D., (Sacramento) and Elias Cooper, M.D., (San Francisco)—historical figures in their own right—set up that landmark first meeting in 1856. Dr. Logan, a notable medical scholar, would later reform the CMA after years of strife, reorganizing the society in 1875 and eventually serving as the state’s Director of Public Health as well as president of the CMA and then the AMA. Dr. Cooper, an eye surgeon and co-founder of the Illinois Medical Society previously, would found the medical school that became Stanford University School of Medicine.
Controversy arose over which physicians were credible, and as a result a credentials committee formed to “prevent admissions of improper persons.” Dr. Morse became the Medical Society’s first Censor, a precursor to the Medical Board of California of today.
Dr. Morse also is credited with starting the first journal of the Medical Society, starting with his own funds a short-lived publication called the California State Journal of Medicine. There were several revivals of publications over the years. In 1873, the society published the first Transactions of the Medical Society of California, a volume published annually until Volume 31, issued in April 1901. In that year it was recommended that, because the annual transactions were “an extravagant and unnecessary way of perpetuating the proceedings of the society, the more rational one of publishing a monthly journal” be adopted. Thus, The California State Journal of Medicine was revived. In 1924 its name was changed to California and Western Medicine, and in 1946 to California Medicine. The late Philip Mills Jones, M.D., is regarded as that journal’s founder.
In 1974, the journal became The Western Journal of Medicine, in conjunction with a plan to create a regional medical journal for the West. For more than twenty years, The Western Journal served as the official journal for the state medical associations of Arizona, Idaho, Montana, Nevada, Utah, Washington, and Wyoming, and six research and specialty societies, in addition to CMA. In 1998, the Journal was taken over by the British Medical Journal, and has since ceased publication.
Because travel was difficult in early years, the society’s focus remained in Northern California, and its counterpart, the Southern California Medical Society, was not created until 1898. County societies sprouted up throughout the late 1800s and early 1900s. In 1900, CMA membership cost $10 and included malpractice coverage.
The society renamed itself the California Medical Association in 1923 to comply with name changes at other state medical associations and the American Medical Association. During the 20th century and beyond, the CMA has led and still leads the fight against tobacco use and smoking and insisted early on—in the face of criticism and fear of the newly found disease—that HIV and AIDS patients deserve needed health care. The CMA continues to advocate for patients on a broad range of health care issues, including broader immunization against disease and universal health care coverage by insurance and other means.
The CMA also helped to establish some of the first blood banks and cornea banks in the West and helped create the California Tumor and Tissue Registry in 1947—what is today the second largest tumor and tissue registry in the world.
MICRA Is Born
In 1975, the CMA preserved access to care for many when it forged ahead on a plan to keep medical malpractice rates affordable. Hearing the outcry of CMA physicians who had faced rate increases up to 400 percent, threatening practice viability, Governor Jerry Brown called together a special session of the legislature to discuss the malpractice cost crisis. They passed that year a collection of statutes called the Malpractice Insurance Compensation Reform Act (MICRA), a model for national medical liability reform. At the insistence of CMA physicians, MICRA kept patients whole and ensured compensation for their injuries while setting a cap on non-economic damages, going a long way in keeping malpractice insurance premiums affordable.
For more than 35 years, CMA has fought to protect MICRA. There have and continue to be numerous attempts to discredit our landmark law. There is no denying that MICRA has kept malpractice premiums in California relatively reasonable. Today, the average California physician saves more than $60,000 a year in malpractice premiums, when compared to colleagues in Florida, New York, and Michigan.
For the past 40 years, CMA has been fighting to protect patients and physicians from the health insurance industry. By the 1960s, it was clear that the managed care industry needed oversight and regulation. In the 1970s, CMA sponsored a key piece of legislation, the Knox-Keene Health Care Services Act. The law instituted financial and quality standards for HMOs, set a basic minimum benefit package, required plans to ensure continuity of patient care, and protected the physician-patient relationship in health care decisions. In 2000, CMA sponsored AB 1455, which gave the Department of Managed Health Care the authority to levy penalties and fines against health plans that engage in unfair business and payment practices.
While CMA had made some progress in the Legislature, physicians were frustrated that despite three decades of legislative and regulatory efforts, health plans still ran roughshod over physicians and patients often couldn’t get the care they needed. In 2000, in a historic action, CMA filed a civil racketeering (RICO) lawsuit against for-profit HMOs in California, alleging that they were using fraud and other illegal activities to interfere in the physician-patient relationship. Eventually, more than 800,000 physicians and 19 state and county medical association’s joined CMA as plaintiffs, becoming the largest class action health care lawsuit in U.S. history.
Of the 10 defendants, six settled (including the now merged Anthem/Wellpoint/Blue Cross), and three had their cases dismissed by the court. The settling health plans agreed to pay a combined $585 million in monetary damages. But of even greater value were the binding commitments made by the insurers to change the way they do business with physicians. These prospective commitments have been valued far in excess of the monetary relief, at well over $1 billion over four years.
While we have made great strides, issues continue to arise, and CMA continues to advocate on behalf of physicians and patients to make sure that health plans are complying with the laws and regulations of the State of California.
Together We Are Stronger
The CMA has a rich ethnic heritage. At the medical society’s second annual session in 1857, the Committee on Education declared that at the very least German, French—and especially Spanish — should be part of a medical student’s education, stating: “In no country in the world is there such a national admixture of languages as this State.” CMA began on the principles that all patients of all ethnicities should be treated for their illnesses, and the CMA supplied the nation with some of its first ethnic medical leaders. Just as in 1857, the CMA continues to work toward bridging language and ethnic barriers with patients by placing new physicians in underserved areas of the state through the Stephen M. Thompson Loan Forgiveness Program, and studying the effects of limited English proficiency on patient care.
In recent decades, the CMA House of Delegates approved “mode-of-practice” forums to provide representation for physicians based on the type of practice they are in—solo/small group; medium; large and very large group; academic; hospital-based; or government employed. An ethnic physicians’ forum also was established.
Today, the California Medical Association has 43,000 members in all modes of practice and specialties representing the patients of California. Now, more than ever, we must stand together. A united front among physicians is what makes CMA so unique and influential on a local, state, and federal level.