Protecting Pain Physicians from Legal Challenges, Part 1
by Forest Tennant, MD, DrPH
 Out of the blue, you get a phone call. One of your best performing patients
was found dead at home. No suicide note. No warning. Just a lifeless body who was quite
pleasant and upbeat at your last clinic visit. You quickly review the chart. Same meds for
the last few months. No warnings of an impending death.
Unfortunately, this scenario has become all too common to ignore it. The “Sudden
Death Syndrome” in opioid-treated pain patients is an issue that all physician’s
must now face lest it ruin medical careers and deprive needy patients of their hard-fought
battle to win the rights for pain treatment. Patients ill enough to require opioids
typically have a shorter life span. The sad fact is that physicians are erroneously being
blamed for many of these deaths when, in fact, they have usually extended the
patient’s life.
This two-part article outlines the common causes of sudden, unexpected deaths, and the
usual post-mortem process that every pain-treating physician must understand. In Part 2, I
will present recent sudden death case examples from my files. Both Parts 1 and 2 present
an approach to avoiding and defending legal challenges. All physicians who treat pain with
opioids need to immediately understand the blatant, malicious, and non-scientific
challenges recently foisted on some excellent physicians. All of us need to institute
means to protect ourselves from malpractice and other legal challenges that may occur when
a pain patient suddenly and unexpectedly dies.
Understanding and Avoiding Fatalities In Pain Patients
Although no systematic studies of the causes of death in opioid treated pain patients have
been published, I have chosen to categorize the causes of sudden, unexpected deaths into
eight types. Physicians should be aware of these causes and make prevention of sudden
death one of the primary goals of pain treatment. The following eight causes listed here
are not necessarily in order of incidence or prevalence:
• Cardiac Arrest or Cerebral Vascular Accident
• Suicide
• Infection
• Family Euthanasia or Murder
• Accidental Poisoning or Intoxication
• Cardiac Conduction Deficit
• Abuse Episode
• Misguided Withdrawal Self-Treatment
Please refer to the March 2008 issue for the complete text. In the event you need to order a back issue, please click here.
— March 2008
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