ABCD Exchange : April 1999 : In the States - Sanctions for Undertreating Pain

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Oregon Board of Medical Examiners Sanctions Doctor for Undertreating Patients’ Pain

The Oregon Board of Medical Examiners has recently vowed to discipline a physician who failed to give dying patients adequate pain relief. The Board’s action reflects increasing efforts to highlight undertreatment of pain as a very real problem. More commonly, state boards have been on the lookout for cases of overprescribing of narcotic painkillers, reflecting America’s "war on drugs." And, though concerns of diversion remain, illegal drug trafficking is not high on the list of concerns for those trying to provide quality end-of-life care to patients. Now, many individuals and organizations are voicing concerns about undertreatment, and urging medical boards to respond to cases in which best practices are not used in treating patients who are in pain.

According to the March 27 issue of The Oregonian, the Oregon Board has accused a 54-year old pulmonary disease specialist of "unprofessional or dishonorable conduct and gross or repeated acts of negligence." Disciplinary actions have yet to be determined, and could range from a reprimand to revocation of the physician’s medical license. Advocates for dying patients hope that the Board’s action sends a message to providers and helps the public understand that people need not die in overwhelming pain.

The action in Oregon comes on the heels of other efforts to curb the problem of undertreatment. The Federation of State Medical Boards of the United States recently published Model Guidelines for the Use of Controlled Substances for the Treatment of Pain. These guidelines are intended for us by medical boards and other health care regulatory agencies in regulating the use of controlled substances.

As previously reported in Exchange, Senator Ron Wyden (D-OR) held a congressional hearing last fall to raise awareness about the importance of untreated pain and related symptoms at the end of life. Wyden’s staff are currently working on a bill to address issues surrounding pain management. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which evaluates and accredits more than 18,000 health care organizations, is working with the University of Wisconsin-Madison Medical School to make pain assessment and treatment an integral part of the nation’s health care system.

There is no question that American attitudes and expectations about pain at the end-of-life are changing. ABCD hopes that with the implementation of improved standards and physician practices will come the reduction of public confusion and fear about facing the end of life.

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