Pubdate: Thu, 14 Jun 2001
Source: San Francisco Chronicle (CA)
Copyright: 2001 San Francisco Chronicle
Contact:  http://www.sfgate.com/chronicle/
Details: http://www.mapinc.org/media/388
Author: Matthew Yi, Chronicle Staff Writer

ELDER-ABUSE VERDICT CHALLENGES PHYSICIANS ON PAIN

Doctors Must Balance Relief Against Addiction

A landmark verdict of elder abuse against an East Bay internist for not 
giving enough painkillers to a dying man has grabbed the attention of 
physicians already under pressure to make treatment decisions based on 
subjective evidence.

"How do you define a satisfactory amount of (pain) medication?" said 
Berkeley pain specialist Dr. Michael H. Park. "When (the patient) says it's 
OK? If the patient says I don't feel OK, do you just simply give more?"

Treating pain, he said, is a fine art that combines what the patient says 
he feels with the doctor's medical knowledge and past experience. 
Treatmentisn't something that should be dictated by fears of malpractice 
lawsuits, he said.

"I think it's dangerous for (lawyers and courts) to decide what doctors 
need to do," said Park, who has been practicing for a decade.

An Alameda County jury on Wednesday found Dr. Wing Chin committed elder 
abuse and reckless negligence for not giving enough pain medication to lung 
cancer patient William Bergman, 85, who was admitted to Eden Medical Center 
in Castro Valley in February 1998. He died  later that month at his home in 
Hayward.

The jury also awarded $1.5 million to the Bergman family, although state 
law puts a cap of $250,000 on pain and suffering damages, attorneys 
on  both sides said yesterday. Alameda County Superior Court Judge David E. 
Hunter is expected to rule on the final figure later this month.

Dr. Jeffrey Randall, president of the hospital's medical staff, said 
yesterday he's unsure how the ruling will affect pain treatment at Eden.

"I think it's too soon to know what the long-term ramification is going to 
be," he said. "But I think it's worrisome that something like this can 
happen  to someone of Dr. Chin's caliber. . . . He's well regarded by his 
colleagues, and he's treated many physicians and their families."

However, the message of the verdict is clear, said Dr. Russell Portenoy, 
former president of the American Pain Society and head of the pain 
management department of Beth Israel Medical Center in New York.

"It begins to create the reality of (punishment) . . . for physicians who 
don't respond to patients who have severe pain," Portenoy said.

In the past, most doctors erred on the side of undermedication, fearing 
malpractice suits from possible addiction to painkillers, leading some 
physicians to be too lax about pain treatment, he said.

In fact, structured guidelines on pain management are relatively new and 
still evolving.

The Joint Commission on Accreditation of Healthcare Organizations, which 
accredits most hospitals and nursing homes in the United States, just  this 
year incorporated standards for pain management, Portenoy said.

The number of state medical boards that have explicit guidelines on 
treating pain is growing but still in the minority, said David Joranson, 
director of the Pain and Policy Studies Group at the University of 
Wisconsin's Comprehensive Cancer Center.

His research group recently came up with pain management guidelines, which 
have been adopted by medical boards in 15 states.

"We had 11 workshops around the country on the subject, and it led to an 
unprecedented increase in the number of state boards coming up with 
guidelines on pain management," he said. .

Not Here

But California isn't one of them. That's because the Golden State's medical 
board instituted its own rules in 1994. Three years later, the state 
Legislature also passed the Pain Patient's Bill of Rights, allowing 
patients to ask for painkillers of their choice.

This year, the state Assembly approved a bill, which is now in the Senate, 
that would require doctors to take pain management courses and the state 
medical board to keep statistics on under-treatment complaints.

The Bergman family filed a complaint with the California Medical Board, but 
it refused to take action against Chin.

Board spokeswoman Candis Cohen admitted the organization doesn't keep an 
accurate count.

"However, historically, complaints regarding the undertreatment of pain 
have been nearly nonexistent. That is the experience of our board," she 
saidyesterday.
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MAP posted-by: Larry Stevens