Alleged breaches of "standards of medical care" in a patient overdose death possibly related to chronic opioid analgesic therapy, application of the controlled substances model guidelines: case report.
OBJECTIVE
The objectives of this medicolegal case report are the following: 1) to present details of a chronic pain patient (CPP) who was placed on chronic opioid analgesic therapy (COAT), and subsequently overdosed on multiple drugs, some of which were not prescribed by his COAT physician; 2) to present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation that COAT prescribing was the cause of death; and 3) based on these opinions, to develop some recommendations on how pain physicians can utilize the use of Controlled Substances Model Guidelines in order to protect the patient and themselves from such an occurrence.


METHODS
This is a case report of a CPP treated by a pain physician.


RESULTS
Differences between the plaintiff's and defendant's expert's opinions are explained utilizing the Controlled Substances Model Guidelines.


CONCLUSIONS
Some CPPs may withhold information critical to their COAT treatment. Application of the Controlled Substances Model Guidelines and the newer Federation of State Medical Boards' policy on opioid prescribing can be helpful in improving patient care and may be helpful in protecting the physician medicolegally.
Fishbain
David A
DA
Departments of Psychiatry, University of Miami, Miami,FL 33136, USA. d.fishbain@miami.edu
Lewis
John E
JE
Gao
Jinrun
J
Cole
Brandly
B
Rosomoff
Rennée Steele
RS
D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D014151:Anti-Anxiety Agents / Q000506:poisoning; D000929:Antidepressive Agents, Tricyclic / Q000506:poisoning; D003975:Diazepam / Q000506:poisoning; D004316:Doxepin / Q000506:poisoning; D062787:Drug Overdose; D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006853:Hydrocodone / Q000506:poisoning; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008691:Methadone / Q000627:therapeutic use; D003708:Nordazepam / Q000506:poisoning; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D017410:Practice Guidelines as Topic / Q000592:standards*; D012782:Shoulder / Q000473:pathology; D000070599:Shoulder Injuries; D013693:Temazepam / Q000506:poisoning
D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D004316:Doxepin; D003708:Nordazepam; D006853:Hydrocodone; D013693:Temazepam; D003975:Diazepam; D008691:Methadone