7/31/2004· Pain Management
I think every doctor has several patients that are etched into his memory. One such patient was Dr. G. He was a doctor, the same age that I was, and he had cancer. Cancer pain is different from other pains
I was asked to assist in the defense of a physician and his practice in a pain management case. The physician was accused of negligence, carelessness and culpable conduct resulting in permanent injuries, pain, suffering and wrongful death. Additional compensation was being sought by the decedent’s spouse for damages related to loss of consortium.
The case involved a patient who had longstanding chronic pain problems stemming from a spinal condition. They had undergone many treatments including surgery prior to their referral to the physician who was the target of this suit. They were subsequently under the care of this provider for nearly five years before they passed away. The patient was found dead in their home and the death certificate listed acute oxycodone intoxication as the cause of death.
My review of the records demonstrated that this patient had received treatment that was solidly within the standard of care for the time period in question. At the time of their referral to the defendant, they had already been receiving high dose opioid therapy for several years from previous providers. The patient was referred for ongoing care to address their refractory pain symptoms. The provider in question assumed responsibility for their opioid analgesics as part of the treatment of this patient. The records demonstrated the defendant performed excellent opioid stewardship with a range of risk mitigation strategies including utilization of urine toxicology examinations, close tracking of medication use and refills as well as regular visits to assess the safety and efficacy of the treatments provided. The patient was treated in a comprehensive fashion with multiple modalities being employed over time to address their symptoms. This comprehensive management strategy helped to limit the patient’s long-term reliance on the opioid analgesics. The provider consistently provided counseling regarding the risks associated with the treatments as well as the importance of patient compliance with dosing instructions. All of these findings supported the conclusion that there was no breech in the standard of care in the treatment this patient received.
I also reviewed records from the coroner who was called to the house on the day this patient was found dead. Their records indicated that some of the medication bottles at the decedent’s home were prematurely “empty”. The police, the coroner, and the decedent’s spouse reportedly undertook a search of the premises to find the “missing medication” but none were located.
As part of my defense for this case I conducted research to establish what was the accepted standard of care during the five-year period this patient was receiving the treatment in question. This is of particular importance as the standard of care regarding the oversight of opioid analgesics has evolved substantially over the past 20+ years. Management that may be criticized by today’s standards may be viewed as fully appropriate when assessed through the lens of what was considered appropriate just five or ten years earlier. My research identified multiple articles and position statements that supported the defendant in this case. My findings demonstrated that the provider’s management was not only well within the standard the care, but actually conformed to the best practice guidelines being employed at the time.
Following my review of the records as well as the research I conducted, I provided an affidavit to the court indicating that the claims of negligence against this provider had no merit. I found that the treatments provided had been fully within the standard of care recognized at the time. The physician’s records actually demonstrated excellent opioid stewardship. Although the patient’s death was tragic, it was most likely the result of patient non-compliance with their medication dosing instructions. Acute intoxication to the opioid analgesics would not have occurred had the patient been using the medication as directed. This non-compliance could not have been predicted by the defendant based on the information available to them at the time. The weight of the evidence available in this case indicated that the claims of negligence being leveled at this provider were meritless. This case was ultimately settled to the defendant’s satisfaction without a trial and without any finding of wrongdoing on the part of the physician in question.
Dr. Joel L. Kent, MD, is an expert in all realms of Pain Medicine and has focused expertise in the prescribing and oversight of opioid analgesics. His specialties include acute and chronic pain management, opioid analgesics, interventional pain management therapies, spinal cord stimulation, intrathecal drug delivery, RSD/CRPS and low back pain. Dr. Kent has provided expert case reviews and testimony for over twenty years. The majority of his expert work has focused on the standard of care in the practice of Pain Medicine and the use of opioid analgesics. Dr. Kent has provided expert case opinions in Federal and State civil courts.
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12/5/2005· Pain Management
Traditionally, pain in children is a topic that has received only minimal attention.Much of our understanding of pain in children has been extrapolated from adult studies.As recently as 20 years ago clinicians felt that it was unnecessary to prevent or treat pain in children because the prevailing opinion was that