Malpractice claims associated with medication management for chronic pain.
BACKGROUND
Medication management is an integral part of chronic pain management. Prompted by an increase in the role of medication management in anesthesia chronic pain liability, we investigated the characteristics of malpractice claims collected from 2005 to 2008.


METHODS
After Institutional Review Board approval, we compared medication management claims with other chronic pain claims from the American Society of Anesthesiologists Closed Claims Database of 8,954 claims. Claims for death underwent in-depth analysis.


RESULTS
Medication management represented 17% of 295 chronic non-cancer pain claims. Compared with other chronic pain claims, medication management patients tended to be younger men (P < 0.01) with back pain. Most patients were prescribed opioids (94%) and also additional psychoactive medications (58%). Eighty percent of patients had at least one factor commonly associated with medication misuse and 24% had >or= 3 factors. Most claims (82%) involved patients who did not cooperate in their care (69%) or inappropriate medication management by physicians (59%). Death was the most common outcome in medication management claims (57% vs. 9% in other chronic pain claims, P < 0.01). Factors associated with death included long-acting opioids, additional psychoactive medications, and >or= 3 factors commonly associated with medication misuse. Alleged addiction from prescribed opioids was the complaint in 24%. Appropriateness of care and payments was similar for medication management versus other chronic pain claims.


CONCLUSIONS
Most anesthesia malpractice claims for medication management problems involved patients with a history of risk behaviors commonly associated with medication misuse. Malpractice claims arising from medication management had a high proportion of deaths with both patient and physician contributions to the outcome.
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA. dermot@u.washington.edu
Dermot R
DR
Fitzgibbon
James P
JP
Rathmell
Edward
E
Michna
Linda S
LS
Stephens
Karen L
KL
Posner
Karen B
KB
Domino
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000776:Anesthesiology / Q000706:statistics & numerical data / Q000639:trends; D002908:Chronic Disease; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007351:Insurance, Liability / Q000706:statistics & numerical data; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000401:mortality; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use; D012309:Risk-Taking; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
D000701:Analgesics, Opioid; D011619:Psychotropic Drugs