Doctor's Personal Beliefs Impacting Father's Health Re Pain Meds

[GuaymasJim]

NEVER REFER TO ANY MEDICATION AS A DRUG!!!!

Adequate pain management is not optional at the VA; it is a hard and fast legal requirement. Those of us who have been dealing with the VA for decades have seen the cyclic nature of the VA's response to pain and narcotic medications. Right now, the DEA is frothing at the mouth about diversion and abuse of prescription narcotic medications. Recent VAOIG investigations showed that it was VA employees at the VA pharmacy mailout facilities who were diverting the narcotics--not the veterans who need them! However, since it is much easier to stop writing prescriptions that it is to apprehend and punish the guilty employees not to mention the PR headaches (pun intended), the VA started restricting the prescriptions. National studies have consistently shown that legitimate pain patients very rarely divert or abuse narcotic medications. I am facing basically the same problem with my new PCP after an almost flawless 12 years with another VA doctor. At one point many years ago, I would receive almost 800 percodan tablets in the mail every three months from the VA with no personal contact with the doctor who wrote the original prescription. A non-VA family doctor was so appalled and furious at this that he sat me down for almost two hours (an extraordinary amount of time for one patient even back then) and explained why this was not the best way to treat the extreme pain I experience. I learned more in that two hours than I have from 40 years with the VA!

You do have some powerful options available to you. I have attached some Joint Commission documents (Pain_Management.pdf and painmanagementbrochure.pdf) which state that a patient has a right to have their pain properly evaluated and adequately treated; and it is the doctor's responsibility to do so. The wisc.edu website below provides a layman's explanation of the Joint Commission's requirements. The Joint Commission is the only non-VA organization that the VA fears.

http://www.whocancer...edu/?q=node/186

If I were you, I would print out the documents provided; take them to the doctor; and politely demand that she fulfill her responsibility to your father. Politely ask her for a full explanation of her treatment plan for your father. Politely ask her to enter the treatment plan in its entirety including all details into the Progress Notes of your father's medical record; and inform her that you are going to the Release of Information office to get a copy of her Progress Notes covering the discussion and plan. If you get a negative or less than adequate response from her, I would:

(1) Go to the Patient's Advocate make a formal complaint and ask for an immediate change of provider as provided for in the VA Patients' Bill of Rights;

http://www.patientad....gov/rights.asp

(2) File a formal complaint with the Joint Commission here:

http://www.jointcomm..._complaint.aspx

The VHA Pain Directive on Pain Management 2009-053 (VHA09PainDirective.pdf) details the VA's responsibility to its patients concerning pain management. It is only 12 pages long and you need to read and understand it. Here is a very relevant quote from Page 2:

"(2) Quality of Life. Quality of life is now accepted by the medical field as a standard outcome measure of effectiveness of treatment, including treatment of pain. The concept includes such factors as level of physical and psychosocial functioning (e.g., in roles at work and home) and treatment satisfaction."

The Clinical Practice Guideline 2010 (CPG_opiodtherapy_fulltext.pdf) is 160 pages long but you should atleast browse through it. Here is a very relevant quote from page 4:

"The VA/DoD published the first Clinical Practice Guideline on management of opioid therapy for chronic pain

in 2003. This original publication was intended to improve pain management, quality of life, and quality of

care for veterans. The focus of the guideline has been to provide education and guidance to primary care

clinicians, researchers and other health professionals as they encounter patients with persistent pain and its

complications.

The current publication aims to update the evidence base of the 2003 Guideline. It is focused, as was the

original CPG, on chronic opioid therapy (opioid therapy for more than one month). It is directed to the

clinician who is interested in knowing more about this approach to the management of chronic pain.

The decision to widen the scope of the 2003 guideline to opioid therapy for chronic pain, as opposed to

chronic non-cancer pain, was debated within the guideline Working Group (WG). The distinction between

"non malignant" or "non cancer" pain is somewhat artificial. The success of opioid therapy in cancer

treatment and the significant increase in the number of cancer survivors with pain required reconsideration of

the narrow scope. There is no scientific evidence to suggest that the effects of cancer pain are any worse than

non-cancer pain. However, long-standing societal aversion to opioid therapy for the population at large is

tempered by the renewed emphasis on the moral imperative to alleviate suffering in the sick. There is a

substantial literature on the use of opioid therapy for cancer pain, and in many areas of treatment and followup,

it is possible to apply the same strategies to the patient with non-cancer pain. The working group

evaluated several suggestions and accepted those that apply to this population. The target population of the

current guideline is therefore inclusive of patients with cancer who have chronic pain due to the cancer or the

treatment they are receiving. However, the recommendations may not be appropriate for patients treated in

the palliative care setting."

The bottom line is that your father (and every other patient VA or not) has the legal right to have their pain treated. If you need to be firm and persistent, then be firm and persistent--BUT do be polite and accurate. Your success in getting proper care and treatment for your father depends both knowing and exercising your (his) rights AND knowing and understanding the VA's responsibilities and politely demanding that the be fulfilled.

With this doctor's horrible attitude and her ignorance of her professional responsibilities, you don't seem to have anything to lose by escalating the situation--if you do it properly. If you are retaliated against for exercising your rights, there are solutions to that also.

Thank you very much for taking care of your father! If you have more questions, just ask.

Good Luck and keep us informed!

Pain_Management.pdf

painmanagementbrochure.pdf

CPG_opioidtherapy_fulltext.pdf

VHA09PainDirective.pdf

Patient and Nursing Home Resident Rights and Responsibilities - Patient Advocate.pdf

Edited July 4, 2011 by GuaymasJim

[carlie]

If I'm not satisfied with my health care, whom do I contact?

I'm dissatisfied with my Patient Advocate contact; what is the next step for resolving my concern?

[halos2]

A few years back I had a new personal physician assigned to me as my other patient care provider took another position after 15 months of not being able to get appointments with her.(She was ill, and took a leave of absence, and came back to part time, which no one ever told me). Lucky I have had my own private physician also for 38+ years)

Anyway I arrived for my appointment 20 minutes prior, waited 40 minutes and asked if I was to been seen or not, after another 10 minutes they put me in an exam room, took my vitals, and I waited another 20 minutes, I came out of the room and said "This is ridiculous...I have another appointment in 30 minutes...they said she is running a little behund...I waited 20 more minutes and to put it midely was PO'ed! I said I was leaving and then they said oh she will see you now.

She came into the office and was there less than 1 minute SHE DID NOTHING! Said she was done. ARE YOU KIDDING!!

So I went to my other appt (BH) so she got a mouthful from me today and then I went to FOIA and requested my copies of records. All are usually available that day except BH...

I read them and became LIVID!!

This liar Dr wrote she did a full exam on me and wrote results she received...I marched up to the Red Team and complained to the Head Nurse and she gave me a form to file stating why I wanted a new Dr and basically told me others complained about her too. Apparently she sits in her office area with the door closed and gives patients VERY FEW minutes if that much!! No one knows what she does...

I was assigned a new Dr in 2 weeks and a new appointment. I knew the Pt Advocate prior, so I did tell her about what happened, and what I did and she said she would check on it too... I requested the Dr's unexam be removed from my records but basically they said we gave you a new provider and you received a new through exam so...no harm no foul! I feel sorry for others if she still is employed there!

GO to the Director as someone else posted, if you don't get another physician, using the request form at his clinic, and the pt advocate route. BTW you need some one to treat your dad for his cancer. Did they give him an oncologist too? What treatment regimen is in order for his Cancer diagnosis? Don't wait for them to act, you need to be your dad's Advocate all the way!

Never should your father be allowed to suffer in pain because a Dr has reservations/beliefs on whether to give pain meds or not!! Especially with pain diagnoses and cancer one's too!!

Edited July 5, 2011 by halos2