Protecting Pain Physicians from Legal Challenges: Part 2
by Forest Tennant, MD, DrPH
 The landscape for risk in pain treatment is rapidly changing.
Heretofore, physicians have been reluctant to prescribe opioids for chronic pain treatment
due to fear of prosecution by State Medical Boards and the Federal Drug Enforcement Agency
(DEA). Due to pressure from a public that demands opioid drugs for pain treatment, most
states, however, have now adopted laws, regulations, and guidelines that allow a physician
to treat chronic pain without fear of retribution. Risk of malpractice is, however,
replacing the risk of government prosecution as the physician’s cross-to-bear. In
this decade, a variety of mal-practice suits have befallen physicians who have attempted
to treat chronic pain with opioid drugs. In the last issue of Practical Pain Management,
we focused on the problem of sudden, unexpected deaths in pain patients and the
misinterpretation of their opioid blood levels. In this second article we wish to
highlight other legal challenges that have come to our attention. In addition to
unexpected deaths we are aware of legal challenges involving undertreatment, withdrawal
from opioids while pain is still present, and complications of severe chronic pain (see
Table 1). Not discussed here are legal challenges that may result from billing practices
or invasive interventions.
Table
1. Malpractice Challenges for Physicians |
- Sudden, unexpected death in a pain patient.
- Undertreatment or opioid withdrawal and failure to prevent
pain flares.
- Complications of severe, chronic pain such as dementia,
infection, or cardiovascular events.
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A ten-point malpractice-prevention program is presented to avoid risk and protect
against legal challenges. Selected cases are then presented to emphasize that all could
have been prevented in a medical practice.
Ten-Point Malpractice Prevention Plan
This plan is designed for the busy practitioner who may have limited time to spend with
each patient (see Table 2). Futhermore, it doesn’t depend upon expensive laboratory
tests, consultations, or large office staff. Due to the high pre-valence of chronic pain
in the general population, it is well recognized that chronic pain treatment with opioid
drugs must be done. Treatment must necessarily take place in busy practice settings
throughout rural and urban areas of America. Put another way, this ten-point plan can be
done in a two-person office, and the author believes that the implementation of these
points either prevented or would have prevented all the malpractice suits personally
reviewed.
Please refer to the April 2008 issue for the complete text. In the event you need to order a back issue, please click here.
— April 2008
The full article is now available as a PDF and may be
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