Health Care Providers' Liability Exposure for Inappropriate Pain Management

Donovan M. Dillon P. McGuire L. , “Incidence and Characteristics of Pain in a Sample of Medical-Surgical Inpatients,” Pain, 30 (1987): 69–78.

Abbott F.V. , “The Prevalence of Pain in Hospitalized Patients and Resolution Over Six Months,” Pain, 50 (1992): 15–28. See also Marks R.M. Sachar E.J. , “Undertreatment of Medical Inpatients with Narcotic Analgesics,” Annals of Internal Medicine, 78 (1973): 173–81 (32 percent of inpatients treated with opioid analgesics for pain continued to experience severe distress and an additional 41 percent were in moderate distress); Foley K.M. , “Pain, Physician-Assisted Suicide and Euthanasia,” Pain Forum, 4 (1995): 163–78; Breitbart W. , “Suicide Risk and Pain in Cancer and AIDS Patients,” in Chapman C.R. Foley K.M. , eds., Current and Emerging Issues in Cancer Pain: Research and Practice (New York: Raven Press, 1993): 49; and Breitbart W. Part R. , “Pain Management in the Patient with AIDS,” Pain Management, 2 (1994): 391.

Desbiens N. , “Pain and Satisfaction with Pain Control in Seriously Ill Hospitalized Adults: Findings from the SUPPORT Research Investigations,” Critical Care Medicine, 24 (1996): 1953–61.

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

Daut R. Cleeland C. , “The Prevalence and Severity of Pain in Cancer,” Cancer, 50 (1982): 1913–18.

Portenoy R.K. , “Therapeutic Use of Opioids: Prescribing and Control Issues,” in Cooper J.M. , eds., Impact of Prescription Drug Diversion Control Systems on Medical Practice and Patient Care (Washington, D.C.: U.S. Government Printing Office, National Institute on Drug Abuse, 1993): 35–50.

Ferrell B.A. Ferrell B.R. Osterwall D. , “Pain in the Nursing Home,” Journal of the American Geriatric Society, 38 (1990): 409.

Foley K.M. , “Treatment of Cancer Pain,” N. Engl. J. Med., 313 (1985): 84–95. See also Melzack R. , “The Tragedy of Needless Pain,” Scientific American, 262 (1990): 27–33; and Cleeland C. , “Pain and Its Treatment in Outpatients with Metastatic Cancer,” N. Engl. J. Med., 330 (1994): 592–96.

Ground S. , “Validation of World Health Organization Guidelines for Cancer Pain Relief During the Last Days and Hours of Life,” Journal of Pain and Symptom Management, 6 (1991): 411–22.

Jacox A. Carr D. Payne R. , “New Clinical-Practice Guidelines for the Management of Pain in Patients with Cancer,” N. Engl. J. Med., 330 (1994): 651–55.

Keeton W. , Prosser & Keeton on the Law of Torts (St. Paul: West, 5th ed., 1984): At 164.

Estate of Henry James v. Hillhaven Corp., Super. Ct. Div. 89CVS64, Hertford County, N.C. (Nov. 20, 1990).

Angarola R. , letter, “Inappropriate Pain Management Results in High Jury Award,” Journal of Pain and Symptom Management, 6 (1991): 407.

Motions Hearing Transcript, Estate of Henry James v. Hillhaven Corp., Super. Ct. Div. 89CVS64, Hertford County, N.C. at 41 (Nov. 20, 1990).

See Angarola , supra note 13.

State v. McAfee, 259 Ga. 579, 385 S.E.2d 651 (1989).

Id. at 652.

See also Bouvia v. Superior Court, 179 Cal. App. 3d 1127, 1145, 225 Cal. Rptr. 297, 306 (1986), wherein the court held that the patient's right to refuse medical treatment entitled her to the immediate removal of her nasogastric tube and that “the hospital and medical staff are still free to perform a substantial, if not greater part of their duty, i.e., that of trying to alleviate Bouvia's pain and suffering.”

Public Health Service Act, § 901(b), 42 U.S.C. § 299(b) (Supp. 1993).

§ 912(a)(1)-(2), 42 U.S.C. § 299b-1(a)(1)-(2).

Agency for Health Care Policy and Research, Clinical Practice Guideline for Acute Pain Management: Operative or Medical Procedures and Trauma (Rockville: Agency for Health Care Policy and Research, Pub. No. 92-0032, Feb. 1992).

Agency for Health Care Policy and Research, Management of Cancer Pain: Clinical Practice Guideline 9 (Rockville: Agency for Health Care Policy and Research, Pub. No. 94-0592, 1994).

Davenport v. Ephraim McDowell Memorial Hospital, 769 S.W.2d 56 (1989).

Rodriguez v. Jackson, 118 Ariz. 13, 574 P.2d 481 (1977).

Cornfeldt v. Tongen, 262 N.W.2d 684, 704 (Minn. 1977).

Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 529, 113 S. Ct. 2786 (1993).

Frye v. United States, 54 App. D.C. 46, 293 F. 1013 (1923).

113 S. Ct. at 2795.

Vt. Stat. Ann. tit. 12, § 7003 (1993).

Me. Rev. Stat. Ann. tit. 24, § 2975 (West 1993).

See, for example, Cal. Bus. & Prof. Code § 2241.5 (West 1994); Fla. Stat. Ann. § 458.326 (West 1995); Mo. Ann. Stat. §§ 344.105 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); Texas Rev. Civ. Stat. Ann. art. 4495c (West 1996); and Va. Code Ann. § 54.1-3408.1 (Michie 1995).

Cent N.D. Code §§ 19-03.3-01 et seq. (1995); and Texas Rev. Civ. Stat. Ann. art. 4495c (West 1996).

Nev. Rev. Stat. § 630.3066 (1995); and Fla. Stat. Ann. § 458.326 (West 1995).

Or. Rev. Stat. §§ 677.470 et seq. (1995).

Project on Legal Constraints on Access to Effective Pain Relief, American Society of Law, Medicine & Ethics, § 3.1 (1996).

Skelly F.J. , “Fear of Sanctions Limits Prescribing of Pain Drugs,” American Medical News, Aug. 15, 1994, at 19.

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

It should be noted that the Pain Relief Act may contribute to a movement that is already underway, in that several states have enacted pain statutes and others are considering statutes. See, for example, 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); Or. Rev. Stat. §§ 677.470 et seq. (1995); Texas Rev. Civ. Stat. Ann. art. 4495c (West 1996); and Va. Code Ann. § 54.1-3408.1 (Michie 1995).

Tinetti M.E. , “Mechanical Restraint Use Among Residents of Skilled Nursing Facilities: Prevalence, Patterns and Predictors,” JAMA, 265 (1991): 468–71.

See Kapp M.B. , “Nursing Home Restraints and Legal Liability,” Journal of Legal Medicine, 13 (1992): 1–32 (citing Kusserow R. , Resident Abuse in Nursing Homes: Undertaking and Preventing Abuse (Washington, D.C.: U.S. Dept. of Health and Human Services, Office of the Inspector General, Office of Evaluations and Inspections, Report OEI 06-88-00360, Apr. 1990): App. B, at 4; and Pillemer K. Moore D. , “Abuse of Patients in Nursing Homes: Findings from a Survey of Staff,” Gerontologist, 29 (1989): 314).

See Kapp , supra note 42 (citing Burger S. , “Inappropriate Use of Chemical and Physical Restraints: An Ombudsman's Resource Paper for Effective Advocacy” (1989) (prepared by the National Citizens' Coalition for Nursing Home Reform for the National Center for State Long Term Care Ombudsman Resource Center, Washington D.C.)).

See Kapp , supra note 42.