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nvrsumr

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  1. Attending Physician
Wow damned if you do damned if you don't
 
nvrsumr said:
www.wdrb.com

$7 million awarded to family of man who killed himself after pain medication denied

A lawsuit blamed a man's suicide on a St. Matthews pain clinic, and a jury agrees.
www.wdrb.com www.wdrb.com

Not a lot of details but appears doc refused to keep a patient on regimen prescribed by another(out of state) doc.

Probably not worth it to ever prescribe opioids.
Click to expand...
I bet if true this is what bugged the jury //Slone was advised that he would need to wait for six days for his appointment.// You either take the case or you do not. If you take the case, then you need to see the patient immediately. Prescribing Oxycontin without seeing the patient, lowering the dose without seeing the patient, "not having the records" is problematic (that is what phones are for). For example, if i was the plaintiff i could argue that Slone was actively suicidal, that seeing him would have made that clear, and that the doc simply gave him the method to carry out his suicide. I don't know how the rest of you practice but i would never prescribe opioids to someone i have never seen. One exception - a colleague runs out of scripts. Did that once. Shame on me.
 
This is insane …. There is no negligence, how could they settle this case?
 
This is just outrageous. If that doctor actually did prescribe the meds this patient wanted then I bet he will be sued 2 years later for getting the patient hooked on painmeds.
You can't win this game. Sometimes the best solution is not to play. As wopr said long time ago
 
Out of pain meds, how about go to the emergency room, how about cal your normal clinic and have them refill and have a family member overnight the meds to you. This might be the most insane lawsuit I have ever seen.
 
I wish we had some more details. On face, this is very worrisome. Lawyers across the country are going to take this and run. Why wouldn’t they? How can you protect yourself from this?
 
Unbelievable. Another argument to not partake in the opioid prescription game.

And for tort reform.
 
jsaul said:
This is just outrageous. If that doctor actually did prescribe the meds this patient wanted then I bet he will be sued 2 years later for getting the patient hooked on painmeds.
You can't win this game. Sometimes the best solution is not to play. As wopr said long time ago
Click to expand...
"How about a nice game of chess?"
 
What the actual ef. This has to be the most ridiculous thing ever.
 
Limited data provided here but to recap:
"The jury's verdict awards Slone's family $6,925,000, including $3,000,000 specifically for his daughter. The lawsuit, filed in 2018, said Slone was involved in a car crash in 2011 that left him paralyzed and other severe injuries. Slone became a regular patient of Commonwealth Pain and Spine for pain management from Jan. 2014 until his death, the lawsuit states. "

He was an established patient with a relationship with that clinic for 4 years prior to the suicide.

"After a surgery in California in 2017, Slone entered an inpatient recovery center in San Diego, where he was prescribed oxycodone and oxycontin."
I assume the clinic felt the patient had discharged himself from their care.

"While returning to Louisville in August, Slone went to the emergency room at Baptist Health for a dislocated hip and ulcer. He was prescribed a small amount of pain medication, as he had run out of the prescription from the San Diego clinic, and was advised to follow up with Commonwealth Pain and Spine. According to the suit, after he was discharged, he called Commonwealth Pain and Spine and requested a "bridge prescription.""

The sued team probably thought they were in the clear. This smells like poor communication, a patient that likely raised a lot of red flags with aggressively contacting the clinic and ER visits, and likely very poor documentation from the clinic side.

"From Sept. 10 to 12, Slone visited Baptist Hospital Louisville and Norton Brownsboro four times in seek of relief, the lawsuit states. Slone and his wife, Sonya Slone, contacted Commonwealth Pain and Spine a combined 12 times during a 36-hour period prior to his suicide to request pain medication"

Sad case all around
 
I am sure inpatient recovery center means inpatient rehab center.
So my question to all of you reading this is, assuming the facts here are the bulk of the important facts, what would you do differently than this doctor did?
Me—nothing. I would do nothing differently. I would try to understand the situation by sending for records and I would absolutely never continue a massive dose of “OxyContin and oxycodone” that was prescribed by inpatient rehab.
Perhaps I would give the patient specific information about an outpatient treatment center (and document this), but who knows what difference that would make.
My mind is blown by this case.
 
ateria radicularis magna said:
I am sure inpatient recovery center means inpatient rehab center.
So my question to all of you reading this is, assuming the facts here are the bulk of the important facts, what would you do differently than this doctor did?
Me—nothing. I would do nothing differently. I would try to understand the situation by sending for records and I would absolutely never continue a massive dose of “OxyContin and oxycodone” that was prescribed by inpatient rehab.
Perhaps I would give the patient specific information about an outpatient treatment center (and document this), but who knows what difference that would make.
My mind is blown by this case.
Click to expand...
I would do nothing different.
Collect the records from inpatient rehab.
start de-escalating opioids as slowly and gently; otherwise encourage second opinion in management
prepare for legal battle if necessary.
 
ateria radicularis magna said:
I am sure inpatient recovery center means inpatient rehab center.
So my question to all of you reading this is, assuming the facts here are the bulk of the important facts, what would you do differently than this doctor did?
Me—nothing. I would do nothing differently. I would try to understand the situation by sending for records and I would absolutely never continue a massive dose of “OxyContin and oxycodone” that was prescribed by inpatient rehab.
Perhaps I would give the patient specific information about an outpatient treatment center (and document this), but who knows what difference that would make.
My mind is blown by this case.
Click to expand...
Timeline still a little hazy. After inpatient discharge, while returning to KY in August, suffered a dislocated hip and ulcer? ER/hospitalized? Why did the inpatient rehab not give him enough to cover travel? Then pain clinic still wasn't able to see him until after 9/10-9/12?

Things I would've done differently, in hindsight:
-never taken him 3 years ago, but assuming so...
-worked him in sooner if he was an established patient of several years, complicated medical history of paralysis, recent surgery and inpatient stint, ER upon coming back for hip dislocation and ulcer
-gotten inpatient medical records sooner
-weaned slower than 50% drop
-given withdrawal meds
-documented better
 
RoloTomassi said:
Timeline still a little hazy. After inpatient discharge, while returning to KY in August, suffered a dislocated hip and ulcer? ER/hospitalized? Why did the inpatient rehab not give him enough to cover travel? Then pain clinic still wasn't able to see him until after 9/10-9/12?

Things I would've done differently, in hindsight:
-never taken him 3 years ago, but assuming so...
-worked him in sooner if he was an established patient of several years, complicated medical history of paralysis, recent surgery and inpatient stint, ER upon coming back for hip dislocation and ulcer
-gotten inpatient medical records sooner
-weaned slower than 50% drop
-given withdrawal meds
-documented better
Click to expand...
What withdrawal meds? U think that would have prevented him from killing himself? He didn’t even wait for the withdrawal to set in..
 
painfree23 said:
What withdrawal meds? U think that would have prevented him from killing himself? He didn’t even wait for the withdrawal to set in..
Click to expand...
Anyone who texts "they denied script im done love you" and offs himself obviously has issues so I'm not going to try and say yes it would've prevented but wouldn't hurt. Sounds like he got 50% dose and was waiting days for the rest, so withdrawal probably did set in. Clonidine and zofran during weans. Again we're talking about ideal management in hindsight here
 
As many have said, the only winning move is not to play. If you don’t start them on it in the first place, it’s not your mess when rehab quadruples the dose then tries to dump them on you. “I’m sorry, I don’t recommend or prescribe opioids. If you feel this is an emergency you need to go to the ER.” Patients who threaten suicide if I won’t prescribe get ride to the ER for involuntary hole, or if they call in the threat they get law enforcement called to their address for a safety check.
 
Doesn’t this clinic/patient have some sort of opioid agreement in place? Multiple outside sources of opioids would violate that agreement and grounds for dismissal or referral to detox.

It’s written somewhere in my office policies that that we do not prescribe fentanyl/methadone/opana/OxyContin and our clinic limit is 60mme (for non-active cancer related pain).

I wonder if having policies in place would have protected in anyway.
 
Agast said:
Surprised this verdict came out of Kentucky. I wonder how much of the jury was on prescription pain medicine.
Click to expand...
Posted this in the private forum:

Can’t believe Kentucky’s courts would allow a case like that to be heard considering their state was one of the most ravaged by the opioid epidemic and collected a ton of $$ from their lawsuit against opioid manufacturers and distributors.
 
this makes little sense.

when that happens, what pops in my mind is that the defense lawyer was incompetent.

from what I get - he had injuries 2011. was in San Diego and went to rehab (not drug) and there they basically loaded him up with oxy.

travelled to Kentucky. admitted to hospital with hip dislocation, discharged on only a little med. he didn't follow up with his pain doc in California, instead called the same name company in Kentucky demanding his high dose treatment.

apparently, they did fill 1 prescription for 55% of his usual dose, then they denied further refills.

why was he not contacting his pain doctor in San Diego?

why was he not going back to San Diego where he apparently lived?

if he didn't get the refill prescription, why didn't he go right back to the hospital where they had given him a prescription?

and why would the Kentucky pain doc write any prescriptions for him?
 
Ducttape said:
this makes little sense.

when that happens, what pops in my mind is that the defense lawyer was incompetent.

from what I get - he had injuries 2011. was in San Diego and went to rehab (not drug) and there they basically loaded him up with oxy.

travelled to Kentucky. admitted to hospital with hip dislocation, discharged on only a little med. he didn't follow up with his pain doc in California, instead called the same name company in Kentucky demanding his high dose treatment.

apparently, they did fill 1 prescription for 55% of his usual dose, then they denied further refills.

why was he not contacting his pain doctor in San Diego?

why was he not going back to San Diego where he apparently lived?

if he didn't get the refill prescription, why didn't he go right back to the hospital where they had given him a prescription?

and why would the Kentucky pain doc write any prescriptions for him?
Click to expand...

Does anyone know if the pain medications he wanted helped or made him feel better?
 
he thought they helped...



time to reiterate my point - don't start people down this horrible path. yes, Legacy patients present a conundrum. lets not make any more.
 
Ducttape said:
and why would the Kentucky pain doc write any prescriptions for him?
Click to expand...
I thought he was their established patient, was seen since 2014(?) so they had a history of prescribing for him
 
not to hijack a threat, but I had a patient with post stroke central pain syndrome who was on high dose oxycontin. she came to me for consultation and I expressed sympathy given the difficult prognosis for this condition. I said upfront I was only comfortable providing various neuropathics and low dose opioids and she agreed. of course at follow-up she said the medications weren't working and if she wasn't back on her insane oxycontin regimen, she would commit suicide or start getting drugs off the street.

i told her i wouldn't change my stance and she was encouraged to seek a second opinion or go to academic center for consideration of DBS.
this story reminded me of the suicide threat.

How do you guys manage post stroke central pain syndrome??
 
JelloIsJigglin said:
not to hijack a threat, but I had a patient with post stroke central pain syndrome who was on high dose oxycontin. she came to me for consultation and I expressed sympathy given the difficult prognosis for this condition. I said upfront I was only comfortable providing various neuropathics and low dose opioids and she agreed. of course at follow-up she said the medications weren't working and if she wasn't back on her insane oxycontin regimen, she would commit suicide or start getting drugs off the street.

i told her i wouldn't change my stance and she was encouraged to seek a second opinion or go to academic center for consideration of DBS.
this story reminded me of the suicide threat.

How do you guys manage post stroke central pain syndrome??
Click to expand...
Neuropathics and bup.
 
Ducttape said:
he thought they helped...



time to reiterate my point - don't start people down this horrible path. yes, Legacy patients present a conundrum. lets not make any more.
Click to expand...
I 100% agree with this. I joined a practice and am stuck with our legacy patients to some degree. I think those are legally, the highest risk but those legacy patients from other clinics that come to me are no longer legacy patients. myself and my partners are the gatekeepers for our clinic and at the time of consult can make it clear that we are going to titrate to a reasonable dose (at or under 90MED is the goal). if they want to play ball, great, if not, then I give them a list of other providers they can see assuming they havent walked out on me by that point.
 
Ducttape said:
this makes little sense.

when that happens, what pops in my mind is that the defense lawyer was incompetent.

from what I get - he had injuries 2011. was in San Diego and went to rehab (not drug) and there they basically loaded him up with oxy.

travelled to Kentucky. admitted to hospital with hip dislocation, discharged on only a little med. he didn't follow up with his pain doc in California, instead called the same name company in Kentucky demanding his high dose treatment.

apparently, they did fill 1 prescription for 55% of his usual dose, then they denied further refills.

why was he not contacting his pain doctor in San Diego?

why was he not going back to San Diego where he apparently lived?

if he didn't get the refill prescription, why didn't he go right back to the hospital where they had given him a prescription?

and why would the Kentucky pain doc write any prescriptions for him?
Click to expand...
Clearly he has psych issues that the opioids were treating. I guess the family would not have sued if he took a whole month script in one mouthful and o/d?
 
geauxg8rs said:
Clearly he has psych issues that the opioids were treating. I guess the family would not have sued if he took a whole month script in one mouthful and o/d?
Click to expand...
100%, died of mental health illness, not of chronic pain and lack of medications. High risk to be on opioids if he was this labile.

I feel as though the few clinics keeping up prescribing to this type of patient put us all at risk when the patient ends up coming to a different clinic, it’s a shame the primary pain clinic took no legal reapinsibility.
 
Ducttape said:
this makes little sense.

when that happens, what pops in my mind is that the defense lawyer was incompetent.

from what I get - he had injuries 2011. was in San Diego and went to rehab (not drug) and there they basically loaded him up with oxy.

travelled to Kentucky. admitted to hospital with hip dislocation, discharged on only a little med. he didn't follow up with his pain doc in California, instead called the same name company in Kentucky demanding his high dose treatment.

apparently, they did fill 1 prescription for 55% of his usual dose, then they denied further refills.

why was he not contacting his pain doctor in San Diego?

why was he not going back to San Diego where he apparently lived?

if he didn't get the refill prescription, why didn't he go right back to the hospital where they had given him a prescription?

and why would the Kentucky pain doc write any prescriptions for him?
Click to expand...

Agree, assuming he was a legacy patient on high-dose medications that went out of state and was lost to the clinic for several months, when the patient called the only answer should have been an office visit, but not necessarily immediately. His poor planning is not your emergency. First available OV is fine.

If the patient is going to run out of meds before then, he should contact the prior prescriber or go to the ER to get meds until the scheduled OV. Never in a million years would I send a "bridge script" or change the dose without seeing the patient. During the OV is the time to come up with a safe plan.
 
Ferrismonk said:
Agree, assuming he was a legacy patient on high-dose medications that went out of state and was lost to the clinic for several months, when the patient called the only answer should have been an office visit, but not necessarily immediately. His poor planning is not your emergency. First available OV is fine.

If the patient is going to run out of meds before then, he should contact the prior prescriber or go to the ER to get meds until the scheduled OV. Never in a million years would I send a "bridge script" or change the dose without seeing the patient. During the OV is the time to come up with a safe plan.
Click to expand...

If only there were guidelines for handling these kinds of situations.
 
all this for a 99214

no effing way

i know some of you believe that taking on these patients or prescribing opioids in general is somehow your "duty". its not. you really really don't have to write these scripts.
 
Also, do any of you document anything about mental health, counseling, advised to go to ED if thoughts of suicide, etc, for a patient like this. I’m currently making a macro as we speak after this.
 
SSdoc33 said:
all this for a 99214

no effing way

i know some of you believe that taking on these patients or prescribing opioids in general is somehow your "duty". its not. you really really don't have to write these scripts.
Click to expand...

Exactly. All of this for 99214? Document more, get him in immediately, etc. How about drop by his house and make him some tea?

Certainly a tragedy but in no way caused by the physician. This is very disturbing and will be used to manipulate physicians to prescribe opioids.
 
SSdoc33 said:
all this for a 99214

no effing way

i know some of you believe that taking on these patients or prescribing opioids in general is somehow your "duty". its not. you really really don't have to write these scripts.
Click to expand...

If your clinic is HOPD-based you also can charge a facility fee. That's a good little bit of juice.
 
NJPAIN said:
Exactly. All of this for 99214? Document more, get him in immediately, etc. How about drop by his house and make him some tea?

Certainly a tragedy but in no way caused by the physician. This is very disturbing and will be used to manipulate physicians to prescribe opioids.
Click to expand...
I think it'll have the opposite effect honestly. Doctors will be even more hesitant to write opioids for people.
 
Ferrismonk said:
I think it'll have the opposite effect honestly. Doctors will be even more hesitant to write opioids for people.
Click to expand...
Exactly, the few PCPs who do write them will be more likely to dump them
 
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