California voters rejected a ballot initiative that would have required doctors to submit to random drug and alcohol testing within 12 hours of when an adverse event has been identified, while voters in South Dakota approved a measure to loosen insurance companies’ provider panels.

With all precincts reporting, more than 67% of California voters (nearly 3.42 million) voted no on Proposition 46, a measure that doctors in the state said would unreasonably penalize doctors unable to meet testing rules and lead to excessive suspensions. The initiative applied only to doctors who practice in hospitals or have hospital privileges.

The ballot initiative also contained two other components – a requirement that doctors consult a statewide database before prescribing schedule II and schedule III drugs and a raising of the medical malpractice cap on noneconomic damages from $250,000 to $1.1 million. Doctors argued that the database lacked the funding and staff to be effective in identifying patients engaged in doctor-shopping or otherwise abusing prescription controlled substances.

In South Dakota, 61.8% of the voters (166,351, with all precincts reporting) approved Measure 17, which allows providers who are willing to meet a health insurer’s coverage terms to provide health care services to insured patients without having to join that patient’s insurance plan network, and protects patients from out-of-network costs if they use that physician.

Voters in Arizona approved Proposition 303, which allows eligible patients with a terminal illness that has no Food and Drug Administration–approved treatment option to have access to an investigational drug, provided the drug has successfully completed phase I testing and remains under clinical investigation. The pharmaceutical manufacturer would decide whether to provide access, and insurance companies are not required under the measure to provide coverage for it. The measure also offered some liability protection for physicians who recommend the investigational treatment. More than 78% of the votes (849,350, with 97% of the precincts reporting) supported the measure.

In Illinois, voters supported a ballot initiative that would require insurance plans in the state that have prescription drug coverage to “include prescription birth control as part of that coverage.” No details were included in the text of the initiative on the scope of what needs to be included, but its passage means the state legislature must enact a law to implement the will of the voters. Sixty-six percent of the votes (2.2 million, with 99 percent of precincts reporting) were in favor of this initiative.

Residents in three states acted on abortion-related measures. In North Dakota, a ballot initiative would have amended the state constitution to provide for the “inalienable right to life” beginning at conception. With all precincts reporting, the amendment failed, with more than 64% of votes against. In Colorado, a constitutional amendment to include the unborn in the definition of “person” and “child” in the state criminal code failed, with more than 64% of the votes (nearly 1.2 million, with 94% of precincts reporting) going against the amendment.

And in Tennessee, voters approved a constitutional amendment that empowers the state legislature “to enact, amend, or repeal statutes regarding abortion, including but not limited to, circumstances of pregnancy resulting from rape or incest, or when necessary to save the life of the mother.” It passed with more than 52% of the votes (728,751 with 99 percent of the precincts reporting). The amendment was in reaction to a 2000 state supreme court ruling that struck down a number of state laws that placed limits around abortions.