Malpractice Case: Protecting Yourself and Your Patient Getting Pain Meds

Gordon T. Ownby


May 05, 2020

Over the past 25 years, physicians have faced a distinct change in attitudes on prescription pain medication. Policy discussions in years past to promote more liberal use of narcotics have been replaced by the current war on opioid addiction. To be sure, a physician attempting to assist a patient on long-term pain medication faces special challenges.

Dr FP, a family practitioner, had been treating his patient for a number of years for a variety of medical complaints, including back pain. When the back pain became chronic, Dr FP's initial treatment plan included oxycodone 40 mg three times a day and cyclobenzaprine. Two months later, Dr FP received a letter from the patient's orthopedic surgeon, who noted that the patient had a tolerance to narcotic medication and who urged Dr FP to take the patient off pain meds while he prescribed a lidocaine patch. Shortly afterward, the patient refused oxycodone and Dr FP prescribed a combination of acetaminophen and tramadol for pain.

On Dr FP's referral, the patient saw a pain management physician a year later. That specialist advised Dr FP that the patient was on acetaminophen and hydrocodone for breakthrough pain, plus duloxetine and carisoprodol. The patient did not continue treatment with the pain specialist, and about 3 years later, Dr FP had to disapprove a refill for carisoprodol until the patient agreed to stop taking the medication in excess of prescribed amounts.

The next year, the patient's health insurer wrote to Dr FP about the possibility of the patient's inappropriate use of controlled substances and an indication that the patient was receiving acetaminophen and hydrocodone from a different physician. Though Dr FP discussed that he would not prescribe medications in addition to those that she was receiving from another physician, Dr FP's chart did not reflect such discussion.

Two years on, a neurosurgeon wrote to Dr FP detailing an exam of the patient showing stenosis and facet disease at L4-5 and L5-S1. The neurosurgeon spoke to the patient about her seeing a pain medicine specialist to wean her off oral opiates. Dr FP's chart did not show any efforts to taper her off pain medications, but on Dr FP's referral, the patient saw another pain management specialist several months later.


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