Wes1212
07-16-2003, 09:00 AM
Hi. I'm having a time locating that there is a law that provides for "Pain: 5th Vital Sign".
I see that "the Joint Commission on Accreditation of Health Organizations (JCAHO) now requires that physicians consider pain as a "5th vital sign" in evaluating patients."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11587108&dopt=Abstract
And that the VA has "Pain as the 5th Vital Sign: Take 5
Section 1: Introduction Veterans Health Administration (VHA) National Pain Management Strategy
http://www.va.gov/oaa/pocketcard/Section1.asp
"HCR ManorCare: Pain: Understanding the 5th Vital Sign. September 23, 1999; Cleveland, Ohio (course director and lecturer)." as well as a few other books and lectures with similar titles.
I just can't find any hard law stating this fact. It seems to be debated and discussed more than anything.
any help?
Thanks,
Wes
I see that "the Joint Commission on Accreditation of Health Organizations (JCAHO) now requires that physicians consider pain as a "5th vital sign" in evaluating patients."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11587108&dopt=Abstract
And that the VA has "Pain as the 5th Vital Sign: Take 5
Section 1: Introduction Veterans Health Administration (VHA) National Pain Management Strategy
http://www.va.gov/oaa/pocketcard/Section1.asp
"HCR ManorCare: Pain: Understanding the 5th Vital Sign. September 23, 1999; Cleveland, Ohio (course director and lecturer)." as well as a few other books and lectures with similar titles.
I just can't find any hard law stating this fact. It seems to be debated and discussed more than anything.
any help?
Thanks,
Wes
Sponsor
painintheneck2
07-16-2003, 09:13 AM
I'm not sure if this is the same thing that you are referring to but look under your states Board of Medical Examiners on the web. I did that for my state and discovered that by law a physician must treat your pain. In other words a doctor cannot turn you away, he must in some form or fashion treat your pain. I wish I could find that section again, but I read it awhile back while doing some research and it stuck with me because I hadn't known that little fact before. Anyway it gives us patients a little ammo whenever or ifever we run into a doc who doesn't acknowledge and/or treat our pain.
This prob has nothing to do with what you are referring to, but it's good for others to know.
This prob has nothing to do with what you are referring to, but it's good for others to know.
cinnomore
07-16-2003, 11:14 AM
IN REALATION TO YOUR STATEMENT, I AGREE WITH YOU TOTALLY. HOW CAN A DOCTOR TURN YOU DOWN WHEN YOUR IN PAIN, I DON'T UNDERSTAND THAT EITHER. SOMEONE TOLD ME THIS, BUT I DON'T BELIEVE ITS TRUE, BUT WANTED SOME INPUT ON THIS, THAT SAY IF A DOCTOR STARTS YOU ON A PAIN MED, SUCH AS PECOCET, AND HE KEEPS GIVING YOU THEM FOR A FEW YEARS, CAN HE JUST CUT YOU OFF COLD TURKEY THAT , OR DOES HE HAVE TO CONTINUE TO GIVE THEM TO YOU. I QUIT TAKING VIKES LAST WEEK AND AM SO GLAD THAT I DID, I WAS HEADING DOWN A VERY BAD ROAD, THANK GOD FOR THE PEOPLE ON THIS BOARD, THEY GOT ME ON THE RIGHT ROAD.
Wes1212
07-16-2003, 10:16 PM
http://www.medsch.wisc.edu/painpolicy/index.htm
[This message has been edited by Wes1212 (edited 07-16-2003).]
[This message has been edited by Wes1212 (edited 07-16-2003).]
Jack Beanstalk
07-16-2003, 11:45 PM
I,m sure most of you remember good ol,Skip Baker.He,s done more than anybody I know of to help CPers.On his old site,I recall JACHO reps stating info on the pain as a vital sign issue as being made law.I,m just unsure of the coverage,if it was a state-by-state deal or a national one.It states that it is now the law that a patient being admitted into a hospital or ER,Primecare,etc.had to have their levels of pain treated as a vital sign.This became effective as of Jan.1,2000.Jack Beanstalk
oceanview88
07-17-2003, 05:59 PM
Hey Guys, I had a tough time finding the actual guidelines without purchasing the workbooks to educate and evaluate but did find an overview.
The JCAHO guidelines only pertain to 8 specific healthcare facilities that require JCAHO accreditation. It does not require docs in private practice or in a PM clinic setting, unless based inside a hospital or residential care facility to abide by or seek acreditation from a group that doesn't oversee private practice.
This overview does state the 8 types of institutional settings that require JCAHO accreditation.
........................................ ............
The Joint Commission on Accreditation of Healthcare Institutions (JCAHO) pain standards are incorporated into seven accreditation manuals that cover eight different types of organizations involved in the direct provision of care: ambulatory care, behavioral health care, home care, hospital, long-term care, long-term care pharmacy, and health care network organizations and managed behavioral health.
The standards emphasize three main points:
Recognize the individual's right to appropriate pain assessment and management.
Identify persons with pain in initial assessments and ongoing (as needed) assessments.
Educate patients, residents, and clients and their families about pain management as appropriate.
Specifically, there are new pain management sections in six different chapters of the accreditation manuals:
Rights and Ethics: "Recognize the right of individuals to appropriate assessment and management of pain."
Health care organizations may make this commitment explicitly through their mission statements; patient, resident, client and family bill of rights; or service standards.
Assessment of Persons with Pain: "Assess the existence and, if so, the nature and intensity of pain in all patients, residents, or clients."
Organizations should incorporate pain assessment into their procedures and ensure staff competency in pain management. Training for pain assessment and management should be included in the orientation of all new clinical staff.
Care of Persons with Pain: "Establish policies and procedures that support the appropriate prescribing or ordering of effective pain medications."
This standard asserts that one goal of care is the treating of symptoms related to a disease, condition, or treatment, including pain.
Education of Persons with Pain: "Educate patients, residents, and clients and their families about effective pain management."
The organization is responsible for helping these people understand pain management as a part of treatment, with a particular emphasis on providing balanced and accurate information on pain medication.
Continuum of Care: "Address the individual's needs for symptom management in the discharge planning process."
Clinicians should address pain when they're considering an individual's needs after discharge.
Improving Organization Performance: "Incorporate pain management into the organization's performance measurement and improvement program."
Data collected to monitor an organization's performance should include how well its pain management program is performing.
........................................ .............
If you were mistreated in one of these settings you can report that institution to the JCAHO by going to the JCAHO homepage. However I don't see where there is any gaurentee that the patients pain will be treated to the patients satisfaction. If they ask, if they report and if the doc decides tylenol or Darvecet is apropriate, If they discharge you with instructions to take tylenol or follow up with a PM doc they have complied with this standard of care.
If they check back a few hours later and your still in pain the doc may prescribe a shot of Toradol. This standard for accreditation does not guarantee that a patients pain will be controlled to their satisfaction. There will be patients that aren't happy until their pain is completely eliminated. That's not always reasonable or possible.It's not a gurentee that a migraine patient qwill get morphine or any other potent anelgesic if the ER doc doesn't see fit. Again you can report ER docs to the JCAHO
Take migraines for example. If you go to the ER which is part of an institution that is obliged to comply to these standards, if the doc gives you a motrin and sends you home with directions to take 2 tablets every 6 hours he has complied with these standards.
Unfortunately if they mandated that each patients pain be managed to each patients satisfaction it would open the doors to every drug seeker looking for a shot of morphine or Demerol. You can't pass a regulation that forces doctors to forgo good judgment in order to maintain accreditation. You can report poor treatment but that's about it.
To answer the question about a doc that has been treating you with opiates, can he just cut you off? the answer is yes. There is something called patient abandonment but if a doc cuts you off and you complain and he suggest you go to a detox facility or see your GP for evaluation, he has not abandoned his patient, He has done all that is required. He's given you medical advice and has no obligation to continue medicating you. It's your choice to go to detox or your GP and ask for continued prescriptions.
If that were the case every post surgery patient that enjoyed their pain meds would have the right to continue taking the meds they wanted indefinitely or bring a law suit against their physician.
Please consider that even if your PM contract guarantees certain treatment even in the case of substance abuse, like a taper or meds to make withdrawal more comfy wouldn't the doc have the right to say the whole contract goes out the window when you broke it. Once a contract is broken you can't then ask to be protected by the same contract that you broke.
If he suggest you go to rehab then he has given you useable medical advice and has not abandoned you. You may not agree with his advice but it doesn't give you grounds for legal action. What actual damage has he done by discontinuing opiate therapy. He will definitely chart his recommendation thus protecting himself from litigation should you have a significant problem withdrawing from the medication. There is no compensatory damage for feeling sick for 3 weeks. No lawyer will take a no win case on contingency.
This is just contract law 101. Once you break the contract the other party is no longer bound by the conditions of that same contract.
The JCAHO is a step in the right direction and does give patients the ability to report a facility that is mentioned in the new JCAHO standards. But it doesn't guarantee anything more than assessment and acknowledgment and treatment chosen by the treating physician. It's really more of an effort to educate the practitioners at specific types of care facilities about the harm of untreated pain.
That's just my interpretation though. I'm sure others may see it differently but lets agree not to flame each other if we don't see this the same way.
Take care, Ocean
The JCAHO guidelines only pertain to 8 specific healthcare facilities that require JCAHO accreditation. It does not require docs in private practice or in a PM clinic setting, unless based inside a hospital or residential care facility to abide by or seek acreditation from a group that doesn't oversee private practice.
This overview does state the 8 types of institutional settings that require JCAHO accreditation.
........................................ ............
The Joint Commission on Accreditation of Healthcare Institutions (JCAHO) pain standards are incorporated into seven accreditation manuals that cover eight different types of organizations involved in the direct provision of care: ambulatory care, behavioral health care, home care, hospital, long-term care, long-term care pharmacy, and health care network organizations and managed behavioral health.
The standards emphasize three main points:
Recognize the individual's right to appropriate pain assessment and management.
Identify persons with pain in initial assessments and ongoing (as needed) assessments.
Educate patients, residents, and clients and their families about pain management as appropriate.
Specifically, there are new pain management sections in six different chapters of the accreditation manuals:
Rights and Ethics: "Recognize the right of individuals to appropriate assessment and management of pain."
Health care organizations may make this commitment explicitly through their mission statements; patient, resident, client and family bill of rights; or service standards.
Assessment of Persons with Pain: "Assess the existence and, if so, the nature and intensity of pain in all patients, residents, or clients."
Organizations should incorporate pain assessment into their procedures and ensure staff competency in pain management. Training for pain assessment and management should be included in the orientation of all new clinical staff.
Care of Persons with Pain: "Establish policies and procedures that support the appropriate prescribing or ordering of effective pain medications."
This standard asserts that one goal of care is the treating of symptoms related to a disease, condition, or treatment, including pain.
Education of Persons with Pain: "Educate patients, residents, and clients and their families about effective pain management."
The organization is responsible for helping these people understand pain management as a part of treatment, with a particular emphasis on providing balanced and accurate information on pain medication.
Continuum of Care: "Address the individual's needs for symptom management in the discharge planning process."
Clinicians should address pain when they're considering an individual's needs after discharge.
Improving Organization Performance: "Incorporate pain management into the organization's performance measurement and improvement program."
Data collected to monitor an organization's performance should include how well its pain management program is performing.
........................................ .............
If you were mistreated in one of these settings you can report that institution to the JCAHO by going to the JCAHO homepage. However I don't see where there is any gaurentee that the patients pain will be treated to the patients satisfaction. If they ask, if they report and if the doc decides tylenol or Darvecet is apropriate, If they discharge you with instructions to take tylenol or follow up with a PM doc they have complied with this standard of care.
If they check back a few hours later and your still in pain the doc may prescribe a shot of Toradol. This standard for accreditation does not guarantee that a patients pain will be controlled to their satisfaction. There will be patients that aren't happy until their pain is completely eliminated. That's not always reasonable or possible.It's not a gurentee that a migraine patient qwill get morphine or any other potent anelgesic if the ER doc doesn't see fit. Again you can report ER docs to the JCAHO
Take migraines for example. If you go to the ER which is part of an institution that is obliged to comply to these standards, if the doc gives you a motrin and sends you home with directions to take 2 tablets every 6 hours he has complied with these standards.
Unfortunately if they mandated that each patients pain be managed to each patients satisfaction it would open the doors to every drug seeker looking for a shot of morphine or Demerol. You can't pass a regulation that forces doctors to forgo good judgment in order to maintain accreditation. You can report poor treatment but that's about it.
To answer the question about a doc that has been treating you with opiates, can he just cut you off? the answer is yes. There is something called patient abandonment but if a doc cuts you off and you complain and he suggest you go to a detox facility or see your GP for evaluation, he has not abandoned his patient, He has done all that is required. He's given you medical advice and has no obligation to continue medicating you. It's your choice to go to detox or your GP and ask for continued prescriptions.
If that were the case every post surgery patient that enjoyed their pain meds would have the right to continue taking the meds they wanted indefinitely or bring a law suit against their physician.
Please consider that even if your PM contract guarantees certain treatment even in the case of substance abuse, like a taper or meds to make withdrawal more comfy wouldn't the doc have the right to say the whole contract goes out the window when you broke it. Once a contract is broken you can't then ask to be protected by the same contract that you broke.
If he suggest you go to rehab then he has given you useable medical advice and has not abandoned you. You may not agree with his advice but it doesn't give you grounds for legal action. What actual damage has he done by discontinuing opiate therapy. He will definitely chart his recommendation thus protecting himself from litigation should you have a significant problem withdrawing from the medication. There is no compensatory damage for feeling sick for 3 weeks. No lawyer will take a no win case on contingency.
This is just contract law 101. Once you break the contract the other party is no longer bound by the conditions of that same contract.
The JCAHO is a step in the right direction and does give patients the ability to report a facility that is mentioned in the new JCAHO standards. But it doesn't guarantee anything more than assessment and acknowledgment and treatment chosen by the treating physician. It's really more of an effort to educate the practitioners at specific types of care facilities about the harm of untreated pain.
That's just my interpretation though. I'm sure others may see it differently but lets agree not to flame each other if we don't see this the same way.
Take care, Ocean
Wes1212
07-17-2003, 08:15 PM
On contracts, I think if a doctor says he will taper a person off he'd better do it. a doctor with the potential to simply cut a person off would be better off to have a contract that says for whatever reason a doctor can no longer trust the patient, the patient will be referred to rehab.
On hospitals, I was in a contract with a pain clinic the doctor said I could go to the ER if needed for more med if he wasn't available or whatever. i went to an ER and they asked what i was presently on and I told them (5) Five mg of methadone every 24 hours and it was not adequate. I thought the ER doctor was going to die. He said, METHADONE? OH MY GOD! We don't have anything here close to that. Just go home and continue with what you have until you can see your regular doctor.
People like that are scary....
[This message has been edited by Wes1212 (edited 07-17-2003).]
On hospitals, I was in a contract with a pain clinic the doctor said I could go to the ER if needed for more med if he wasn't available or whatever. i went to an ER and they asked what i was presently on and I told them (5) Five mg of methadone every 24 hours and it was not adequate. I thought the ER doctor was going to die. He said, METHADONE? OH MY GOD! We don't have anything here close to that. Just go home and continue with what you have until you can see your regular doctor.
People like that are scary....
[This message has been edited by Wes1212 (edited 07-17-2003).]
oceanview88
07-18-2003, 01:16 PM
He wes, I wouldn't go to an ER for simple pain management unles a rod was sticking out of my back. I've heard some real horror stories like the patient tried to be honest and took all their meds with them and the doc confiscated those meds and refused to give them anything else.
As far as PM contracts, They really aren't enforcable through the court system. They educate and tell you what they expect your behavior to be and may include the patients right to a comfortable taper if the doc decides to discontinue opiate therapy. But if a patient breaks the contract by running out early or doc shopping the contract goes out the window. Once a contract is broken by the patient the Doctor is no longer bound by the contract. The contract becomes null and void once it's broken by either party.
He can avoid abondonment charges simply by suggesting you go to rehab. I'm sure we've all seen a patients bill of rights at a hospital or docs offfice but it's really no more than a mission statement. What they attempt to do and comply to a standard of care. But they are not enforcable through the court system.
Lawyers can not force docs to treat a patient they have discharged and recomeded detox too. Just because you have become physically dependent on the medication the doctor prescribed.
That's really the purpose of PM cotracts, to protect the doc from law suits from people that say they didn't know they would become physically dependent on a med the doc prescribed and to inform the patient about the potency and hazzards of these medications and the potential for harm when these meds are abused.
Take care, Ocean
As far as PM contracts, They really aren't enforcable through the court system. They educate and tell you what they expect your behavior to be and may include the patients right to a comfortable taper if the doc decides to discontinue opiate therapy. But if a patient breaks the contract by running out early or doc shopping the contract goes out the window. Once a contract is broken by the patient the Doctor is no longer bound by the contract. The contract becomes null and void once it's broken by either party.
He can avoid abondonment charges simply by suggesting you go to rehab. I'm sure we've all seen a patients bill of rights at a hospital or docs offfice but it's really no more than a mission statement. What they attempt to do and comply to a standard of care. But they are not enforcable through the court system.
Lawyers can not force docs to treat a patient they have discharged and recomeded detox too. Just because you have become physically dependent on the medication the doctor prescribed.
That's really the purpose of PM cotracts, to protect the doc from law suits from people that say they didn't know they would become physically dependent on a med the doc prescribed and to inform the patient about the potency and hazzards of these medications and the potential for harm when these meds are abused.
Take care, Ocean
Wes1212
07-18-2003, 01:30 PM
You might go to the ER for pain management if you had an explosive chemo headache...
..kind of reminds me of hearing about doctors driving past car accidents because they don't want to get involved..
when a doctor signs papers with me in an agreement, he is going to be bound as i will by the same contract. there is no voodoo you have to do to make a written agreement legal. the doctor may be able to stop prescribing meds and refer you to rehab and still keep his license, but he still has injured the person he was in agreement with, to some degree.
[This message has been edited by Wes1212 (edited 07-18-2003).]
..kind of reminds me of hearing about doctors driving past car accidents because they don't want to get involved..
when a doctor signs papers with me in an agreement, he is going to be bound as i will by the same contract. there is no voodoo you have to do to make a written agreement legal. the doctor may be able to stop prescribing meds and refer you to rehab and still keep his license, but he still has injured the person he was in agreement with, to some degree.
[This message has been edited by Wes1212 (edited 07-18-2003).]