Hospice and litigation question

LPN_mn · Oct 20, 2005

I did read an article somewhere about a man that was terminally ill and family claimed he did not receive proper pain control. They sued the doctor after the man died and if I remember correctly they did win a settlement. I will try to find the article. I found 2 cases one against a nurse and one against the doctor that I mentioned above. Here is where I found it http://www.postgradmed.com/issues/2001/09_01/sept01.htm.

mc3, ASN, RN · Oct 22, 2005

That's an interesting question, and one and I have been looking to an answer for myself. Can I ask why you're asking? I'm curious....PM me if you like.

mc3

jsteine1 · Oct 22, 2005

marketing purposes!

Katillac, RN · Oct 22, 2005

Your answer is a little unclear, I'm afraid. What are you marketing and how will this information help you to market it?

jsteine1 · Oct 22, 2005

Your answer is a little unclear, I'm afraid. What are you marketing and how will this information help you to market it?

Physicians are concerned about the tracking of their opiate prescribing habits and as a result, the terminally ill elderly are often undermedicated for pain, particularly in the skilled nursing environment. Lately, I have "heard" of more and more instances of litigation by families because pain control was not managed well. I am seeking hard data and information on specific cases and outcomes. I have been told many times by physicians I know that they fear referring to hospice as they are unfamiliar as well as uncomfortable with the pain management approaches used in palliation because it deviates from their "norms". I would like to be well informed on both sides of this equation for discussion purposes.

suebird3 · Oct 22, 2005

We use two different Hospices where I am at. One MD had his patient on Vico-profen, and finally MSO4. Pt. is basically unresponsive, with minimal moaning d/t dx.

Other patient doesn't warrent pain meds. Just gradually declining.

If I hear/find anything, will let you know. Have you checked out Medscape?

Suebird

jsteine1 · Oct 22, 2005

Thank you Suebird. I found a few articles in physician executive magazine about failure to manage pain appropriately and the risks. I guess that got me to thinking a lot about this subject. I will search back issues of medscape as well. Keep your eyes open for me!

Katillac, RN · Oct 22, 2005

I'm all for any advocacy that helps get patients appropriate symptom management. However, a more effective approach with the doctors that I know would be to work on establishing that there is little risk of censure associated with thoughtful and medically justified prescription of opioids. If a clinician truly fears that he or she risks losing their license for providing good symptom relief I wonder if also creating the spectre of being sued for undermedicating won't establish the impression that a doctor just can't win when referring to hospice. Maybe the better approach would be to research the question of how much risk there actually is to doctors prudently prescribing in nursing homes, and bringing that research to the attention of narcophobic docs.

Those who are being investigated tend to be those whose prescribing index is greatly over the norm and who have had complains filed against them.

Additionally, the greatest risk factor to doctors comes from prescribing to patients in their homes, where the potential for misdirection and abuse is much greater than when the meds are administered by a nurse in a controlled setting. While this doesn't help if you are trying to advocate for patients in the home, it might be useful for the patients about whom you are concerned: patients in nursing homes.

You may also be interested in discussing methadone with narcophobic docs. In my practice, we use it extensively for its outstanding analgesic effect (comparable or better than oxycodone or morphine), low cost, and nearly nonexistent abuse potential.

suebird3 · Oct 22, 2005

Kattilac.....only one problem with Methadone with me. I work LTC, and we cannot use it. Forgot why. (Midnights will do that to ya!) I know we have a free standing Hospice Home down the way, and perhaps they can use it there.

Katillac, RN · Oct 22, 2005

Well, methadone is tricky to dose. It's used as both a long acting and a PRN but it has a DAYS long half life so titration can be challenging. We really have to stay on top of it, especially when we first start it. I'd be interested in why you can't use it, if you happen to remember. Maybe there's something I need to know about the stuff!!!!

suebird3 · Oct 22, 2005

Hey, Kattilac. I will call our Pharmacy later on tonight, and let ya know. I do remember some one had the stuff ordered for pain last year, and there was no end to the hassle in getting the stuff. Then again....not sure on the Hospice side. Will find out.