Two Doctors File Lawsuit Challenging California Law Requiring ‘Implicit Bias’ Training in Medical Education

Two California doctors are challenging a state law that requires them to call the doctors they teach racists.

In 2019, California passed Assembly Bill 241 by then-Assemblywoman Sydney Kamlager-Dove (D-Los Angeles), requiring that starting in 2022 teachers of continuing medical education for doctors would include “implicit bias” training–namely telling doctors they are bigoted whether they realize it or not. Kamlager-Dove is now serving as the U.S. representative for California’s 37th congressional district.

In other words bias is asserted but not proved. There are some crimes so serious that innocence is no defense.

All courses are required to tell doctors “how implicit bias affects perceptions and treatment decisions of physicians and surgeons, leading to disparities in health outcomes” and include “strategies to address” this supposed subconscious bias.

Now, two doctors who teach continuing medical education courses in California are challenging the law on First Amendment grounds. Their federal lawsuit says the requirement for teaching implicit bias amounts to compelled speech in violation of the First Amendment.

California “cannot condition a speaker’s ability to offer courses for credit on the requirement that she espouse the government’s favored view on a controversial topic,” the lawsuit argues.

Interestingly, neither of the doctors suing is white. One plaintiff, Azadeh Khatibi, is an Iranian immigrant, who is now an ophthalmologist in Los Angeles.

The other plaintiff, Marilyn Singleton is a black anesthesiologist who finds the notion that white doctors are racists who need to be disabused of their prejudices obnoxious and untrue.

Do No Harm, an organization which fights the politicization of medicine, particularly diversity dictates, is another plaintiff because one of their members teaches continuing medical education classes in California.

The defendants are officials of the Medical Board of California, the state agency which licenses doctors and administers the continuing medical education (CME) classes. California doctors are required to have 50 hours of CME classes every two years in order to renew their licenses.

Stanley Goldfarb, a longtime University of Pennsylvania Medical School professor and founder of Do No Harm, told the California Globe that the notion doctors are biased and their prejudice causes health disparities is a pernicious myth. “There is no good evidence that there is bias,” he said. “It is a dangerous concept. It’s another effort to inject divisiveness into the way that Americans interact with each other. That undermines the trust that physicians need to have with patients.”

Goldfarb said health disparities across races are actually caused by poverty. And that the requirement to teach implicit bias in the CME courses is coercive. “I think it forces the faculty members [for the CME courses]  and doctors to buy into the idea that the basic cause of health care disparities is the way they are treating patients. The bias they have towards patients.  This is a postulate that has not been proven. They are required to have this idea and accept this notion. They resent that coercion.”

Dr. Singleton, the black anesthesiologist, expressed similar sentiments in an opinion piece for FoxNews.com.  “I don’t care that I’m not the target. This [requirement] still represents the kind of racist thinking that was starting to fade 50 years ago. I don’t want to be taught this evil, nor do I want to teach it to others.”

“The law’s authors and advocates think the new racism is justified by health disparities between White and Black patients. These things are real, yet blaming bias for health disparities is the easy way out, since it ignores the host of cultural, economic and other factors that influence patient health.”

She added that “if implicit bias were real, you’d think I would have seen it in 50 years of medical practice. I haven’t, neither in how my peers have treated me nor in how they’ve treated patients of different races. I certainly have never seen a White colleague provide worse care to a Black patient.”

Dr. Singleton and the other plaintiffs are being represented for free by the libertarian Pacific Legal Foundation in Sacramento. The lawsuit was filed earlier this month in the United States District Court for the Central District of California.

It argues that, “Rather than respect the freedom and judgment of continuing medical education instructors to choose which topics to teach, California law now requires the Medical Board of California to enforce the mandate that all continuing medical education courses include discussion of implicit bias. Under the First Amendment to the United States Constitution, the government cannot compel speakers to engage in discussions on subjects they prefer to remain silent about. Likewise, the government cannot condition a speaker’s ability to offer courses for credit on the requirement that she espouse the government’s favored view on a controversial topic. This case seeks to vindicate those important constitutional rights.”

Pacific Legal Foundation lawyer Joshua Thompson, who is working on the case, told the California Globe that the CME requirement to teach implicit bias is poisonous for doctor-patient relationships. “The CME requirement injects race/sex and other immutable characteristics into every education course that doctors take,” he emailed. “Rather than instructing doctors on how to provide better care, improve skills, or increase knowledge, the implicit bias mandate says that doctors ought to be thinking about race and how to treat patients differently because of their race.”

“The doctor-patient relationship is sacrosanct,“ Thompson continued. “Patients wants doctors to provide the best care possible. Doctors want to provide the best care possible. No one needs CA legislators’ opinions of what ought to be in the patient room.”

The Medical Board of California press office did not reply to a request for comment about the lawsuit.

 (The Globe reported in a January 2023 article that California’s Medical Board, is made up of 12 individuals: 6 Medical Doctors, 3 attorneys, a Public Relations consultant, an “Ethics Reformer,” and a Life Coach. The ethics reformer has since been replaced by an entrepreneur.)