Doctor
Sanctioned
for
Undertreating
Patients'
Pain
9/3/99
Last April, the Week Online
reported that the Oregon Board of Medical Examiners had taken the unprecedented
step of disciplining a doctor, Dr. Paul A. Bilder, for undertreating pain
(http:www.drcnet.org/wol/087.html#undertreatment). In
The Associated Press reported yesterday that the Board had determined a penalty in the case, requiring Bilder, 55, to sign a stipulated order acknowledging that his treatment showed unprofessional or dishonorable conduct and negligence; complete the Physicians Evaluation Education Renewal program (PEER), a one-year program in which another doctor in Bilder's field works with him to assess his practice and make improvements; complete a course on physician-patient communication; and continue meeting with a psychiatrist who will give regular reports to the board for at least a year. Dr. Harvey Rose, a California physician who led the effort to pass California's Intractable Pain Treatment Act, feels the penalty was too severe. Rose told the Week Online, "It reminds me of the old cartoon of the devil offering his new visitor the choice of two doors: one of them labeled 'damned if you do' and the other 'damned if you don't'." Rose explained, "The article says that people described him as a compassionate doctor, and he probably was. But he was a scared doctor, and the board is the reason he was scared, because of its past policies." Rose suggested the board's approach at this point should be educational, rather than punitive. "They should have made him take some CME courses to be reeducated on pain management, and kept him under observation for a year to give him a chance to modify his practice." Rose continued, "the danger of punishing doctors for underprescribing, when for years the situation has been the opposite, is that doctors won't want to have anything to do with pain patients at all." Dr. Rose was featured in an August 9th article in the New York Times. Fear of medical board sanctions may pale in comparison to the fear of criminal prosecution by drug enforcers. Dr. Allen S. Licher, former president of the American Society of Clinical Oncology, told the New York Times that relatively few criminal cases for overprescribing narcotics have been brought against doctors, "but the ones that were had a tremendously chilling effect. Doctors just did not want to take the chance of getting caught up in that." Fear of hard prison time at the hands of prosecutors and juries who misinterpret the evidence on pain control could go a long way to explain why doctors undertreat or don't treat pain. (Visit the American Society for Action on Pain at http://www.actiononpain.org for much more information on this important issue and how patients can help themselves find adequate treatment. See our June 18 issue at http://www.drcnet.org/wol/095.html#painbill to read about current pain legislation that some advocates think will hurt rather help pain control. Read our 1996 article, War on Pain Control at http://www.drcnet.org/guide10-96/pain.html for an example of what can happen to pain patients and the doctors who treat them in the drug war.)
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