Malpractice Case: Protecting Yourself and Your Patient Getting Pain Meds

Gordon T. Ownby

Disclosures

May 05, 2020

That specialist's assessment was that the patient was dependent on hydromorphone, and his plan was to stop the hydromorphone and change her to methadone. The specialist expressed his view that, based on his exam and MRI, the patient did not warrant using excessive narcotics to control pain.

Medscape Editor's Key Notes:

  • Understand that prescribing a patient long-term pain medication comes with challenges and scrutiny, from both the medical community and others.

  • Document in a patient's chart what you will prescribe, won't prescribe, and when, in addition to making that clear during in-person visits.

  • Having a plan or contract for pain management between doctor and patient benefits both parties.

The patient continued to see Dr FP for treatment and on several occasions expressed a desire to get off her medications. The patient's daughter told Dr FP of her concerns about her mother's use of narcotics. At one point, approximately 10 years into the back pain issue, Dr FP unsuccessfully attempted to taper the patient's opioids by prescribing clonidine and propranolol. In year 11 of the issue, Dr FP prescribed oxycodone 100 mg four times a day, 350 mg of carisoprodol three times a day, 75 mg of pregabalin twice a day, and 250 mg of sertraline daily. At this time, Dr FP referred his patient back to the second pain management specialist because of his concerns over the patient's drug dependency.

Five days later, the patient's daughter found her at home, face-down on the couch and unresponsive. The coroner characterized the patient's death as accidental and attributed oxycodone toxicity as the cause. In a subsequent lawsuit, the daughter alleged that Dr FP prescribed medication at fatal dosages and missed multiple opportunities to make things better. In his deposition, Dr FP said he disagreed with the coroner's conclusions, testifying that he believed his patient's death was from a heart attack or suicide. The lawsuit resolved informally without a trial.

Whatever the public policy environment on pain relief, when a family practitioner's treatment triggers alerts from consulting specialists, pharmacies, government drug databases, and health insurers about a patient's potential for drug dependency and abuse, a specific plan or "contract" may be a benefit to both.

This case comes from the "Case of the Month" column featured in the member newsletter published by the Cooperative of American Physicians, Inc. The article was originally titled "When Pain Medication Challenges Mount, Implement a Plan."

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