A couple of weekends ago in a residential community in Davis, a board member came to a homeowner’s door with uncorroborated claims that the homeowner’s son had accepted a ride from a third party who speeds in the neighborhood. The details, including the car type, color, and driver’s complexion, did not match reality. When the homeowner said he would speak with his son, the board member identified himself by title and threatened to “cause trouble in the community” if the matter was not handled to his satisfaction. The homeowner later raised the conduct with the community’s board. No one apologized or acknowledged the overreach. Instead, the board pointed to its relationship with the local police department and noted that street cameras will be installed “to prevent speeding.” The original issue of abuse of a board position was never addressed. Safety language and expanded surveillance substituted for accountability.
This sequence reveals a deeper institutional pattern. Institutions that possess power frequently operate with little or no obligation to be accountable for how they exercise it. They can intimidate, overreach, and create real harm, then deflect attention by invoking safety, patient protection, or community welfare. They face no meaningful requirement to acknowledge error, apologize, repair the damage, or restrain themselves. The banner of safety becomes both the justification for expansion of control and the shield that protects the institution from scrutiny. That absence of accountability turns ordinary authority into a tool of selective enforcement and self-preservation.
The identical dynamic is already routine across health care regulation in California. Administrative burden is driving severe physician burnout. Layers of documentation requirements, prior-authorization mandates, step-therapy protocols, and electronic-health-record demands consume roughly half of many physicians’ time. The result is delayed care, demoralization, and early exits from practice. High state taxes combined with aggressive Medical Board of California activity are accelerating the physician shortage. The regulatory climate raises both the financial cost and the professional risk of practicing medicine, pushing doctors out of the state or out of the profession altogether. Pain-management physicians report that punitive board tactics, i.e., investigations triggered by prescribing data, threats of license action, public discipline, and retroactive scrutiny of records using outdated guidelines, have chilled legitimate treatment of chronic pain. The stated goal is patient safety; the observable outcome is reduced access for patients who need carefully supervised controlled substances. Medical-board regulation and prosecutorial overreach carry additional hidden costs: defensive practice, avoidance of complex cases, prolonged investigations averaging more than a thousand days, reliance on questionable experts, and a climate of fear that prioritizes paperwork and risk avoidance over individualized clinical judgment.
A parallel and reinforcing pressure comes from payer audits. Declining real reimbursement rates (Medicare physician payments have fallen approximately 33 percent in inflation-adjusted terms since 2001) push practices to increase patient volume simply to maintain revenue. Higher volume compresses the time available for thorough documentation. Incomplete or templated notes, which are often produced under genuine time constraints, then trigger payer audits, denials, and clawbacks of already-paid claims, further destabilizing practice finances. The cycle is self-reinforcing: Rate pressure leads to higher volume, thinner documentation, greater audit risk, and still more pressure. This process systematically erodes moral agency in medicine and, instead of measuring the capacity to synthesize a patient’s unique circumstances into a coherent assessment and plan based on professional judgment of right and wrong, rather normalizes the risk-averse actions dictated by external scrutiny. Guidelines, payer policies, and enforcement climate increasingly shape what physicians feel they can safely do. In chronic pain management, rigid interpretations of earlier prescribing guidance produced forced tapering, patient dismissal, and restricted access, contributing to untreated pain and moral distress, and sometimes contributing to suicide. Patients with complex or stigmatized conditions lose access to individualized care; clinicians experience the collision between what they believe is clinically right and institutional or financial barriers. Burnout, early exit from practice, and consolidation into larger systems that further standardize decisions follow.
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In each of these settings, the pattern matches the neighborhood episode exactly. An allegation surfaces, or a statistical outlier is flagged. The institutional response is not careful inquiry or correction of genuine misconduct. It is expanded rules, expanded surveillance (prescription-drug monitoring programs, quality metrics, mandatory reporting, retrospective payer audits), and the implicit threat that institutional power can be turned against anyone who objects. Safety or patient protection is the public rationale. Control and the suppression of independent professional judgment are the practical results. Because the institution itself faces no real obligation to admit error or repair the harm it creates, the cycle continues and intensifies. The same deflection that substituted cameras and a police relationship for accountability in that neighborhood appears in health care as audits, board investigations, and documentation mandates that expand institutional leverage while leaving the original harm (or the original overreach) unaddressed.
A KevinMD analysis published in June 2026 examining the California governor’s race underscores how these issues intersect with the choice voters face. Xavier Becerra has long emphasized government-led expansion of access, protections against federal rollbacks, cost controls through regulation and state purchasing power, workforce investment, and a long-term vision that still includes single-payer aspirations, though moderated in the current campaign toward incremental reforms and “immediate wins.” Steve Hilton emphasizes reducing government spending (particularly full Medi-Cal coverage for undocumented residents, with the savings redirected toward citizens and legal residents), combating fraud and waste through mechanisms such as a proposed “Cal DOGE,” increasing competition and deregulation, and prioritizing affordability for working Californians through market-oriented reforms rather than further expansion of government scope. These are substantive differences about the proper size and reach of institutional power.
The next governor will appoint members of regulatory boards, including those that oversee the practice of medicine. That person will shape tax policy, health care financing, and the rules that govern how medical boards investigate and discipline physicians. The governor will help determine whether the default institutional response to problems remains more rules, more monitoring, and more leverage, or whether genuine accountability, due process, and restraint become possible. The neighborhood pattern, where they are invoking safety to expand control while deflecting from the original abuse of power, with no obligation to correct the harm, is already normalized inside health care regulation. Continuing that trajectory risks deeper administrative burden, further physician shortages, reduced patient access, and denser webs of institutional power that can be applied selectively and without consequence.
Voters who will choose California’s next governor on November 3, 2026, should weigh this carefully. More cameras on neighborhood streets, more prior-authorization forms, more board investigations, higher taxes, and expanded regulatory authority do not automatically produce safer communities or better medicine. They can produce denser systems of control that silence objection and prioritize institutional self-protection over professional judgment and individual rights. When institutions hold power without a corresponding duty to be accountable for the harm they create, the language of safety and patient protection becomes a shield rather than a standard. That mindset is being normalized across local boards, medical boards, and state government. Once accepted as ordinary, it becomes far harder to reverse. It will shape the future of California’s health care system, its communities, and the daily lives of the people who live here. Think twice before casting that vote.
Kayvan Haddadan is a physiatrist and pain management physician, and president and medical director of Advanced Pain Diagnostic & Solutions, a multidisciplinary pain management practice in California that he founded in 2012. A physician and surgeon licensed by the Medical Board of California, he is double board-certified in pain medicine and physical medicine and rehabilitation. He is also certified in controlled substance registration through the DEA and serves as a qualified medical examiner through California’s Department of Industrial Relations Division of Workers’ Compensation.
Dr. Haddadan earned his Bachelor of Science degree from the College of Alborz in Tehran, Iran, and his medical degree from Shahid Beheshti University of Medical Sciences. He later received his Educational Commission for Foreign Medical Graduates certification in Philadelphia, completed an internship in medical surgery at Loyola University Medical Center’s Stritch School of Medicine in Illinois, and finished his residency in physical medicine and rehabilitation at the same institution. He completed his fellowship in pain medicine at California Pacific Medical Center’s Pacific Pain Treatment Center and also trained in medical acupuncture for physicians at the University of California, Los Angeles David Geffen School of Medicine.
Dr. Haddadan has contributed to 29 research publications across multiple specialties, including pain management, cardiology, pulmonology, endocrinology, gastroenterology, and infectious disease. His work has examined topics such as hyperlipidemia in high cardiovascular risk patients, hyperuricemia and gout management, type 2 diabetes and hypertension, chronic obstructive pulmonary disease and asthma therapies, influenza treatment, irritable bowel syndrome, and opioid related complications in chronic pain care. His research has also included clinical outcome studies in spinal cord stimulation and award-winning presentations on neuropathic pain management and neuromuscular disorders.
