Patient dies after being prescribed opioids right after detoxification.
A 52-YEAR-OLD WOMAN had been going to the same physician for 17 years. While she was under his care, she had been prescribed various narcotics, benzodiazepines, and barbiturates, and she had become addicted to them. The patient suffered a fall at home that was allegedly caused by an overdose of these medications. During a 3-week hospitalization after her fall, the woman went through a detoxification protocol to ease her dependence on the drugs. During her next appointment with her physician, he prescribed alprazolam and morphine sulfate daily. A week later, the woman died, allegedly due to an overdose of the alprazolam and morphine sulfate.
PLAINTIFF'S CLAIM The defendant's failure to investigate the reason for the decedent's hospitalization violated the standard of care. If the physician had inquired about his patient's recent hospitalization, he would have been told about her detoxification, and wouldn't have prescribed her any potentially addictive drugs.
THE DEFENSE The physician admitted that if he had known about his patient's detoxification, he would not have prescribed her any medication. However, the doctor in charge of overseeing the detoxification told the patient not to see the defendant again, and not to take any prescriptions from him.
VERDICT $156,853 Illinois verdict.
COMMENT There is good reason to be wary of prescribing strong opioids and benzodiazepines for chronic pain in primary care practice. With the sharp increase in overdose deaths from opioids and the marginal evidence, at best, that supports the use of opioids for chronic, nonmalignant pain, such patients should--in my opinion--be managed directly in a pain/addiction program, or in close collaboration with one.
State Boards of Medicine are becoming appropriately stringent about opioids, so don't risk losing your medical license or being sued. Use narcotic-use contracts, random drug testing and co-management, and check your state narcotic prescribing database regularly if you treat chronic pain patients.
This is a sober reminder that doing more tests does not protect one from litigation.
COMMENTARY PROVIDED BY
John Hickner, MD, MSc
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|Title Annotation:||WHAT'S THE VERDICT?|
|Publication:||Journal of Family Practice|
|Date:||Nov 1, 2015|
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