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Could I Be Liable For Prescribing Narcotics???
Hello everyone,
I was not sure where to post this, but I could use some help, advice, suggestions, etc....please!
I'm a newly practicing pain management doctor. Like many pain management Dr's I prescribe narcotics and am concerned with the growing problem of patients becoming addicted.
Problem: I prescribe a few narcotics to a patient over a period of 2 years. I find out later on, that the patient claims to have become addicted to these narcotics.
My question: Can I be held Liable/responsible for failure to recognize his addiction, not screening urine for signs of possible abuse and not monitoring his blood levels, liver, kidney for possible damage???
The patient was coming in every month for new prescriptions for 2 years and just recently moved to visits every 2 months. We started off with vic's and moved to Norco, then moved to currently giving ms contin 30mg 4xday for break thru and Duragesic patch 200mc every 2 days. The patient looks fine when he comes in. Granted I'm a specialist in pain management and know more about drugs then my patient. Unless he tells me he is having problems, like addiction, how am I to know what's wrong?
Could I really be sued for this?
Please tell me what you think,
DrRosenPM
I was not sure where to post this, but I could use some help, advice, suggestions, etc....please!
I'm a newly practicing pain management doctor. Like many pain management Dr's I prescribe narcotics and am concerned with the growing problem of patients becoming addicted.
Problem: I prescribe a few narcotics to a patient over a period of 2 years. I find out later on, that the patient claims to have become addicted to these narcotics.
My question: Can I be held Liable/responsible for failure to recognize his addiction, not screening urine for signs of possible abuse and not monitoring his blood levels, liver, kidney for possible damage???
The patient was coming in every month for new prescriptions for 2 years and just recently moved to visits every 2 months. We started off with vic's and moved to Norco, then moved to currently giving ms contin 30mg 4xday for break thru and Duragesic patch 200mc every 2 days. The patient looks fine when he comes in. Granted I'm a specialist in pain management and know more about drugs then my patient. Unless he tells me he is having problems, like addiction, how am I to know what's wrong?
Could I really be sued for this?
Please tell me what you think,
DrRosenPM
Dr. Rosen, I think it is quite a fine post and appropriate to post here, but again I would make additional inquiries to discuss the matter with other pain management specialists in your region of your state. From my experience as a patient and as a medical professional (not a phsyician), I will share with you my experience with having two ruptured discs at L5/S1 and L4/L5. I addentially, at the young age of 42 have osteoarthritis that shows up rather profoundly on an x-ray of facet inflammation with spurs due to the stenosis and the vertebrea rubbing together.
I have a wonderful pain management specialist who did indeed take a felowship in pain management in addition to being a practicing anesthesiologist. I know most pain management specialist are typically either anesthesioligist or physiatritrists (rehabilitative medicine for those reading this post and may not be familar with all the new medical specialties).
In any case, my Doctor, who sees me monthly, has me sign a contract that I will submit to a drug test without any prior notice if and when he thinks it may be needed or whether it just comes up randomly as a patient that needs one. My contract also states that I will not seek nor be allowed to receive any pain management medications, controlled or otherwise from any other physician. He requires me to use one pharmacy and provide to him that pharmacies name, number and senior pharmist. I must bring in any and all bottles of medication that he has prescribed for any pill counts if necessary, although he has never done a pill count on me.
Before he did facet injections on me, and later had an orthopaedic surgeon perform two microdiscectomies on me, I was managed on doeses of schedule II controlled substances, long acting and one for breakthrough. After the discectomy, he, my PM specialist, did a bilateral radio frequency sonic nerve ablation in, around or about the nerves that were causing me the most pain.
Since that time, I no longer take any of the schedule II medications at all!!! I am managed with strong prescription NSAIDs and hyrocodone, 10 mg with 325 of apap, #90 per month PRN and always have 25%-35% of my medication left over at the end of the month when I go back to see him.
He is a wonderful doctor and tries to involve me in every aspect of my treatment, his goals are for he and I to work together to keep me employed (I am an engineer and drive constanctly for work, without pain management I would not be able work for my current employer and would likely have to find a job making much less money). I am also a paramedic and did go to nursing school for 3.5 years but left that BSN program to enter another career field having become disenganted with how males were treated as RNs at the time (1985). My father is an internist, my oldest brother is a psychiatrist, my mom is a pediatric RN, retired, another brother is an MSW who runs an inpatient psych unit at a large general hospital and I have a sister who is a Critical Care RN with over 20 years CCU/ICU experience and is now working in the emergency department and just received her CEN (certified emergency nurse). I am only giving you this information to qualify that while I am a chronic pain patient, I grew up in a medical family with both my mom and dad having similar back issues with both having had open, invasive procedures including fusions. So I know a bit about treatment, outcomes, phamacology, DEA regulations, and anatomy and physiology of disease processes.
If I can be of futher help to you, as a patient's experience and to give you an idea of what pain management physicians with up to 400 regular patients in their practice, I will be more than happy to share with you their procedures to protect themselves from DEA problems as well as patient problems.
I apologize for the long post, but I did want you to know where I am coming from when I respond to your post.
I think you are one of the good ones out there. There are so many pracitioners that are limiting their medication management of pain to cancer patients, and performing procedures only on other chronic pain patients such as someone in my position who would not be able to work my current job as an engineer and lead an active enough life to pick up my 16 month old grandson when he tugs at my pants raising his arms for me to pick him up, without the schedule III prn medications and the facet injections every 9-12 months and NASAIDs he prescribes me, along with a regimen of self physical therapy through stretching exercises twice daily and walking.... now up to several miles per day.
NOW ON TO YOUR LIABILITY QUESTIONS..... In addition to being an engineer for an insurance carrier, I was a licensed Property and liability agent for many years while still working as a safety engineer for the brokerage form I worked for. I dealt with several physician practices that I insured for professional liability (medical malpractice for those of you that don't know that insurance lingo).
I have never seen, nor heard of (from the MedMal insurers I represented) of any patient suing based upon withdrawl from appropriately prescribed opiates. There have been some patients who were dropped from pain management practices for doctor shopping, for having medication in their drug screens that were not prescribed like cocaine and for selling their medications. These patients are often given enough medication with a regimen for detoxification and a prescription for a clonidine patch. It was imparitive and emphasized boldly that these patients not seek to detoxify themselves. They were given a list of additional pain management specialists in the area that were taking on new patients, they were also given referall information to detoxification facilities and doctors that specialize in addiction medicine while not implying that the patient may still need pain management.
Many of these patients, I was told threatened to call the state medical boards or sue, but they were people that were criminals, drug addicts and clearly in violoation of their pain management contracts with their pain management physician, so these were just ticked off patients that were caugt in lies, fraud and deceipt.
I would be more than happy, in the context of a long term chronic pain patient that is hyper-compliant with all of my pain management doctors suggestions, presriptions and my pain management contract, to provide you with any forms that I had to sign, any information that my doctor made available to me describing what was expected of me, including the overall introduction to his practice and requirements for being prescribed controlled substances if you like. The documents are not copyrighted, although I will check when I see my doctor on 1.3.07, next week to make sure he does not mind, I am sure he won't he is a strong proponent of helping patients to lead active lives, able to work and fall into the cycle of unemployabilty, depression, anxiety, exascerbated pain and disability.
I know that a reply post from a "patient" was likely what you were not looking for, but as a medical professional, as a chronic pain patient for many years who went from high dosages of round the clock schedule II medications to low to moderate doess of PRN schedule III medications, believe me, I have some things to share that may benefit your practice if you if are interested in any information, beyond just my experience and opinions, but actual supporting documentation, that may be of help for you.
Feel free to contact me at ***@****
With Kindest regard, JimmyK
I have a wonderful pain management specialist who did indeed take a felowship in pain management in addition to being a practicing anesthesiologist. I know most pain management specialist are typically either anesthesioligist or physiatritrists (rehabilitative medicine for those reading this post and may not be familar with all the new medical specialties).
In any case, my Doctor, who sees me monthly, has me sign a contract that I will submit to a drug test without any prior notice if and when he thinks it may be needed or whether it just comes up randomly as a patient that needs one. My contract also states that I will not seek nor be allowed to receive any pain management medications, controlled or otherwise from any other physician. He requires me to use one pharmacy and provide to him that pharmacies name, number and senior pharmist. I must bring in any and all bottles of medication that he has prescribed for any pill counts if necessary, although he has never done a pill count on me.
Before he did facet injections on me, and later had an orthopaedic surgeon perform two microdiscectomies on me, I was managed on doeses of schedule II controlled substances, long acting and one for breakthrough. After the discectomy, he, my PM specialist, did a bilateral radio frequency sonic nerve ablation in, around or about the nerves that were causing me the most pain.
Since that time, I no longer take any of the schedule II medications at all!!! I am managed with strong prescription NSAIDs and hyrocodone, 10 mg with 325 of apap, #90 per month PRN and always have 25%-35% of my medication left over at the end of the month when I go back to see him.
He is a wonderful doctor and tries to involve me in every aspect of my treatment, his goals are for he and I to work together to keep me employed (I am an engineer and drive constanctly for work, without pain management I would not be able work for my current employer and would likely have to find a job making much less money). I am also a paramedic and did go to nursing school for 3.5 years but left that BSN program to enter another career field having become disenganted with how males were treated as RNs at the time (1985). My father is an internist, my oldest brother is a psychiatrist, my mom is a pediatric RN, retired, another brother is an MSW who runs an inpatient psych unit at a large general hospital and I have a sister who is a Critical Care RN with over 20 years CCU/ICU experience and is now working in the emergency department and just received her CEN (certified emergency nurse). I am only giving you this information to qualify that while I am a chronic pain patient, I grew up in a medical family with both my mom and dad having similar back issues with both having had open, invasive procedures including fusions. So I know a bit about treatment, outcomes, phamacology, DEA regulations, and anatomy and physiology of disease processes.
If I can be of futher help to you, as a patient's experience and to give you an idea of what pain management physicians with up to 400 regular patients in their practice, I will be more than happy to share with you their procedures to protect themselves from DEA problems as well as patient problems.
I apologize for the long post, but I did want you to know where I am coming from when I respond to your post.
I think you are one of the good ones out there. There are so many pracitioners that are limiting their medication management of pain to cancer patients, and performing procedures only on other chronic pain patients such as someone in my position who would not be able to work my current job as an engineer and lead an active enough life to pick up my 16 month old grandson when he tugs at my pants raising his arms for me to pick him up, without the schedule III prn medications and the facet injections every 9-12 months and NASAIDs he prescribes me, along with a regimen of self physical therapy through stretching exercises twice daily and walking.... now up to several miles per day.
NOW ON TO YOUR LIABILITY QUESTIONS..... In addition to being an engineer for an insurance carrier, I was a licensed Property and liability agent for many years while still working as a safety engineer for the brokerage form I worked for. I dealt with several physician practices that I insured for professional liability (medical malpractice for those of you that don't know that insurance lingo).
I have never seen, nor heard of (from the MedMal insurers I represented) of any patient suing based upon withdrawl from appropriately prescribed opiates. There have been some patients who were dropped from pain management practices for doctor shopping, for having medication in their drug screens that were not prescribed like cocaine and for selling their medications. These patients are often given enough medication with a regimen for detoxification and a prescription for a clonidine patch. It was imparitive and emphasized boldly that these patients not seek to detoxify themselves. They were given a list of additional pain management specialists in the area that were taking on new patients, they were also given referall information to detoxification facilities and doctors that specialize in addiction medicine while not implying that the patient may still need pain management.
Many of these patients, I was told threatened to call the state medical boards or sue, but they were people that were criminals, drug addicts and clearly in violoation of their pain management contracts with their pain management physician, so these were just ticked off patients that were caugt in lies, fraud and deceipt.
I would be more than happy, in the context of a long term chronic pain patient that is hyper-compliant with all of my pain management doctors suggestions, presriptions and my pain management contract, to provide you with any forms that I had to sign, any information that my doctor made available to me describing what was expected of me, including the overall introduction to his practice and requirements for being prescribed controlled substances if you like. The documents are not copyrighted, although I will check when I see my doctor on 1.3.07, next week to make sure he does not mind, I am sure he won't he is a strong proponent of helping patients to lead active lives, able to work and fall into the cycle of unemployabilty, depression, anxiety, exascerbated pain and disability.
I know that a reply post from a "patient" was likely what you were not looking for, but as a medical professional, as a chronic pain patient for many years who went from high dosages of round the clock schedule II medications to low to moderate doess of PRN schedule III medications, believe me, I have some things to share that may benefit your practice if you if are interested in any information, beyond just my experience and opinions, but actual supporting documentation, that may be of help for you.
Feel free to contact me at ***@****
With Kindest regard, JimmyK
Please be advised, DrRosenPM is NOT the doctor but rather the patient, one who has been researching and trying to develop some sort of a case against their PM doctor and possibly illegal activities since at least January 2006. Please see this link for details to verify. They have been posting on numerous forums under both "DOCTOR" and "Patient" moniker's. http://www.expertlaw.com/forums/showthread.php?t=16552 Please don't fall for this scam. or aid and abet them, Thank You,
Crystalball
Crystalball
All PT's I've ever been to weren't MD's. What is a PM & are
you in US? The rules go up/dwn state to state as far as dosage
& type script & how often. You must have a board to contact &
ask for regulations & codes. Many states have them on net &
state board can give you url. At any given time, states can
request pharmacies to tell if they see controlled substance
prescribed often to a patient. They can not give patient info
but can give Dr's name after filing proper papers of release.
Most states don't waste the time unless they are known for
street sales. You can do this anonymous by phone. Just hit me,
PM is pain mngmnt. Dah! Anyway, same response applies. Call
State board for their ruling on drugs. If with in state range
& not abuse, you're in the wrong profession for not using
your common sense but would probably fall under same rules as
MD script writing. Learn from your mistake & don't alter files.
If sued, it's easy to read the altered remarks. If this person
is holding you accountable for an addiction, humble & settle
out of court w/ legal counsel. Most MD's get off by saying they
didn't authorize. If your signature is on orig. script, settle
quietly & pray. Dr's make mistakes. My Dr wrote wrong dose in
file for refills on an anxiety rx & I went into seizures. I'm
ok & Dr gives me top care now. Hers was error. Yours was just
really dumb. Treat by the rules & not the praise. Up Insurance.
you in US? The rules go up/dwn state to state as far as dosage
& type script & how often. You must have a board to contact &
ask for regulations & codes. Many states have them on net &
state board can give you url. At any given time, states can
request pharmacies to tell if they see controlled substance
prescribed often to a patient. They can not give patient info
but can give Dr's name after filing proper papers of release.
Most states don't waste the time unless they are known for
street sales. You can do this anonymous by phone. Just hit me,
PM is pain mngmnt. Dah! Anyway, same response applies. Call
State board for their ruling on drugs. If with in state range
& not abuse, you're in the wrong profession for not using
your common sense but would probably fall under same rules as
MD script writing. Learn from your mistake & don't alter files.
If sued, it's easy to read the altered remarks. If this person
is holding you accountable for an addiction, humble & settle
out of court w/ legal counsel. Most MD's get off by saying they
didn't authorize. If your signature is on orig. script, settle
quietly & pray. Dr's make mistakes. My Dr wrote wrong dose in
file for refills on an anxiety rx & I went into seizures. I'm
ok & Dr gives me top care now. Hers was error. Yours was just
really dumb. Treat by the rules & not the praise. Up Insurance.
Call and attorney (and keep one around). I'm not in medicine but I am an elected official and, believe me, ANYONE can (and will) sue ANYONE over ANYTHING.
We suggest you contact the AMA, the American Board of Anesthesiology or the American Board of Pain Medicine. They would likely be able to answer all of your questions on this subject.
Cindy Thompson
Med Help International
Cindy Thompson
Med Help International
Dr. R,
This is a patient to patient forum regarding neuro issues. There are no doctors posting here, so you probably would want to ask your question elsewhere for advice. Maybe there are some legal forums or medico-legal forums online where you could type in the keywords in your question and get a response. I wouldn't use your real name either. Good luck.
This is a patient to patient forum regarding neuro issues. There are no doctors posting here, so you probably would want to ask your question elsewhere for advice. Maybe there are some legal forums or medico-legal forums online where you could type in the keywords in your question and get a response. I wouldn't use your real name either. Good luck.
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