Q: I am concerned about liability exposure regarding pain management; can you offer any suggestions to reduce my risk with these patients?
A: The Centers for Disease Control and Prevention (CDC) reported Nov. 1 that overdoses from prescription drugs increased more than three-fold from 1999 to 2008. More than 40 people die each day from narcotic painkiller overdoses, and the CDC reports increases are due to prescription painkiller abuse.
To protect yourself against potential liability, consider the following risk management suggestions as you manage your patients with chronic or persistent pain.
- Write prescriptions for limited quantities.
- Make a copy of the patient’s photo identification and Social Security number for the medical record. Confirm the patient’s telephone number.
- If a patient’s complaints of pain are chronic or persistent beyond an expected recovery, the medical record should reflect all diagnostic efforts to determine the underlying source of pain.
- Confirm a new patient’s pain diagnosis by obtaining previous treating records or ordering appropriate diagnostic tests. If the patient is unwilling to cooperate, consider cessation of prescriptions.
- Remember that treatment of chronic pain requires more than treatment of symptoms.
- Frequent appointments may be necessary to monitor and document the patient’s progress.
- Maintain detailed records, including medication flow sheets, documenting each prescription and refill, including the type, strength and quantity. Monitor drug usage in compliance with your instructions.
- Pain management contracts may be good to employ with chronic pain management patients using controlled substances long term.
- If your pain management plan is ineffective, consider referral to a pain clinic.
- If an active substance abuse problem is identified, directly address the issue with the patient and consider referral for substance abuse treatment.
View a CDC Vital Signs brief with additional information on the CDC website.
Physicians insured by ProAssurance may contact our Risk Management department for prompt answers to liability questions by calling(800) 292-1036 or via email.