Alleged medical abandonment in chronic opioid analgesic therapy: case report.

Abstract

OBJECTIVES:

The objectives of this medicolegal case report were the following: 1) present details of a chronic pain patient (CPP) on chronic opioid analgesic therapy (COAT), who diverted her opioids and was terminated from treatment, and subsequently committed suicide; 2) present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation of medical abandonment of this patient and other allegations; and 3) based on these opinions, to develop some recommendations as to how pain physicians can minimize their medicolegal risk when termination of the physician-patient relationship is warranted.

METHODS:

This is a case report of a CPP treated by a pain physician who demonstrated aberrant drug-related behaviors and required large doses of controlled-release oxycodone.

RESULTS:

Differences between the plaintiff's and defendant's experts' opinions are presented by utilizing the COAT literature. Options for avoiding allegations of abandonment are proposed.

CONCLUSIONS:

To avoid and protect themselves against potential abandonment allegations when termination of the physician-patient relationship is warranted, physicians are advised to consider following the outlined procedures.

• Authors: David A Fishbain, John E Lewis, Jinrun Gao, Brandly Cole, Rennee Steele Rosomoff
• Journal: Pain medicine (Malden, Mass.) (Pain Med) 2009 May-Jun Vol. 10 Issue 4 Pg. 722-9 ISSN: 1526-4637 [Electronic] England
• PMID: 19453957 (Publication Type: Case Reports, Journal Article)

Chemical References

• Analgesics, Opioid
• Hypnotics and Sedatives
• Oxycodone
• Alprazolam

Topics

• Abdominal Pain (drug therapy, etiology, physiopathology)
• Adult
• Alcoholism (complications)
• Alprazolam (administration & dosage)
• Analgesics, Opioid (administration & dosage, adverse effects)
• Crime
• Drug Administration Schedule
• Fatal Outcome
• Female
• Humans
• Hypnotics and Sedatives (administration & dosage)
• Malpractice (legislation & jurisprudence)
• Opioid-Related Disorders (etiology, psychology)
• Oxycodone (administration & dosage, adverse effects)
• Pain, Intractable (drug therapy, etiology, physiopathology)
• Pancreatitis, Chronic (complications, physiopathology)
• Patient Compliance
• Physician-Patient Relations
• Refusal to Treat (ethics, legislation & jurisprudence)
• Self Medication (psychology)
• Suicide (ethics, legislation & jurisprudence)