• Quote of the Day
    "Your living is determined not so much by what life brings to you as by the attitude you bring to life;
    not so much by what happens to you as by the way your mind looks at what happens."
    Kahlil Gibran, posted by David Baxter

drrosenPM

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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?


Please tell me what you think,


DrRosenPM
 

David Baxter

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I would think that this is a question better addressed to your professional licensing college. Most professional colleges are happy to give you legal opinions on "tricky issues".
 

drrosenPM

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Oct 11, 2006
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Hello,

First want to say thank you for taking the time to lend some advice. As for talking about this with some colleges, the only ones to speak with are in my office and they prescribe the same way.

I really could use some advice on this matter. If there are any Dr.'s or even people who know of possible cases similar to my issue, please post.

I just don't understand from some of the things I read online, that I might liable if the patient dies but not from becoming addicted. But to me, if my patient comes in with pain and becomes addicted from my treating him, and failing to monitor him, then I should be sued....no?

Please help,

Rosen
 

Halo

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From reading both your posts and that of Dr. Baxter, I think that there might have been a misinterpretation on a word. Dr. Baxter refers to the professional college in which you are a member and I think you might be reading it as your colleagues with whom you practice.

The advice that Dr. Baxter was giving you was to contact your professional college in which you are a member as they would be the ones that would be able to help you and advise you best on an issue like this. For example here in Canada each Province has their own College of Physicians and Surgeons of which the practicing physician is a member of that association. I am sure that wherever you are located there is an association in which you are a member and they would be able to help you as well.

I hope that this clarifies things for you somewhat.

Good luck
 

ThatLady

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I don't know the details with regard to legal ramifications in cases of addiction to pain killers. I've never heard of a doctor being found guilty for someone else's addiction to narcotics. I will say, however, that any doctor prescribing medications (narcotic or otherwise) should be ordering periodic blood chemistries to ensure that no damage is being done to vital organs. It wouldn't be a problem to check for blood levels at that time, I'd think; although, I don't know that it would be necessary.

If the patient is taking medications as prescribed, and is not "doctor hopping" for multiple prescriptions, you're doing what you can to help control his/her pain. Presumably, you are prescribing the necessary, effective dose and keeping that dose within safe limits. If the patient is "doctor hopping", there's no way for you to know that, so I don't see how you could be held liable. To be sure of all the facts, I'd contact your local Physicians' Association.
 

drrosenPM

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Hello everyone,


Again I thank everyone for taking the time to help out. Ok...I know it might be hard for the patient to sue for his addiction, but what about could he claim that I was neglegent because I never monitored his blodd levels, I never monitored his prescription intake. And etc etc???



Thanks
Rosen
 

David Baxter

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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???
I'm not a physician and I'm not a lawyer, but I'll give you my take on this.

I think the issue is twofold:

1. Informed consent: Ensure that you discuss with your patients the addiction potential (and any other adverse effects) and if you're worried have them sign a standard form indicating that they have discussed them with you and understand the risks of this type of medication. I do that with issues of confidentiality and the limits to confidentiality to protect myself from such liability.

2. Reasonable Precautions: If there is a possibility of problems with any body organs or systems that as a doctor you should be aware of, ensure that the patient completes any tests for such issues before you renew the prescription and warn them in advance that this is your standard practice.
 

ThatLady

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Hello everyone,


Again I thank everyone for taking the time to help out. Ok...I know it might be hard for the patient to sue for his addiction, but what about could he claim that I was neglegent because I never monitored his blodd levels, I never monitored his prescription intake. And etc etc???



Thanks
Rosen

A patient can claim anything, Rosen. One could claim that dogs can fly, but I haven't seen any airborne dogs lately. ;)

Seriously, frivolous suits are nothing new in our society. They happen all the time. People claim any number of ludicrous things in order to sue other people. However, if you're reasonably careful and alert, it's doubtful that such a suit could be won in a court of law.

As Dr. Baxter said, if you're concerned about this issue, I'd suggest you have patients sign a waiver after explaining the risks of whatever medication you prescribe. I'd also suggest that you ensure that the patient has periodic blood tests to check vital organ efficiency (Complete Blood Count, Basic Metabolic Panel, Liver Function Test, etc). Know the medication you're prescribing well, know how it is cleared by the body and its physiological mechanisms and test accordingly. That will put you in a position of having done all you can do to see to the patient's physical well-being.
 

drrosenPM

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Hello everyone,

Again, thank you for taking the time. I understand what some of you said about informed consent and all but the problem I'm having is not about preventing future patients but about a current patient right now.

Yes, I know a patient or anyone for that matter can sue anyone for anything. What I'm trying to figure or find out is if failing to monitor my patient shows that I didnt provide a level of 'standard of care'.


Rosen
 

Kanadiana

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DID you fail to monitor and is that sue-able? I'm on the patient side of things and know nothing about caregiver and legal side of things, but I guess that I assume that if I were a licenced caregiver with prescribing powers, that whatever system has the power to licence and revoke licences, would also be able to inform about all the rules and policies about prescribing, medications, and monitoring and liabilities and such.

I figure that when taking addictive medications the necessary addiction comes with the territory, but my thinking is that its only when a patient goes beyond "necessary level of addiction in dosage and duration in order to manage pain and symptoms" then its a case of "over addiction" and is into the territory of misuse and abuse by "more than is actually necessary". Over-addiction I guess? :) It must be really REALLY hard to find that line in patients who have to be on addictive medications, especially when its hard for a prescriber to always know when a patient isn't being straight with them.

Lots of meds, I learn here and there, need to be tapered off of because of the addictive way they are. I'm on prednisone (cortico-steroid) and have been told its addictive as well. I'm addicted to the fact that on it I can walk. Before I was on it, I couldn't. If I could suddenly stop it I would revert immediately to being unable to walk. Its meant to be short term while finding other treatments and meds that can help enough so that I can get off it again. I don't care if I'm addicted until I don't need to be anymore and when I can go off it I will, first chance I get ... and that means a long time slow tapering.
 

David Baxter

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Kanadiana makes a good point. It would be easier if you told us the details of what happened and what's being claimed. It's beginning to sound as if this is more a legal issue than a health care issue.
 

Kanadiana

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Hello everyone,
What I'm trying to figure or find out is if failing to monitor my patient shows that I didnt provide a level of 'standard of care'.


Rosen


Hi Rosen,

I would guess (not knowing anything legally or ethically as I'm just a consumer of healthcare) that if you were prescribing medications that required specific kinds of monitoring of and by labwork and/or exams by the prescriber as part of the medication treatment you prescribed, and that if you failed to monitor as was needed and required for patient safety, then my wild guess would be that yes you could be legally held accountable for that neglecting to do so if the patient decided to take issue and could back that up with proof.

I figure that if you failed to perform a required medical duty to specific monitoring that was actually officially required, then you blew it and that maybe having a consult with a lawyer who knows this stuff, and can advise, might be a really good plan about now. Your posts give me the impression that you failed to monitor when you should have and that now you're afraid of being sued. I would guess a lawyer who knows about this stuff could answer your questions.

I would also guess that if a patient became over-addicted to prescriptions that as soon as the prescriber realized that, that the prescriber would do whatever was necessary to get the patient safely unaddicted as part of their caregiving role of responsibility. If the patient refuses the help and wants to stay addicted, aren't there protections in place for the caregiver to withdraw as a caregiver and prescriber under the circumstances because the patient is ideally refusing advice and proper treatment, and if the caregiver advises the patient whats up and why? I would, in this case, worry about the patients addiction and would refer the patient to appropriate resourses to help them get safely unaddicted. You can't force the patient to accept your help to getting unaddicted, or force them to use the resources you give them as you step out of the picture because they refuse your professional advice and care. The patient will do what they will do.

I hope you get your answers quickly and get this all sorted out for you and the patient in question so you can know how to proceed.
 

foghlaim

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I agree with Kanadiana when she says
I would, in this case, worry about the patients addiction and would refer the patient to appropriate resourses to help them get safely unaddicted

The patient needs help here wanted or unwanted.. so maybe go back to basics and do the monitoring\lab work that's needed and tell the patient why. Also check if the patient has access to other meds from elsewhere. It could be that you are not the only doc prescribing . Just a thought if your patient is addicted.

You can be getting any legal advice needed while you do this as a just in case measure.
 

crystalball

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Nov 5, 2006
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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?


Please tell me what you think,


DrRosenPM

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. I am notifying as many as I can locate, they have been very busy! This is why they cannot process the reasonable suggestions and advice they receive, certainally not that of a licensed professional! http://www.expertlaw.com/forums/showthread.php?t=16552 Please don't fall for this scam, or aid and abet them, Thank You,
Crystalball
 

David Baxter

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Thank you for this information, Crystalball.

Mystery solved "Doctor" is really Patient

Recently we had a thread here involving a new poster "drrosenpm" claiming to be a Pain Management specialist who was worried that they might be sued for malprctice. Something didn't ring true and in fact, they were not forthright in answers to reasonable questions and their demeanor was incongruent with a medical professional with specialized credentials. They had in fact posted on many forums, registering with the same moniker and posting the same question, claiming to be or inpersonating a Pain Management specialist. Unable to answer a simple question, such as their credentialing organization, not able to follow simple referrals to the appropriate professional organization, not wanting to draw attention yet posting what would appear to be a name.

I also noticed in the same state, postings on several forums over a long period of time, from at least Jan 2006, several posters who appeared to be the "patient"! I pointed this out because many people have spend a lot of time answering this ficticious question that appeared to be a case study or a fishing expedition and several members here have used this as a springboard to attack my credibility while failing to vet the question or recognizing the obvious weakness. On the other forum they finally slipped up, answering as the physcian but under the "patient" moniker.
Busted.

http://www.expertlaw.com/forums/showthread.php?t=15827
http://forum.freeadvice.com/showthread.php?p=1505814
Today, 04:15 PM
Mec4040
Member

Join Date: Mar 2005
Posts: 39
Hello,

First to asnwer some of the questions. Yes, I have posted this on a different forum and the reason why was because when I found out about this, I became nervous and wanted to find some help fast... I didnt want to discuss this with my partner yet and or any other mds I know. I also thought if I asked around I could find the answr and to be honest I'm not getting the sae answers from everyone...some people say I should not worry...some say I should be very concerned. I do have to add that what barry said..was interesting and no else has rasied that point.

Barry...you mentioned about if 'financial component for the patient.' What did you mean by this? Also you said about not posting on the forum because it can come back to you. The whole reason I posted on the forum was because I thought I was protected by the fact no one knows me and or how to find me. I'm guessing I dont know something that you do, could you please tell me how I could get this back in my face...very interested in knowing.


Thanks for all the help,
Rosen

Here they are known as myfind2006
http://www.expertlaw.com/forums/showthread.php?t=6164

Needless to say, while polite, this poster "patient" needs to be referred to some sort of a rehab program as I advised the poser "painddoc" early on. If they had any malpractice case, their deception will mitigate any nelgligence the doctor might have committed and it appers if they are dishonest with us when no one knows who they are, what are they telling their doctor? What are they doing with the medications they claim the doctor still prescribes but they no longer take? Also their recent post looking for a starving attorney with new admission to the bar to take their case is illadvised as a new attorney while eager is not competent or well funded enough to attempt a medical malpractice lawsuit in this instance, however if they need a criminal defense attorney a new attorney may fit the bill insofar as eagerness and need to gain experience.


Myfind2006/DrRosenPM/Mec4040 please get yourself into a drug rehab program, ask your pain management doctor to refer you ASAP.
 

Kanadiana

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Messages
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I've had no problem from the beginning in guessing that this wasn't a real licenced practitioner and suspected along the lines of someone trying to find out if they had grounds for neglect or somesuch, and/or a lawsuit. I almost PM'ed you a few times regards my thoughts about this David ;) But I figured that if this were an unsure patient trying to find out in a roundabout way if they've actually experienced some kind of professional neglect and are thinking about a lawsuit if they have, that they got some good feedback and advice in here about where to get more professional feedback and advice.

I understand roundabout fishing for information and advice before coming out directly and approaching professionals on something that could so seriously effect lives and livelihoods and have serious repercussions and reactions all round, especially if reporting someone with unfounded reasons.
 

David Baxter

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I suppose. I would have been happier if the individual had been honest to begin with. I think we tried to help in good faith and now, to be frank, I feel used and annoyed.
 

Kanadiana

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Yeah. Understood. I feel okay about "roundabout" when I think intentions aren't malicious, but outright deception like posing as someone else really crosses a line beyond roundabout and I don't like being tricked like that either. I did almost ask point blank a couple of times in the thread if the person was REALLY a licenced therapist, hoping they'd come clean or something, but didn't. My impulse to do that was pretty strong though. It just feels all really yukky at this point :( Just yuk. We all did try to help in good faith, giving the person the benefit of the doubt. It would be nice if the person came back and could be straight and apologize for the deception to us, and to you as site owner.
 

David Baxter

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The individual calling himself DrRosenPM has apparently been posting this stuff in every forum he or she can find: see this Google search.

For those of you still wondering, this seems entirely consistent with what crystalball says and not at all consistent with the person "DrRosenPM" claims to be.
 

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