Jury awards $7M for opioid reduction suicide

[paindoc007]

Her husband died by suicide. She sued his pain doctors — a rare challenge over an opioid dose reduction

He died by suicide. In an unusual step, his wife sued his pain doctors — a rare legal challenge to physicians over their decisions to reduce patients’ opioid doses.

www.statnews.com

---

Members don't see this ad.

 

[willabeast]

I cannot help thinking this is the result of government intrusion into medical decision making. Rather than an informed doc doing what is best for his/her own patient and later proving that to a jury, docs make their opioid decisions based on government mandates and then use those mandates to justify their decisions to a jury. The jury makes up it's own mind, and deals out what the jury thinks is justice, because the jury does not recognize the guv as the last word when it comes to treating patients. The docs are then crucified by the justice system. “The thing that hath been, it is that which shall be; and that which is done is that which shall be done: and there is no new thing under the sun.”

 

[epidural man]

Her husband died by suicide. She sued his pain doctors — a rare challenge over an opioid dose reduction

He died by suicide. In an unusual step, his wife sued his pain doctors — a rare legal challenge to physicians over their decisions to reduce patients’ opioid doses.

www.statnews.com

Well written article that I thought explained both sides very well. It was worth reading.

Thanks for sharing.

 

[Ferrismonk]

I saw this come across PainMedicine News. I thought it was a very well informed and balanced article, which is rare.

Here's my 2 cents:
The crazy thing is that this clinic did give him a bridge script until he could be seen in the office even though the clinic was not participatory in discharge planning, and put him back on his chronic opioid medication dose (240 MME!!) at the visit. The patient took more than prescribed and freaked out. The clinic made an appointment for him for first available slot. Patient goes to ER several times freaking out and at no time did the ER admit him for detox, set him up with a suboxone provider, or give him enough meds to make it until his pain appointment. Patient then commits suicide.

One could argue the drop was too aggressive based on what he was discharged on, but the defense argument was that his acute phase was over (he was in extended rehab) and he was now back to his chronic pain level medication needs.

If a patient of mine took too many of their pills and ran out early, I'd do the same thing and make first available appointment theirs. Possible discharge depending on the circumstances. They certainly aren't getting more pills sight-unseen as a reward.

If anything, this decision further proves that people shouldn't be on high-dose opioid pain medication long term and will ensure more providers will not write for opioid pain medications at all.

 

[Ducttape]

this is a tough situation. the taper was the right thing to do, but the rapidity can be questioned.

im not sure the ER doc could have given him suboxone - it would have completely screwed up his treatment plan, would really only have been for if he had + withdrawal symptoms. likewise prescribing him any medications - might be construed to be a violation of the treatment agreement by getting prescriptions from another doctor. detox might have refused seeing him because he is not interested in coming off of opioid medication.

the only real "treatment" that the ER doc can do is direct communication with the pain doc to make sure that there isn't some misunderstanding.


---
as the alternate side, imagine if this individual called to say that they took too many pills and needed a refill.

without seeing them, someone refills the prescription.

next thing, "someone" comes knocking and states that the extra pills were bought on the open market.

---

If anything, this decision further proves that people shouldn't be on high-dose opioid pain medication long term and will ensure more providers will not write for opioid pain medications at all.

at multiple different points in time, things could have been done differently. dont start is the simplest. no dose titration upwards is another.

 

[Agast]

My 2 cents

If you’re going to have someone like this established in your clinic to begin with, which I don’t recommend, the least risky prescribing would be to initiate a “tight-leash” protocol where the patient receives 1 week of medication at a time until you’ve weaned them down. This gives you more control over how much is issued at a time (I dislike sending high risk patients home with 100s of pills) and the patient will only be a few days away from the next fill if they are unable to control themselves. If they have a supportive spouse like this guy you can ask the spouse to be in charge of dispensing the pain medication. It’s a ton more work for you or your midlevel but if you’re going to allow for high MED - which he was before his surgery - you are already accepting the responsibility.

 

[epidural man]

I've asked this before because I don't know about private practice much -

but wouldn't it be possible when applying for your DEA - to ONLY ask for schedule IV and V privileges?

You can make excellent recommendations all day long for the PCM, but it would seem to make life so much easier if it were impossible (illegal) for you to write an opioid script.

I think I would do this. Maybe must V, so I could write for Lyrica. Even then - you could easily just give recommendations and PCM could write all scripts.

Okay, I've changed my mind. If I were private practice, I wouldn't even apply for a DEA license.

 

[hyperalgesia]

This patient was a time bomb.

 

[NITRAS]

I've asked this before because I don't know about private practice much -

but wouldn't it be possible when applying for your DEA - to ONLY ask for schedule IV and V privileges?

You can make excellent recommendations all day long for the PCM, but it would seem to make life so much easier if it were impossible (illegal) for you to write an opioid script.

I think I would do this. Maybe must V, so I could write for Lyrica. Even then - you could easily just give recommendations and PCM could write all scripts.

Okay, I've changed my mind. If I were private practice, I wouldn't even apply for a DEA license.

I’m not a PCP, but if a pain doctor recommended opiates and didn’t write for him, no way in hell I’d send patients to him.

 

[Laryngospasm]

Further proof that playing in the high mme sandbox is folly. All for a level 4 office visit.

 

[epidural man]

I’m not a PCP, but if a pain doctor recommended opiates and didn’t write for him, no way in hell I’d send patients to him.

Maybe -

I just know in my fellowship, we did Recs only. Seemed like we had plenty of business.

 

[mid|ine]

Maybe -

I just know in my fellowship, we did Recs only. Seemed like we had plenty of business.

Academics is different. No way this would work in most PP settings. Just stay away from high MME. I don't think I have any patients over 30, definitely none over 45 (unless actively weaning from outside prescriber).

 

[painfree23]

What would you do differently in this case? Just not take the patient in the clinic at all (ie better screening?)

 

[Agast]

What would you do differently in this case? Just not take the patient in the clinic at all (ie better screening?)

This was an established patient who had out of state surgery and then returned. It would be kind of ballsy to deny them returning to your clinic. It sounds like the initial escalation of pain meds to MED 240 was with this clinic to begin with. It's too bad we don't know what exact medications were prescribed, I'm wondering if the high MED is in part from use of Fentanyl patches since that will jack up your MED quickly.

 

[mid|ine]

They didn't deny them returning to the clinic. In fact, they gave them a bridge dose, sight unseen. IMO, it would be the responsibility of whoever jacked the dose up to be sure they had enough to get to a f/u at a minimum, and really should have started a taper back to pre-surgical levels.

 

[Ferrismonk]

Maybe -

I just know in my fellowship, we did Recs only. Seemed like we had plenty of business.

Yeah, working a large hospital system is completely different. Referral source is built in.

In private practice, you CAN have a med-rec only policy and it works just fine. Just make sure your referral sources are okay with that. My local PCPs feel better knowing that a pain specialist has rubber-stamped their treatment plan.

On the other hand, I never recommend patients initiate opioid therapy and I'm careful not to recommend patients continue or escalate opioid therapy. I will provide a risk assessment and make suggestions that would either improve the patient's current therapy or state the regimen is reasonable already. That opinion is based on the fact that opioid therapy is already established and assuming it will likely continue no matter what I say.

 

[mid|ine]

I would like to know if this doc would have been held liable for the suicide had he decided NOT to provide any refills to the patient until seen in the office (NOT provide the bridge Rx).

 

[hyperalgesia]

I don't know all the details but it seems completely outrageous to blame a doc for a patient committing suicide unless something extraordinary happened, like the doc intentionally goaded him into doing it.

The patient explicitly does NOT claim "abandonment" but rather he was unhappy with the care that was offered.

I wonder if this could get overturned on appeal? If not, I think we need to consider letting our DEA's lapse and making it clear to pts for full transparency.

 

[myrandom2003]

1. why didn't this guy get a pump?
2. MED is tricky without knowing what they get, My states PDMP calculate people getting Nucynta as getting a very high MED even if they are on 75mg QID.
3. Would having written office protocols in place have protected the practice?
4. This was not tried as medical malpractice correct? How was this tried? If this was tried as malpractice, then tort reforms are needed.

 

[macman]

1. This is why screening referrals is so important

2. Blue state blues

3. Reason # 63 why high dose opioid therapy is a bad idea

 

[lobelsteve]

Surgeon fined $3,000 for amputating patient's wrong leg | CNN

An Austrian court has fined a surgeon 2,700 euros ($3,050) for mistakenly amputating the wrong leg of a patient.

www.cnn.com

Austrian rules must be different.

 

[painfree23]

Surgeon fined $3,000 for amputating patient's wrong leg | CNN

An Austrian court has fined a surgeon 2,700 euros ($3,050) for mistakenly amputating the wrong leg of a patient.

www.cnn.com

Austrian rules must be different.

$3,000 ain’t bad. Plaintiff Should’ve gotten a US lawyer

 

[Agast]

I came across this comment while browsing Reddit. Amazing prison can cut off pain meds cold turkey (this guy admits he was an addict but he did have a prescription) but if a doctor tapers you they owe $7 million

 

[RoloTomassi]

View attachment 346522I came across this comment while browsing Reddit. Amazing prison can cut off pain meds cold turkey (this guy admits he was an addict but he did have a prescription) but if a doctor tapers you they owe $7 million

2400 mg/day oxy? Sounds like BS but fun read

 

[drpainfree]

I've asked this before because I don't know about private practice much -

but wouldn't it be possible when applying for your DEA - to ONLY ask for schedule IV and V privileges?

You can make excellent recommendations all day long for the PCM, but it would seem to make life so much easier if it were impossible (illegal) for you to write an opioid script.

I think I would do this. Maybe must V, so I could write for Lyrica. Even then - you could easily just give recommendations and PCM could write all scripts.

Okay, I've changed my mind. If I were private practice, I wouldn't even apply for a DEA license.

it's why you are not in private practice.

 

[Laryngospasm]

Not sure if it’s BS about the 2400, was just listening to a documentary today about a doctor who was prosecuted after several deaths and was giving 3000 tablets of oxy per month PER PATIENT! Not sure how the pharmacy filled it?

 

[au bon pain]

Not sure if it’s BS about the 2400, was just listening to a documentary today about a doctor who was prosecuted after several deaths and was giving 3000 tablets of oxy per month PER PATIENT! Not sure how the pharmacy filled it?

Insanity

2400 mg/day oxy? Sounds like BS but fun read

Some of these rare birds are still flying.

Saw a pt looking for a new home as their pcp was on the verge of retirement. Guy had been Rxing 1100 tabs of ms ir/er per month for years to this pt. A touch over 4200mme/d. Pt was not invited to join the practice

 

[geauxg8rs]

Insanity



Some of these rare birds are still flying.

Saw a pt looking for a new home as their pcp was on the verge of retirement. Guy had been Rxing 1100 tabs of ms ir/er per month for years to this pt. A touch over 4200mme/d. Pt was not invited to join the practice

A pharmacy was filling that? The ones near me balk at tramadol

 

[Agast]

A pharmacy was filling that? The ones near me balk at tramadol

Probably a mail order pharmacy created specifically to fill drugs other pharmacies don’t want to touch. They don’t have to worry about getting robbed and they don’t ask questions. Doctors use them because they don’t have to worry about prescriptions getting denied. Same goes for mom and pop pharmacies, it’s hard for them to compete with big box so they will accept the more unsavory scripts.

 

[au bon pain]

Probably a mail order pharmacy created specifically to fill drugs other pharmacies don’t want to touch. They don’t have to worry about getting robbed and they don’t ask questions. Doctors use them because they don’t have to worry about prescriptions getting denied. Same goes for mom and pop pharmacies, it’s hard for them to compete with big box so they will accept the more unsavory scripts.

Yup, an ancient mom&pop place.