The Social,Professional,and Legal Framework for the Problem of Pain Management in Emergency Medicine

See, e.g., House Resolution 1020, introduced on March 1, 2005, “to declare adequate pain care research, education, and treatment as national public health priorities,” at <http://thomas.loc.gov/cgi-bin/bdquery/D?d109:3:./temp/∼bdU0Um> (last visited October 21, 2005); National Medical Association Panel Says Untreated Pain is a Public Health Crisis for Minorities at <http://www.exodusnews.com/HEALTH/Health036.htm> (last visited September 26, 2005).

Hansen G. R. , “Management of Chronic Pain in the Acute Care Setting,” Emergency Medicine Clinics of North America 23, no. 2 (2005): 307–38, at 318.

Rich B. A. , “A Prescription for the Pain: The Emerging Standard of Care for Pain Management,” William Mitchell Law Review 26, no. 1 (2000): 1–92.

Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 467–475; Rupp T. , “Inadequate Analgesia in Emergency Medicine,” Annals Emergency Medicine 23, no. 2 (2004): 494–503; Hinline B. , “Chronic Pain: Physiological, Diagnostic, and Management Considerations,” Psychiatry Clinic North America 28, no. 3 (2005): 715–735; Lawrence L. L. , “Legal Issues in Pain Management: Striking the Balance,” Emergency Medicine Clinics of North America 23, no. 2 (2005): 573–84; McManus J. G. Jr. , “Pain Management in the Pre-hospital Environment,” Emergency Medicine Clinics of North America 23, no. 2 (2005): 415–31.

Eder S. C. Sloan E. P. Todd K. , “Documentation of ED Patient Pain by Nurses and Physicians,” American Journal of Emergency Medicine 2 (2003): 253; Cordell W. H. Keene K. K. Giles B. K. , “The High Prevalence of Pain in Emergency Medical Care,” American Journal of Emergency Medicine 20, no. 3 (2002): 1654–1659; McIntosh S. E. Leffler S. , “Pain Management After Discharge from the ED,” American Journal of Emergency Medicine 22, no. 2 (2002): 98–100.

Todd K. H. Sloan E. P. Chen C. , “Survey of Pain Etiology, Management Practices and Patient Satisfaction in Two Urban Emergency Departments,” Canadian Journal of Emergency Medicine 4 (2002): 252–256.

Bernard A. M. , “Chronic Pain in the ED,” American Journal of Emergency Medicine 22, no. 6 (2004): 444–447. Todd K. , “Chronic Pain and Aberrant Drug-Related Behavior in the Emergency Department,” Journal of Law, Medicine & Ethics 33, no. 4 (2005): 761–769.

Cordell W. H. Keene K. K. , “The High Prevalence of Pain in Emergency Medical Care,” American Journal of Emergency Medicine 20, no. 3 (2002): 165–169.

See, e.g., American College of Emergency Physicians, Policy Statement, “Pain Management in the Emergency Department,” March, 2004 available at <http://www.acep.org/webportal/PracticeResources/PolicyStatements/PracticeManagement/PainManagementintheEmergencyDepartment.htm> (last visited September 26, 2005). See also, American College of Emergency Physicians, “The Use of Pediatric Sedation and Analgesia,” Annals of Emergency Medicine 22 (1993): 626–627; US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Acute Pain Management Guideline Panel: Clinical Practice Guideline-Acute Pain Management: Operative or Medical Procedures and Trauma (February, 1992).

Wilsey B. Fishman S. Rose J. S. , “Pain Management in the ED,” American Journal of Emergency Medicine 22 (2004): 51–57, at 56.

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 297–306, at 303.

Rich B. A. , “A Prescription for the Pain: The Emerging Standard of Care for Pain Management,” William Mitchell Law Review 26, no. 1 (2000): 1–92.

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 297–306; Hansen G. R. , “Management of Chronic Pain in the Acute Care Setting,” Emergency Medicine Clinics of North America 23 (2005): 307–338; Katz J. , “Perioperative Predictors of Long-Term Pain Following Surgery,” in Jensen T. Turner J. Weisenfeld-Hallin Z. , eds., Proceedings of the 8th World Congress on Pain (Seattle: IASP Press, 1997): Vol. 8; Kalso E. , “Prevention of Chronicity,” in Jensen T. Turner J. Weisenfeld-Hallin Z. , eds., Proceedings of the 8th World Congress on Pain (Seattle: IASP Press, 1997): vol. 8.

Ducharme J. , “Acute Pain and Pain Control: State of the Art,” Annals of Emergency Medicine 35, no. 6 (2000): 592–603.

Drayer R. Henderson J. Reidenberg M. , “Barriers to Better Pain Control in Hospitalized Patients,” Journal of Pain & Symptom Management 17 (1999): 434.

Ducharme J. , “Acute Pain and Pain Control: State of the Art,” Annals of Emergency Medicine 35, no. 6 (2000): 592–603.

Wilson J. Pendleton J. , “Oligoanalgesia in the Emergency Department,” American Journal of Emergency Medicine 7 (1989): 620–623.

Todd K. H. , “Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia,” JAMA 269 (1993): 1537; Todd K. H. Deaton C. D'Adamo A. P. , “Ethnicity and Analgesia Practice,” Annals of Emergency Medicine 35 (2000): 11. These findings were not always repeated in other EDs. See, for example, Neighbor M. L. Honner S. Kohn M. A. , “Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients,” Academic Emergency Medicine 11, no. 12 (2004): 1290–1296.

Green C. R. Anderson K. O. Baker T. A. , “The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain,” Pain Medicine 4 (2003): 277; Bonham V. L. , “Race, Ethnicity, and the Disparities in Pain Treatment” Journal of Law, Medicine & Ethics 29 (2001): 52.

Bauman B. H. McManus J. G. , “Pediatric Pain Management in the Emergency Department,” Emergency Medicine Clinics of North America 23 (2005): 393–414; Neighbor M. L. Honner S. Kohn M. A. , “Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients,” Academic Emergency Medicine 11, no. 12 (2004): 1290–1296; See also, Ngai B. Ducharme J. , “Documented Use of Analgesics in the Emergency Department and Upon Release of Patients with Extremity Fractures,” Academic Emergency Medicine 4, no. 12 (1997): 1176–1178.

Bauman B. H. , “Pediatric Pain Management in the Emergency Department,” Emergency Medicine Clinics of North America 23, no. 2 (2005): 393–414.

Tamariz V. P. Fuchs S. Baren J. M. , “Pediatric Emergency Medical Education in Emergency Medicine Training Programs,” Academic Emergency Medicine 7 (2000): 774–8.

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 297–306, at 299, documenting a 400% increase in the number of articles published between 1996 and 2003.

Singer A. J. Chisum E. Stark M. J. , “An Educational Intervention to Reduce Oligoanalgesia in the Emergency Department,” Annals of Emergency Medicine 42, no. 4 (2003): S41; Lewis L. M. Lasater L. C. Ruoff B. E. , “Failure of a Chest Pain Clinical Policy to Modify Physician Evaluation and Management,” Annals of Emergency Medicine 25, no. 1 (1995): 9–14.

DuCharme J. , this symposium “Clinical Guidelines and Policies: Can they Improve Emergency Department Pain Management?” Journal of Law, Medicine & Ethics 33, no. 4 (2005): 783–790.

Johnson S. H. , ed., “Symposium: Appropriate Management of Pain: Addressing the Clinical, Legal, and Regulatory Barriers,” Journal of Law, Medicine & Ethics 24, (1996): 285; Johnson S. H. , ed., “Symposium: The Undertreatment of Pain: Legal, Regulatory, and Research Perspectives and Solutions,” Journal of Law, Medicine & Ethics 29 (2001): 11; Johnson S. H. , ed., “Symposium: Improving the Treatment for Pain: Legal, Regulatory, and Research Perspectives,” Journal of Law, Medicine & Ethics 31 (2003): 15.

Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494; Jones J. B. , “Assessment of Pain Management Skills in Emergency Medicine Residents: The Role of a Pain Education Program,” Journal of Emergency Medicine 17 (1999): 349; Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medicine Clinics of North America 23, (2005): 467–475, at 468.

Hoffmann D. E. , “Pain Management and Palliative Care in the Era of Managed Care: Issues for Health Insurers,” Journal of Law and Medical Ethics 26, no. 4 (1998): 267–89; Jost T. S. , “Public Financing of Pain Management: Leaky Umbrellas and Ragged Safety Nets,” Journal of Law, Medicine, & Ethics 26, no. 4 (1998): 290–307.

Bayley M. D. , “The Financial Burden of Emergency Department Congestion and Hospital Crowding for Chest Pain Patients Awaiting Admission,” Annals of Emergency Medicine 45, no 2 (2005): 110–117.

Hollifield M. B. Fosnocht D. E. Swanson E. R. , “Effect of Patient Volume and Acuity on Pain Management in the ED,” Academic Emergency Medicine 10 (2003): 483–484.

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 297–306, at 301.

Neighbor M. L. Honner S. Kohn M. A. , “Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients,” Academic Emergency Medicine 11, no. 12 (2004): 1290–1296, at 1292.

Fosnocht E. D. Swanson E. R. Bossart P. , “Patient Expectations for Pain Medication Delivery,” American Journal of Emergency Medicine 19, no. 5 (2001): 399–402, reporting that patients' expected to receive their first administration of pain medication on average within 23 minutes of arrival while the actual time to administration was 78 minutes. McManus J. G. Sallee D. R. , “Pain Management in the Prehospital Environment,” Emergency Medicine Clinics of North America 23 (2005): 415–431.

McManus J. C. Sallee D. R. , “Pain Management in the Prehospital Environment,” Emergency Medical Clinics of North America 23 (2005): 415–431.

Fonsnocht , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 297–306; Lawrence L. L. , “Legal Issues in Pain Management: Striking the Balance,” Emergency Medical Clinics of North America 23 (2005): 573–584; Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 467–475; McManus J. G. Sallee D. R. , “Pain Management in the Prehospital Environment,” Emergency Medical Clinics of North America 23 (2005): 415–431.

Fosnocht E. D. Swanson E. R. Bossart P. , “Patient Expectations for Pain Medication Delivery,” American Journal of Emergency Medicine 19, no. 5 (2001): 399–402, reporting that patients' expected to receive their first administration of pain medication on average within 23 minutes of arrival while the actual time to administration was 78 minutes.

Singer A. J. Richman P. B. Kowalska A. , “Comparison of Patient and Practitioner Assessments from Commonly Performed Emergency Department Procedures,” Annals of Emergency Medicine 33 (1999).

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 297–306, at 299.

See, e.g., Power v. Arlington Hospital Association, 42 F. 3d 851 (4th cir. 1994).

Pace S. Burke T. F. , “Intravenous Morphine for Early Pain Relief in Patients with Acute Abdominal Pain”, Academic Emergency Medicine 3 (1996): 1086; LoVecchio F. Oster N. Sturmann K. , “The Use of Analgesics in Patients with Acute Abdominal Pain,” Journal of Emergency Medicine 15 (1997): 775; Kim M. K. Strait R. T. Sato T. T. , “A Randomized Clinical Trial of Analgesia in Children with Acute Abdominal Pain,” Academic Emergency Medicine 9 (2002): 281; American College of Emergency Physicians, “Clinical Policy: Critical Issues for the Initial Evaluation and Management of Patients Presenting with Chief Complaint of Nontraumatic Acute Abdominal Pain,” Annals of Emergency Medicine 36 (2000): 406; Evidence Report/Technology Assessment No. 43, “Making Health Care Safer: A Critical Analysis of Patient Safety Practices,” AHRQ, Publications 01-E058 (Rockville, MD, 2001): 396.

As quoted in, Linklater D. R. , Painful Dilemmas: An Evidence-based Look at Challenging Clinical Scenarios, Emergency Medicine Clinics of North America 23 (2005): 367–392, at 384.

Nissman S. A. Kaplan L. J. Mann B. D. , “Critically Reappraising the Literature-Driven Practice of Analgesia Administration for Acute Abdominal Pain in the Emergency room Prior to Surgical Evaluation,” American Journal of Surgery 185 (2003): 291–296, at 291.

Linklater D. R. , “Painful Dilemmas: An Evidence-based Look at Challenging Clinical Scenarios,” Emergency Medicine Clinics of North America 23 (2005): 367–392, at 384.

Pace S. Burke T. , “Intraveneous Morphine for Early Pain Relief in Patients with Acute Abdominal Pain,” Academic Emergency Medicine 3 (1996): 1086–1091; LoVecchio F. Oster N. , “The Use of Analgesics in Patients with Acute Abdominal Pain,” Journal of Emergency Medicine 15 (1997): 775–779.

Wolfe J. M. Smithline H. A. Phipen S. Montano G. Garb J. L. Fiallo V. , “Does Morphine Change the Physical Examination in Patients with Acute Appendicitis?” American Journal of Emergency Medicine 22, no. 4 (2004): 280–5; Thomas S. H. , “Effects of Morphine Analgesia on Diagnostic Accuracy in Emergency Department Patients with Abdominal Pain: A Prospective Randomized Trial,” Journal of the American College of Surgeons 196, no. 1 (2003): 18–31.

“Clinical Policy: Critical Issues for the Initial Evaluation and Management of Patients Presenting with a Chief Complaint of Nontraumatic Acute Abdominal Pain,” Annals of Emergency Medicine 36, no. 4 (2000): 406–415.

“Clinical Policy: Critical Issues for the Initial Evaluation and Management of Patients Presenting with a Chief Complaint of Nontraumatic Acute Abdominal Pain,” Annals of Emergency Medicine 36, no. 4 (2000): 406–415, at 410.

“Clinical Policy: Critical Issues for the Initial Evaluation and Management of Patients Presenting with a Chief Complaint of Nontraumatic Acute Abdominal Pain,” Annals of Emergency Medicine 36, no. 4 (2000): 406–415, at 407.

Attard A. R. Corlett M. J. Kidner N. J. , “Safety of Early Pain Relief for Acute Abdomen Pain,” British Medical Journal 305 (1992): 504–556; LoVecchio F. Oster N. Sturmann K. , “The Use of Analgesics in Patients with Acute Abdominal Pain,” Journal of Emergency Medicine 15 (1997): 775–779; Pace S. Burke T. F. , “Intravenous Morphine for Early Pain Relief in Patients with Acute Abdominal Pain,” Academic Emergency Medicine 3 (1996): 1086–1092; Zoltie N. Cust M. P. , “Analgesia in the Acute Abdomen,” Annals of the Royal College of Surgeons of England 68 (1986): 209–210.

21 C.F.R. § 50.24 (2005).

Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494–503.

Todd K. H. , “Emergency Medicine and Pain: A Topography of Influence,” Annals of Emergency Medicine 43 (2004): 504.

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 297–306.

Nissman S. A. Kaplan L. J. Mann B. D. , “Critically Reappraising the Literature-Driven Practice of Analgesia Administration for Acute Abdominal Pain in the Emergency Room Prior to Surgical Evaluation,” American Journal of Surgery 185 (2003): 291–296, at 292.

Nissman S. A. Kaplan L. J. Mann B. D. , “Critically Reappraising the Literature-Driven Practice of Analgesia Administration for Acute Abdominal Pain in the Emergency Room Prior to Surgical Evaluation,” American Journal of Surgery 185 (2003): 291–296, at 292.

Graber M. A. Ely J. W. Clarke S. , “Informed Consent and General Surgeons' Attitudes toward the use of Pain Mediation in the Acute Abdomen,” American Journal of Emergency Medicine 17 (1999): 113–6.

Nissman S. A. Kaplan L. J. Mann B. D. , “Critically Reappraising the Literature-Driven Practice of Analgesia Administration for Acute Abdominal Pain in the Emergency Room Prior to Surgical Evaluation,” American Journal of Surgery 185 (2003): 291–296.

Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494–503.

Matulonis U. A. , “End of Life Issues in Older Patients,” Seminars in Oncology 31, no. 2 (2004): 274–281.

Bauman B. H. McManus J. G. , “Pediatric Pain Management in the Emergency Department,” Emergency Clinics of North America 23 (2005): 393–414, at 397.

Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 467–475, at 469 recommending further research comparing unidimensional and multidimensional instruments for pain assessment of emergency patients.

Matulonis U. A. , “End of Life Issues in Older Patients,” Seminars in Oncology 31, no. 2 (2004): 274–281; Sheehan D. K. Schirm V. , “End-of-Life Care of Older Adults,” American Journal of Nursing 103, no. 11 (2003): 48–58.

Bauman B. H. , “Pediatric Pain Management in the Emergency Department,” Emergency Medicine Clinics of North America 23, no. 2 (2005): 393–414, at 394.

Neighbor M. L. Honner S. Kohn M. A. , “Factors Affecting Emergency Department Opioid Administration to Severely Injured Patients,” Academic Emergency Medicine 11, no. 12 (2004): 1290–1296, at 1294.

Singer A. J. Richman P. B. Kowalska A. , “Comparison of Patient and Practitioner Assessments from Commonly Performed Emergency Department Procedures,” Annals of Emergency Medicine 33 (1999).

Joint Commission on Accreditation of Healthcare Organizations, “Accreditation Issues of Emergency Departments,” Joint Commission Resources (IL: Oakbrook Terrace, 2003).

Eder S. C. Sloan E. P. Todd K. , “Documentation of ED Patient Pain by Nurses and Physicians,” American Journal of Emergency Medicine 2 (2003): 253.

Maurice S. C. O'Donnell J. J. Beattie T. F. , “Emergency Analgesia in the Pediatric Population: Part I Current Practice and Perspectives,” Emergency Medical Journal 19 (2002): 4.

Sheehan D. K. Schirm V. , “End-of-Life Care of Older Adults,” American Journal of Nursing 103, no. 11 (2003): 48–58.

Sheehan D. K. Schirm V. , “End-of-Life Care of Older Adults,” American Journal of Nursing 103, no. 11 (2003): 48–58.

Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 467–475.

Nelson B. P. , “Mandated Pain Scales Improve Frequency of ED Analgesic Administration,” American Journal of Emergency Medicine 22, no. 7 (2004): 582–585.

Todd K. H. , “Emergency Medicine and Pain: A Topography of Influence,” Annals of Emergency Medicine 43 (2004): 504.

Tamayo-Sarver J. H. Sawson N. V. Cydulka R. K. , “Variability in Emergency Physician Decisionmaking About Prescribing Opioid Analgesics,” Annals of Emergency Medicine 43, no. 4 (2003): 483–493.

Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 467–475, 469.

Schnittker J. , “Social Distance in the Clinical Encounter: Interactional and Sociodemographic Foundations for Mistrust of Physicians,” Social Psychology Quarterly 67, no. 3 (2004): 217–235, at 217.

Sanders A. B. , “Unique Aspects of Ethics in Emergency Medicine,” in Iserson K.V. Sanders A. B. Methieu D. , eds., Ethics in Emergency Medicine (2d ed., Tucson, AZ: Galen Press, 1995): 7.

Schnittker J. , “Social Distance in the Clinical Encounter: Interactional and Sociodemographic Foundations for Mistrust of Physicians,” Social Psychology Quarterly 67, no. 3 (2004): 217–235, at 217.

Schnittker J. , “Social Distance in the Clinical Encounter: Interactional and Sociodemographic Foundations for Mistrust of Physicians,” Social Psychology Quarterly 67, no. 3 (2004): 217–235, at 217.

Tamayo-Sarver J. H. Sawson N. V. Cydulka R. K. , “Variability in Emergency Physician Decisionmaking about Prescribing Opioid Analgesics,” Annals of Emergency Medicine 43, no. 4 (2003): 483–493, at 484.

American College of Emergency Physicians, “Code of Ethics for Emergency Physicains,” (October 2001) available at <http://www.acep.org/webportal/PracticeResources/PolicyStatements/Ethics/CodeofEthicsforEmergencyPhysicians.htm> (last visited September 19, 2005).

Olson E. J. , “No Room at the Inn: A Snapshot of an American Emergency Room,” Stanford Law Review 46, no. 2 (1994): 449–502.

Tait R. C. Chibnall J. T. , “Physician Judgments of Chronic Pain Patients,” Social Science Medicine 45 (1997): 1199.

Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494; Todd K. H. Deaton C. D'Adamo A. P. , “Ethnicity and Analgesia Practice,” Annals of Emergency Medicine 35 (2000).

Society for Academic Emergency Medicine, “Five Sometimes Not so Helpful Habits of Academic Emergency Physicians,” (March 2001) available at <http://www.saem.org/newsltr/2001/march.april/pmmarc01.htm> (last visited September 19, 2005).

Wilsey B. Fishman S. Rose J. S. , “Pain Management in the ED,” American Journal of Emergency Medicine 22 (2004): 51.

Tamayo-Sarver J. H. Sawson N. V. Cydulka R. K. , “Variability in Emergency Physician Decisionmaking about Prescribing Opioid Analgesics,” Annals of Emergency Medicine 43, no. 4 (2003): 483–493.

Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494.

Hansen G. R. , “The Drug Seeking Patient in the Emergency Room,” Emergency Medicine Clinics of North America 23, no. 2 (2005): 349–65, at 352.

Tamayo-Sarver J. H. Sawson N. V. Cydulka R. K. , “Variability in Emergency Physician Decisionmaking about Prescribing Opioid Analgesics,” Annals of Emergency Medicine 43, no. 4 (2003): 483–493.

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes About Pain and Pain Control in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 297–306, at 302.

Tamayo-Sarver J. H. Sawson N. V. Cydulka R. K. , “Variability in Emergency Physician Decisionmaking about Prescribing Opioid Analgesics,” Annals of Emergency Medicine 43, no. 4 (2003): 483–493.

Fosnocht D. E. Swanson E. R. Barton E. D. , “Changing Attitudes about Pain and Pain Control in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 297–306, at 301.

American College of Emergency Physicians, “Code of Ethics for Emergency Physicains,” (October 2001), available at <http://www.acep.org/webportal/PracticeResources/PolicyStatements/Ethics/CodeofEthicsforEmergencyPhysicians.htm> (last visited September 19, 2005).

Cassell E. J. , “Uses of the Subjective in Medical Practice,” in Cassell E. J. Siegler J. , eds., Changing Values in Medicine (1979): 151–166; May C. , “Framing the Doctor-Patient Relationship in Chronic Illness: A Comparative Study of General Practitioners' Accounts,” Sociology of Health & Illness 26, no. 2 (2004): 135–158, at 151.

Furrow B. R. , “Pain Management and Provider Liability: No More Excuses,” Journal of Law, Medicines & Ethics 29 (2001): 28; Rich B.A. , “Physicians' Legal Duty to Relieve Suffering,” Western Journal of Medicine 175 (2001): 151.

11 BNA Health Law Reporter 1222; Federation of State Medical Boards, “Model Policy for the Use of Controlled Substances for the Treatment of Pain,” (2004) available at <http://www.fsmb.org/pdf/2004_grpol_Controlled_Substances.pdf> (last visited Septmeber 26, 2005).

Joint Commission on Accreditation of Healthcare Organizations, “Accreditation Issues of Emergency Departments,” Joint Commission Resources (IL: Oakbrook Terrace, 2003).

See, e.g., American College of Emergency Physicians, “Clinical Policy: Critical Issues for the Initial Evaluation and Management of Patients Presenting with Chief Complaint of Non-traumatic Acute Abdominal Pain,” Annals of Emergency Medicine 36 (2000): 406.

Lawrence L. L. , “Legal Issues in Pain Management: Striking the Balance,” Emergency Medical Clinics of North America 23 (2005): 573–584, at 581.

Brennan T. A. Leape L. L. Laird M. N. , “Incidence of Adverse Events and Negligence in Hospitalized Patients: Results of the Harvard Medical Practice Study,” N. Eng. J. Med. 324 (1991): 370.

Tucker K. L. , “Medico-legal Case Report and Commentary: Inadequate Pain Management in the Context of Terminal Cancer, the Case of Lester Tomlinson,” Pain Medicine 5 (2004): 214.

Johnson S. H. , “Commentary on Medico-legal Case Report,” Pain Medicine 5 (2004): 219.

Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medicine Clinics of North America 23 (2005): 467–475.

McIntosh S. E. , “Pain Management after Discharge from the ED,” American Journal of Emergency Medicine 22, no. 2 (2004): 98–100.

Ducharme J. , “Acute Pain and Pain Control: State of the Art,” Annals of Emergency Medicine 35 (2000): 592–603.

American College of Emergency Physicians, “Clinical Policy for Procedural Sedation and Analgesia in the Emergency Department,” Annals of Emergency Medicine 31 (1998): 663–677.

Todd K. H. , “Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia,” JAMA 269 (1993): 1537.

Bernard A. M. , “Chronic Pain in the ED,” American Journal of Emergency Medicine 22, no. 6 (2004): 444–447; Cordell W. H. Keene K. K. , “The High Prevalence of Pain in Emergency Medical Care,” American Journal of Emergency Medicine 20, no. 3 (2002): 165–169.

Frader J. , “Referral Back to an Incompetent Primary Care Provider,” in Iserson K. V. Sanders A. B. Methieu D. , eds., Ethics in Emergency Medicine (2d ed., Tucson: Galen Press, 1995): 276.

Kapp M. B. , “Legal Anxieties and End-of-Life Care in Nursing Homes,” Issues in Law and Medicine 19 (2003): 1–23.

Bottrell M. M. O'Sulhvan J. E. Robbins M. A. Mitty E. L. Mazey M. D. , “Transferring Dying Nursing Home Patients to the Hospital: DON Perspectives on the Nurse's Role in Transfer Decisions,” Geriatric Nursing 22, no. 6 (2001): 313–317; see, generally, American College of Emergency Physicians, Policy on Ethical Issues for Resuscitation, October 2001, available at <http://www.acep.org/webportal/PracticeResources/PolicyStatements/Ethics/EthicalIssuesResuscitation.htm> (last visited September 26, 2005); American College of Emergency Physicians, Policy on Non-Beneficial (“Futile”) Emergency Medical Interventions, October 2002, available at <http://www.acep.org/webportal/PracticeResources/PolicyStatements/Ethics/NonbeneficialFutileEMInterventions.htm> (last visited Septmeber 26, 2005).

Jacobs L. G. Bonuck K. Burton W. Mulvihill M. , “Hospital Care at the End of Life: An Institutional Assessment,” Journal of Pain and Symptom Management 24, no. 3 (2002): 291–298.

Ferris F. D. , “Models, Standards and Guidelines,” Clinical Geriatric Medicine 21, no. 1 (2005): 17–44; Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494–503.

Canterbury v. Spence, 464 F.2d 772 (D.C. App. 1972).

Miller v. Rhode Island Hosp., 625 A.2d 778 (RI, 1993); Shine v. Vega, 709 N.E.2d 58 (MA, 1999).

Wright v. John Hopkins Health System Corp., 728 A.2d 166 (MD, 1999).

Anderson v. St. Francis-St. George Hosp., 614 N.E.2d 841 (OH, App. 1992).

American College of Emergency Physicians, “Clinical Policy for Procedural Sedation and Analgesia in the Emergency Department,” Annals of Emergency Medicine 31 (1998): 663–677.

Blackburn P. Visser R. , “Pharmacology of Emergency Pain Management and Conscious Sedation,” Emergency Medicine Clinics of North America 18 (2000): 76–101.

“Autonomy and Informed Consent,” in Iserson K. A. Sanders A. B. Mathieu D. , eds., Ethics in Emergency Medicine (2d ed., Tucson: Galen Press, Ltd., 1995): 51.

Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494–503; Todd K. H. , “Emergency Medicine and Pain: A Topography of Influence,” Annals of Emergency Medicine 43 (2004): 504.

Burroughs v. Magee, 118 S.W.3d 323 (TN, 2003); McKenzie v. Hawaii Permanente Medical Group, Inc., 47 P.3d 1209 (HI, 2002).

McIntosh S. E. Leffler S. , “Pain Management after Discharge from the ED,” American Journal of Emergency Medicine 22, no. 2 (2004): 98.

Ducharme J. , “Acute Pain and Pain Control: State of the Art,” Annals of Emergency Medicine 35 (2000): 592–603.

Central Anesthesia Assoc. v. Worthy, 325 S.E.2d 819 (GA, App. 1984).

American College of Emergency Physicians, “Clinical Policy for Procedural Sedation and Analgesia in the Emergency Department,” Annals of Emergency Medicine 31 (1998): 663–677.

42 U.S.C.A. § 1395dd (2003).

General Accounting Office, EMTALA Implementation and Enforcement Issues. GAO-01-747 (2001); “Access to Health Care,” in Furrow B. Greaney T. Johnson S. , 5th ed. Health Law Cases, Materials and Problems (St. Paul, MN: Thomson West, 2004): 528.

Centers for Medicare and Medicaid Services, State Operations Manual, Appendix V, Interpretive Guidelines, Responsibilities of Medicare Participating Hospitals in Emergency Cases, Tag A406 (Rev. 1), May 21, 2004.

42 U.S.C.A. § 1395dd(e)(1)(A) (2003).

42 U.S.C.A. § 1395dd(e)(3)(A) (2003).

21 U.S.C. s 801 et seq.

Ducharme J. , “Acute Pain and Pain Control: State of the Art,” Annals of Emergency Medicine 35 (2000): 592–603; Rupp T. Delaney K. A. , “Inadequate Analgesia in Emergency Medicine,” Annals of Emergency Medicine 43 (2004): 494.

Hoffmann D. Tarzian A. , “Achieving the Right Balance in Oversight of Physician Opioid Prescribing for Pain: The Role of the State Medical Boards,” Journal of Law, Medicine & Ethics 31 (2003): 21–40.

Bonham V. L. , “Race, Ethnicity, and the Disparities in Pain Treatment,” Journal of Law, Medicine & Ethics 29 (2001): 52.

Federation of State Medical Boards, “Model Policy for the Use of Controlled Substances for the Treatment of Pain,” (2004) available at <http://www.fsmb.org/pdf/2004_grpol_Controlled_Substances.pdf> (last visited September 26, 2005).

Joranson D. E. Gilson A. M. Ryan K. M. Maurer M. A. Nelson J. M. , “Achieving Balance in State Pain Policy: A Guide to Evaluation, Part I,” The Pain and Policy Studies Group, University of Wisconsin Comprehensive Cancer Center (Madison, WI: 1999).

Federation of State Medical Boards, “Model Policy for the Use of Controlled Substances for the Treatment of Pain,” (2004) available at <http://www.fsmb.org/pdf/2004_grpol_Controlled_Substances.pdf> (last visited September 26, 2005).

Johnson S. H. , “Providing Relief to Those in Pain: A Retrospective on the Scholarship and Impact of the Mayday Project,” Journal of Law, Medicine & Ehics 31 (2003): 15–20.

Id. at 17.

11 BNA Health Law Reporter 1222.

Gonzales v. Raich, 125 S.Ct. 2195 (2005).

Gonzales v. Raich, 125 S.Ct. 2195 (2005); Gonzales v. Oregon, 368 F.3d 1118.

Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act, available at <www.unr.edu/ncehp/downloads/Consensus.pdf> (last visited September 20, 2005).

Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals, and Law Enforcement Personnel, at <http://www.aapsonline.org/painman/deafaq.pdf> (last visited September 19, 2005).

See generally, Lee K. F. , “Palliative Care: Good Legal Defense,” Surgery Clinics of North America 85 (2005): 287–302; Miller N. S. , “Prescription Opiate Medications: Medical Uses and Consequences, Laws and Controls,” Psychiatry Clinics of North America 27 (2004): 689–708.

Fonsnocht , “Changing Attitudes about Pain and Pain Control in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 297–306; Lawrence L. L. , “Legal Issues in Pain Management: Striking the Balance,” Emergency Medical Clinics of North America 23 (2005): 573–584; Ducharme J. , “The Future of Pain Management in Emergency Medicine,” Emergency Medical Clinics of North America 23 (2005): 467–475; McManus J. G. Sallee D. R. , “Pain Management in the Prehospital Environment,” Emergency Medical Clinics of North America 23 (2005): 415–431.

Lawrence L. L. , “Legal Issues in Pain Management: Striking the Balance,” Emergency Medical Clinics of North America 23 (2005): 573–584.

The Myth of the Chilling Effect, available at <http://www.usdoj.gov/dea/pubs/pressrel/pr103003.html> (last visited September 19, 2005).

69 Fed. Reg. 67,170–01.

National Association of Attorney's General, “Letter from the National Association of Attorney's General to the Drug Enforcement Administration Regarding DEA Withdrawal of Pain Management Prescription Guidelines,” available at <http://www.naag.org/news/pdf/so-20050119-prescription-pain-med.pdf> (last visited September 19, 2005).