I hear from pts .. nearly daily.. about their medications being pulled back, dropped altogether and/or discharged from a practice. I read in a lot of state laws and CDC guidelines the word “PALLIATIVE” which is often aligned with the clause that exempts terminal/cancer pts from any limitations on their opiate/pain management therapy.
If you look to WHO (World Health Organization) as to their definition of Palliative care you get the following
WHO Definition of Palliative Care
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:
http://www.who.int/cancer/palliative/definition/en/
- provides relief from pain and other distressing symptoms;
- affirms life and regards dying as a normal process;
- intends neither to hasten or postpone death;
- integrates the psychological and spiritual aspects of patient care;
- offers a support system to help patients live as actively as possible until death;
- offers a support system to help the family cope during the patients illness and in their own bereavement;
- uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
- will enhance quality of life, and may also positively influence the course of illness;
- is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
Palliative care seems to have a very broad definition and while normally associated with treating pts with cancer…there seems to be the potential to apply to pts with a large array of chronic disease states.
The CDC guidelines and/or any guidelines – while don’t carry the weight of law – they do bear the weight of creating a “standard of care” and/or “best practices”. To establish a MINIMUM OF CARE for pts but not to exclude care provided to the pt above and beyond the MINIMUM care.
It is common knowledge that chronic pain pts typically suffers from depression and anxiety and is at twice the risk of committing suicide.
A pt’s medical records is clinical proof of what has been tried and what has been successful. When a prescriber start changing/reducing the pt’s medication therapy.. could that be considered a form of pt abandonment or a form of malpractice because they are deviating from what has been proven clinically successful for a particular pt.
Currently Barb’s pain management is – IMO – at a optimum level, but like everyone else… she/we are at risk of various changes that could impact that situation… PCP retiring, dying… the teaching hospital where her pain clinic is located could have a change in policies and procedures.
If her pain management is reduced.. it is obvious that her quality of life goes in the same direction… and to the same degree it has an impact on my quality of life..
There is a part of the law:
What is Loss of Companionship and Consortium?
Loss of companionship and consortium also called the loss of society, loss of conjugal fellowship, and loss of marital compatibility are all different names for the same thing. Essentially, these terms refer to the emotional sadness one goes through when an immediate family member (spouse or child) has been injured or killed. It can include the grief from the loss of sexual relations or the loss of the ability to have children.
Under these circumstances… deviating away from therapy that has proven to optimize her quality of life… we could have a pt that is being placed at a higher risk of suicide and loss of companionship on my part..
Personally, I would have my attorney send the physician a certified letter that the palliative care provision of the law applies to Barb… that there is clinical evidence of what amount of medication that she needs to optimize her pain management and quality of life… so do anything less would constitute a failure to meet ‘best practices” and “standard of care”… a form of malpractice and pt abandonment … and if the prescriber’s actions/in-actions contributes to her committing suicide that I will file charges that he contributed to/assisted in causing her to take that action.
This could paint the prescriber into a corner … “CHECK MATE”… if he discharges her… then there is the issue of retaliation, pt abandonment and I am sure that a good attorney can think up a few other charges.
One has to ask, if a prescriber can be charged with the death of a pt that OD’s for prescribing opiates to them… why can’t they be charged equally if a pt – who the prescriber knew or should have known was at risk of a deepening depression – if their medication was reduced or eliminated.
What I think would be quite interesting is the spouse suing the prescriber for lost of companionship because of their actions/in-actions. This would probably only work if the pt’s pain management had been stable and went downhill because of reduction of pain management meds.
Filed under: General Problems
I lost all of my relatives within five years except my brother and the children of my brother, sister and myself. My sister died young with four children in tow. She was the only cancer patient. My brother and I are left. One day we just looked at each other with wide eyes and disbelief that our entire family had died!
Everyone was in Hospice — sometimes two at a time. Palliative care was skipped (via doctors’ and nurses’ suggestions that they go straight to Hospice due to their conditions in some cases and for obvious reasons in other cases). Other than a few employees of Hospice who I fired for lack of brains and love of self, my experiences were good. I was a caregiver to every family member during their times in Hospice (and for each prior to Hospice). I watched them all go from robust healthy loved ones to the moment of death, when I sat with every of them and held their hands and sang softly. The Hospice program was wonderful and some of the most responsive, compassionate and mindful employees I’ve ever met in any setting took care of my family. They have a tough job; and are so sad when they lose a patient. They come to the funerals, they take extra time from their schedules and they are highly-trained (except those few who fooled the people who hired them). I know there is a certain amount of theft and abuse among some of the nurses’s employees and surely there are nurses who aren’t so great too, but I have to say that in Minnesota there were people in that program who I could never have lived without during the course of these horrible deaths. On top of Hospice, we had me, hired caregivers and personal nurses, so I don’t know what it’s like to only have Hospice.
Now I am becoming the next one of the group, and it isn’t because of my chronic pain or the disease/syndromes the pain comes from. I want to start new things in my life right now, and have opportunities to go on some amazing adventures, but that won’t happen. That, to me is the hard part. I’m not done yet! I hadn’t even thought of Palliative Care until I read this. I guess I”m feeling sad for myself, but I want to say that I hope everyone reads and understands what Steve is saying, and if you can talk to people who are in PC, it might be a good learning thing. I believe that’s what I will do. I have no idea how this all works in Florida. In fact, until I read the comment about NJ, I didn’t realize this care was a state’s decision; I thought it was a Federal program. Thanks, Steve, for providing more great information!
Steve, you might find this interesting. I’d forgotten about it until reading what your wrote. The bassist for a popular heavy metal band, Paul Gray, died of an overdose of morphine and fentanyl along with “significant heart disease” about 6 years ago. His doctor, Dr. Daniel Baldi (Iowa), was originally charged with 9 counts of involuntary manslaughter, but two of those were dismissed.
The doctor was acquitted of all charges because he did not prescribe any of the drugs that those 7 people died from. (“None of the patients in question died from overdoses of drugs the doctor prescribed.”) (“Experts for the defense also testified that three of the patients probably died of heart problems, and that another apparently committed suicide.”)
http://www.desmoinesregister.com/story/news/crime-and-courts/2014/05/01/baldi–verdict-jury/8576229/
Paul’s wife filed a civil suit on behalf of herself and their 5 year old (October Gray, who was 3 months shy of being born at the time of Paul’s death) against Dr. Baldi for “wrongful death.” The Iowa Supreme Court threw out wife’s case against Baldi due to statute of limitations but is allowing their daughter’s case against the doctor.
“The first-of-its kind case required the Iowa justices to weigh whether October Gray could bring a lawsuit for the loss of her father’s love and emotional support — known as loss of consortium — even though she was still in her mother’s womb when Gray died of a drug overdose in May 2010.”
“The young daughter could still suffer the emotional effects of her father’s death after her birth, making her claim eligible to be decided by a jury, Justice Daryl Hecht wrote in the ruling. The ruling went against arguments from lawyers representing Dr. Daniel Baldi, who claimed October Gray had no relationship with her late father and should be unable to sue.”
http://www.desmoinesregister.com/story/news/crime-and-courts/2016/05/06/court-slipknot-bassists-unborn-child-can-sue-dads-overdose/84015388/
[…] If you read the WHO’s definition of palliative care in this post what would happen if ? […]
Lisa in NJ can not find any palliative if you have any information please post. Member Long Term Services? Could that possibly be palliative? Any help greatly appreciated.
In NJ appears palliative and hospice now are combined. To get services you must be terminal with 6 months or less to survive or to qualify for palliative be under 21. There is NO palliative in NJ! There was 1 1/2 years ago but now they are combined.
Doesn’t it figure if you are an adult and not imminently dying there is no help
I actually know some chronic pain patients who are being treated very well by palliative care centers. That might be places to recommend to patients who are dropped from a pain management Doctor/clinic. ?
Lisa Davis Budzinski
VP of CPSFoundation
I tried to get into several pallliative care centers here in Pittsburgh for chronic pain and I was told I do not qualify
Lisa left you a post below. Thank you
Reply to cheek50 , you can’t teach anything to someone with a closed mind. We need to find a way to open minds to ideas contrary to their strongly held opinions especially when they are so wrong. I wish I knew how.
It is even harder to teach something to someone who knows everything. You can not tell someone who knows everything something they do not already know. Take 90% or more of PROP members, for example. Politicians aren’t much better. And forget about Steve Rummler Hope Foundation founders (all those “chronic pain” patients screaming they need their medication are “just like my son. They are addicted.”)
Now, if we can only get that 1.1 billion dollars, and stop the bleeding of public health funding into Zika virus efforts. God forbid that we should actually pay attention to an emerging threat to public health that might actually be real! We need to get our job done and funnel billions into the “non-profit” Phoenix House, and Hazeldon Betty Ford!
Instead of going through all of that negativism, how about just educating people that opiates aren’t the cause of addiction.
We are more and more dealing with prescribers that have no concern about the suffering of pts… they are treating GUIDELINES as LAW.. They fear the DEA and others.. and that fear causes them to . if nothing else.. slowing abandon the pts… cutting their pain meds visit by visit. The suffering/consequences to the pt is NOT THEIR CONCERN.. because to date there has been no consequences to them for doing it. A prescriber that is cutting a pt’s dose that has been on it for years, maybe even decades .. is not afraid of addiction. When laws are involved.. it is getting more and more common that the only solution is use of an attorney and the law to get proper medical care. If pt goes to see a prescriber… they should expect that their issues will be properly diagnosed… and a means of curing/treating will be made.. if the condition cannot be cured.. then some sort of treatment should be offered to help the pt manage the symptoms or issues that are impacting the pt’s quality of life. If prescriber maximizes pain management and then starts taking it away… then the prescriber is no longer practicing medicine.. they are just collecting fees for sub-par care. It is unfortunate that the TRUTH.. is viewed by some as NEGATIVITY