Something else to discuss...

[ERMudPhud]

... other than the lady who died calling 911 from the King-Harbor ER


http://www.nytimes.com/2007/06/17/magazine/17pain-t.html?pagewanted=1&_r=1&ref=magazine

The whole article pissed me off and left me not wanting to prescribe anything more than ibuprofen ever again. Basically some of his patients lied to him repeatedly to get narcotics to abuse and resell. He tried to get authorities to investigate the patients but they refused. Instead the patients testimony was used to find him guilty of drug diversion and sentenced to 30 years in prison. Now those same patients are suing him for the few assets the government didn't confiscate.

This smiley doesn't even begin to express how I feel

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[Hayduke]

The article made me pretty nauseous so I took my laptop and propped it onto my toilet tank while reading the brief linked here.


http://www.doctordeluca.com/Library/WOD/WPS9-McIver/McIverReplyBrief06.pdf

Nothing like a good purge.

 

[Hayduke]

On the other hand, as evidenced by this case, this is a high risk specialty to enter. Pain mgt., by definition, puts you in daily contact with folks that have potential for addiction, unstable social situations, and complaints with few objective verifiers. It also has a fairly comfortable reimbursement profile. As a DO, I flirt with the idea of a part-time cash only manipualtion practice. It can be lucrative and professionally satisfying. The down-side is the cadre of addicts and freaks that come with the job.

In the interest of some discussion; as an EM intern in 4 days, I'm wondering about my potential exposure to this kind of situation working out of the ED. Does anyone have any examples of EPs getting prosecuted for this?

While it is not optimal care, it seems like sharply limited Rx. of narcs would offer some protection. The model I have seen sounds like, "here's 24-36 hours of opioid coverage. You must see your FP/pain doc for any more." Of course with more cases like these, the chronic pain managers will continue to shrink.

 

[EctopicFetus]

NO EP should ever get in trouble for this. I have on numerous occasions told pts, look I have no doubt you are in pain BUT this is your 4th visit in 12 days. I am not a dentist, here are some resources for dental work, and what NON-narc would you like. Its a fact of life for us.

 

[Jeff698]

This is a true double edged sword. You can, as in this case, go to jail for the rest of your life for "over-prescribing" narcotics. You can also be sued, successfully, for "under" treating pain.

The real joy is that there is no (and can be no) solid definition for what constitutes adequate treatment of pain. It is, by its nature, variable between individuals.

I haven't hear of cases involving EPs treating acute pain in the ED with even whopping doses of IV narcotics (assuming they actually monitor the patient for, say, apnea) nor for over-prescribing narcotics in anything resembling typical standard amounts.

My approach is to relatively aggressively treat pain in the ED with whatever it takes, including large amounts of IV dilaudid if necessary. I'm also relatively liberal with prescribing vicodin. I do not give more than 30 pills and refuse, under any circumstances, to include any refills. If they still need PO pain meds, they need to see their PCP.

Hopefully, this will keep me out of trouble while allowing me to care for my patients. Maybe I'll be wrong, but that's my approach today.

Take care,
Jeff

 

[Apollyon]

I'm also relatively liberal with prescribing vicodin. I do not give more than 30 pills and refuse, under any circumstances, to include any refills. If they still need PO pain meds, they need to see their PCP.

Hopefully, this will keep me out of trouble while allowing me to care for my patients. Maybe I'll be wrong, but that's my approach today.

Take care,
Jeff

30 Vicodin? I entice the patients to follow up with their PMD by giving 5 or 7 oxycodone. Even the renal stone patients get, maybe 13 Dilaudid 2mg - much less if it's a 5mm stone, or obstructing, because I've had good luck (knock on wood - no pun intended) with setting up pts to f/u with urology the next day or later that day, to get it basketed or lithotripted (ouch - is that a word?).

And I've never (again, knock wood) had a renal colic patient bounce back for inadequate analgesia.

 

[Hard24Get]

... other than the lady who died calling 911 from the King-Harbor ER


http://www.nytimes.com/2007/06/17/magazine/17pain-t.html?pagewanted=1&_r=1&ref=magazine

The whole article pissed me off and left me not wanting to prescribe anything more than ibuprofen ever again. Basically some of his patients lied to him repeatedly to get narcotics to abuse and resell. He tried to get authorities to investigate the patients but they refused. Instead the patients testimony was used to find him guilty of drug diversion and sentenced to 30 years in prison. Now those same patients are suing him for the few assets the government didn't confiscate.

This smiley doesn't even begin to express how I feel

Simply horrific. We got to an era where we got less bashful about treating pain, and pain specialists were born to help chronic pain sufferers. Now, docs are going to feel like their hands are tied. And that they had the nerve to turn his own civil responsibility against him by saying if he suspected something he should have cut them off - well he did once he had an opportunity to! The juror's reasoning was ridiculous, "it's just excessive, the amounts of pain medicine they were taking", and then comparing it to how much they took when they sprained their pinky toe? We really need a jury of peers for these cases, not medical know-nothings. And a pain specialist saying he only goes for 5/10 pain? Any hack can pull that off - why didn't the defendant recruit his own expert witness? PLEASE tell me he is going to get parole shortly. Really the worse thing I've ever heard.

Although, I would think by treating acute pain and having electronic systems to check for repeat offenders the EP is relatively immune from this unless they really do cause respiratory depression or send someone home as a 10/10.

 

[ditch doctor]

... other than the lady who died calling 911 from the King-Harbor ER


http://www.nytimes.com/2007/06/17/magazine/17pain-t.html?pagewanted=1&_r=1&ref=magazine

The whole article pissed me off and left me not wanting to prescribe anything more than ibuprofen ever again. Basically some of his patients lied to him repeatedly to get narcotics to abuse and resell. He tried to get authorities to investigate the patients but they refused. Instead the patients testimony was used to find him guilty of drug diversion and sentenced to 30 years in prison. Now those same patients are suing him for the few assets the government didn't confiscate.

This smiley doesn't even begin to express how I feel

After reading this article, I think I threw up a little in my mouth...

 

[DeLaughterDO]

We really need a jury of peers for these cases, not medical know-nothings.

Agree 10000000000000000000000000000000000% I don't think any med-mal case should have a jury from the general population - that is not a jury of MY peers... they know nothing of medicine or medical practice, and as such cannot possibly understand the facts put before them. This is why so many med-mal lawsuits end up becoming tear-jerk-fests by the complainants.



jd

 

[DeLaughterDO]

After reading this article, I think I threw up a little in my mouth...

like that? I know what you mean. The "addicts" who tricked, then testified against this guy should be sent out to dry.

jd

 

[ditch doctor]

Agree 10000000000000000000000000000000000% I don't think any med-mal case should have a jury from the general population - that is not a jury of MY peers... they know nothing of medicine or medical practice, and as such cannot possibly understand the facts put before them. This is why so many med-mal lawsuits end up becoming tear-jerk-fests by the complainants.



jd

And I thought my high school football coach asking for 110% was a lot.... wow....