Disciplinary Actions and Pain Relief: Analysis of the Pain Relief Act

As quoted in Ferrell B.R. , “The Impact of Pain on Quality of Life: A Decade of Research,” Nursing Clinics of North America, 30 (1995): At 620.

Snyder C.A. , “An Open Letter to Physicians Who Have Patients with Chronic Nonmalignant Pain,” Journal of Law, Medicine & Ethics, 22 (1994): At 204–05.

Research reviewed in Agency for Health Care Policy and Research, Management of Cancer Pain: Clinical Practice Guidelines (Rockville: Dept. Health and Human Services, Pub. No. 94-0592, Mar. 1994): At 4.

Portenoy R.K. , “Therapeutic Use of Opioids: Prescribing and Control Issues,” in Cooper J.R. Czechowicz D.J. Molinari S.P. , eds., Impact of Prescription Drug Diversion Control Systems on Medical Practice and Patient Cart (Washington, D.C.: U.S. Government Printing Office, National Institute on Drug Abuse, Research Mono. 131, 1993).

Ferrell B.A. Ferrell B.R. Osterweil D. , “Pain in the Nursing Home,” Journal of the American Geriatric Society, 37 (1990): 409.

Shapiro B.S. Ferrell B.R. , “Pain in Children and the Frail Elderly: Similarities and Implications,” American Pain Society Bulletin, Oct./Nov. (1992): 1; and Knox K.H. Samaroo N. Hoffman J.R. , “Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia,” JAMA, 269 (1993): 1537–39.

Agency for Health Care Policy and Research, Acute Pain Management: Operative or Medical Procedures and Trauma (Rockville: Dept. of Health and Human Services, Pub. No. 94-0592, Feb. 1992): At 4 (emphasis added). See also, Opinions of the Council on Ethical and Judicial Affairs, American Medical Association, Opinion 2.20 (1994).

Cherny N.I. Portenoy R.K. , “The Management of Cancer Pain,” Cancer, 44 (1994): At 287; and Melzack R. , “The Tragedy of Needless Pain,” Scientific American, 262, no. 2 (1990): 27–34.

Skelly F.J. , “Painful Barriers,” American Medical News, May 9, 1994, at 15; Skelly F.J. , “Price of Pain Control: Is This the Risk You Face When Appropriately Prescribing Narcotics for Pain?,” American Medical News, May 16, 1994, at 17; and Skelly F.J. , “Fear of Sanctions Limits Prescribing of Pain Drugs,” American Medical News, Aug. 15, 1994, at 19.

See Skelly (Aug. 15, 1994), id.

Portenoy R.K. , “Opioid Therapy for Chronic Nonmalignant Pain: A Review of the Critical Issues,” Journal of Pain and Symptom Management, 11 (1996): At 204.

Many narratives by professionals and agencies describe inspections related to the prescription of controlled substances. For a court's description of an investigation of suspected illegal prescriptive practices, see Howard v. Miller, 870 F. Supp. 340 (N.D. Ga. 1994). See also “General Counsel Defends State Medical Licensure Board,” Journal of the Oklahoma State Medical Association, Oct. (1993): 86 (responding to criticism of the board's handling of prescriptive practices cases); Joranson D.E. , “Controlled Substances, Medical Practice and the Law,” in Schwartz H.I. , ed., Psychiatric Practice Under Fire (Washington, D.C.: American Psychiatric Press, 1994): 173–94; and Benton O. , “Innocent Victim of the Drug War?,” American Pain Society Bulletin, Feb. (1993).

Joranson D.E. , “Opioids for Chronic Cancer and Non-Cancer Pain: A Survey of State Medical Board Members,” Federation Bulletin: The Journal of Medical Licensure and Discipline, 79, no. 2 (1992): 15–49.

General Accounting Office, Prescription Drugs and Medicaid—Automated Review Systems Can Help Promote Safety, Save Money (Washington, D.C.: General Accounting Office, May 30, 1996); and Soumerai S.B. , “A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline,” Milbank Quarterly, 71 (1993): 217–52.

In the Matter of DiLeo, 661 So. 2d 162 (La. App. 1995).

See id.

Hoover v. Agency for Health Care Administration, 676 So. 2d 1380 (Fla. Dist. Ct. App. 1996).

Sneij v. Department of Professional Regulation, Board of Medical Examiners, 454 So. 2d 795 (Fla. App. 1984).

See id.

See also Hollabaugh v. Arkansas State Medical Board, 861 S.W.2d 317 (Ark. App. 1993); and Williams v. Tennessee Board of Medical Examiners, WL 420910 (Tenn. App. 1994).

See Group Health Plan, Inc. v. State Board of Registration for the Healing Arts, 787 S.W.2d 745 (Mo. App. 1990).

Wiener R.L. Pound P.F. , Report on State Medical Board Interviews, Project on Legal Constraints on Access to Effective Pain Relief, Dept. of Psychology, St. Louis University (1996).

Project on Legal Constraints on Access to Effective Pain Relief, American Society of Law, Medicine & Ethics, The Pain Relief Act (1996) (as cited in Journal of Law, Medicine & Ethics, 24 (1996): 317–18; see also at http://www.aslme.org).

See, for example, Federation of State Medical Boards, Report of the Ad Hoc Committee on Physician Impairment (Apr. 1995).

See, for example, United States v. Jones, 570 F.2d 765 (8th Cir. 1978); and United States v. Mahar, 801 F.2d 1477 (6th Cir. 1986).

General Accounting Office, supra note 16; and Soumerai , supra note 16.

Wilford B.B. , “An Overview of Prescription Drug Misuse and Abuse: Defining the Problem and Seeking Solutions,” Journal of Law, Medicine & Ethics, 22 (1994): 197–203; and Shapiro R.S. , “Legal Bases for the Control of Analgesic Drugs,” Journal of Pain and Symptom Management, 9 (1994): 153–59. The scope of this problem is largely undocumented. See Cooper J.R. , “Prescription Drug Diversion Control and Medical Practice,” JAMA, 268 (1992): 1306–10.

See Joranson D.E. , “Intractable Pain Treatment Laws and Regulations,” American Pain Society Bulletin, Mar./Apr. (1995): 1–3, 15–17; and Joranson D.E. , “State Medical Board Guidelines for Treatment of Intractable Pain,” American Pain Society Bulletin, May/June (1995): 1–5. The most well known and comprehensive regulation is California's. See State of California, Summit on Effective Pain Management: Removing Impediments to Appropriate Prescribing (Mar. 18, 1994); and Medical Board of California, “Statement by the Medical Board,” Action Report, 50 (July 1994): 4–5. One of the more recent is the proposed regulation developed by the New Jersey State Board of Medical Examiners. Proposed N.J. Admin. Code tit.13:35-7-6 (1996).

See Wiener Pound , supra note 24.

See Group Health Plan, Inc., 787 S.W.2d 745 (discussing the appropriateness of a declaratory judgment action against the board for threats of disciplinary action where no disciplinary action was actually being pursued).

See, for example, Fattah v. State Medical Board of Ohio, 1994 WL 73903 (Ohio App. 1994); Brown v. Louisiana State Board of Medical Examiners, 637 So. 2d 1113 (La. App. 1994); DiLeo, 661 So. 2d 162; and People v. Schade, 32 Cal. Rptr. 2d 59 (Cal. App. 1994).

Furrow B.R. , Health Law (St. Paul: West, 1995): § 3–25a.

Many such organizations are developing guidelines. The Agency for Health Care Policy and Research, a federal agency, has developed several. See, for example, American Pain Society Quality of Care Committee, “Quality Improvement Guidelines for the Treatment of Acute Pain and Cancer Pain,” JAMA, 274 (1995): 1874–80; Crowley P. , “‘No Pain, No Gain?’ The Agency for Health Care Policy and Research's Attempt to Change Inefficient Health Care Practice of Withholding Medication from Patients in Pain,” Journal of Contemporary Health Law and Policy, 10 (1993): 383–403; and Agency for Health Care Policy and Research, supra note 5.

Medical Board of California, “Clinical Practice Guidelines: Cancer Pain Management,” Action Report, 49 (Apr. 1994): 6.

General Accounting Office, Practice Guidelines: The Experience of Medical Specialty Societies (Washington, D.C.: General Accounting Office, 1991).

Joranson D.E. Gilson A.M. , “Policy Issues and Imperatives in the Use of Opioids to Treat Pain in Substance Abusers,” Journal of Law, Medicine & Ethics, 22 (1994): 215–23. Diagnosis of addiction may depend on the specialty and background of the diagnostician, with pain specialists and addiction specialists reaching different conclusions. See, for example, Savage S.R. , “Pain Medicine and Addiction Medicine—Controversies and Collaboration,” Journal of Pain and Symptom Management, 8 (1993): 254–56. Courts have also had difficulty in interpreting the terms addiction and dependency. See, for example, Schade, 32 Cal. Rptr. 2d 59. But see, Reynolds v. Louisiana State Board of Medical Examiners, 646 So. 2d 1244 (La. App. 1994) (holding that the board's discipline of physician for prescription of controlled substances for persons who were “abusing” was supported by sufficient evidence).

Cal. Bus. & Prof. Code § 2241.5 (West 1994); Fla. Stat. Ann. § 458.326 (West 1995); Mo. Ann. Stat. §§ 334.105 et seq. (Vernon 1995); Nev. Rev. Stat. § 630.3066 (1995); N.D. Cent. Code §§ 19-03.3-01 et seq. (1995); Or. Rev. Stat. §§ 677.470 et seq. (1995); Tex. Rev. Civ. Stat. Ann. art. 4495c (West 1996); and Va. Code Ann. § 54.1-3408.1 (Michie 1995).

See, for example, 1996 Ariz. H.B. 2362; and 1996 N.J. A.B. 1482.

Cal. Bus. & Prof. Code § 2241.5 (West 1994).

Nev. Rev. Stat. § 630.3066 (1995); Or. Rev. Stat. § 677.475 (1995); and Tex. Rev. Civ. Stat. Ann. art. 4495c (West 1996).

Va. Code Ann. § 54.1-3408.1 (Michie 1995).

Fla. Stat. Ann. § 458.326 (West 1995).

Nev. Rev. Stat. § 630.3066 (1995).

Cal. Bus. & Prof. Code § 2251.5(b) (West 1994). See also Or. Rev. Stat. § 677.470(2) (1995).

N.D. Cent. Code § 19-03.3-05 (1995); Tex. Rev. Civ. Stat. Ann. art. 4495c (West 1996); and Cal. Bus. & Prof. Code § 2241.5 (West 1994).

See, for example, Mo. Stat. § 334.106(3) (Vernon 1995) (but see § 334.101(d)(4), providing that “drug dependency” is not a sufficient reason for withholding pain medication); Tex. Rev. Civ. Stat. Ann. art. 4495c(6)(b) (West 1996); N.D. Cent. Code § 19-03.3-05 (1995); and Cal. Bus. & Prof. Code § 2241.5(e) (West 1994).

Or. Rev. Stat. § 677.485 (1995).

See, for example, Post L.F. , “Pain: Ethics, Culture, and Informed Consent to Relief,” Journal of Law, Medicine & Ethics, 24 (1996): At 348 n.1.

See, for example, Del. Code Ann. tit. 16, §§ 2505, 2510 (Michie Supp. 1996); Ohio Rev. Code Ann. § 2133.12(E)(1) (Baldwin 1994); Va. Code Ann. § 54.1-2984 (Michie 1995). But see Md. Health-Gen. Code Ann., § 5-603 (Michie Supp. 1996) (providing an option on the advance directive form to allow the patient to direct that pain medication not be given if it would shorten the patient's life).