As we now know,
Joint Commission requires that all patients have a right to pain control. Vital
signs must address all of the elements of the pain scale, and EMTALA expects
that medical records at least at the time of discharge vitals demonstrate improvement
in pain levels. Undiagnosed acute pain is an emergency medical condition under
EMTALA.
Many physicians,
however, are still imbued with the idea that it is a dangerous thing to give
patients drugs and that it is their responsibility to turn in offenders. Wrong.
The US Supreme
Court in the Ferguson case indicated that in the absence of a law that requires
reports to the police of certain types of incidents, reporting drug issues both
violates informed consent requirements and breaches the patient's right to privacy.
The physician and hospital that turns over patients who present to the ED for
what they believe to be drug seeking purposes can be sued by the patient and
win.
If the patient
commits a direct crime, such as stealing a prescription pad, it may be reported.
The medical or conversational details of a visit where the patient sought medical
care -- even under a ficticious name -- for the alleged purpose of getting drugs
is not free to be discussed with police. Medical records must be subpoenaed.
While Emergency
Department personnel work closely with law enforcement in many ways, disclosure
of medical visit details must be specifically authorized law or a specific patient
consent that indicates that they know that the information will be turned over
to police and consent. This type of consent must not be buried in general consent
or it will not be likely to stand up in court.
If a patient
appears to be drug-seeking, DO NOT be confrontational. Conduct a reasonable
examination and treat the patient with respect when indicating that you intend
to prescribe only non-narcotics or minimum quantities. If the patient protests,
offer to contact their treating physician or to call in a pain specialist/anesthesiologist
or neurologist as appropriate to the patient's complaints.
At least one
hospital has already gotten an investigation letter from JCAHO over alleged
refusal to give drugs for an established diagnosis of chronic pain syndrome
and verbal comments about the patient being an addict and being able to "kick"
the habit with a little will-power.
Most state licensure
boards clearly indicate that pain management is not a licensure issue, even
where the patient is drug dependent as a result, as long as an appropriate medical
management plan is in place and is consistent with demonstrated need. Dependence
is not addiction under these standards.
Acting on one's
own in the ED without a consult or appropriate exam, or telling a patient before
an exam that they will not be given pain medication may be considered a refusal
to provide emergency care under EMTALA.
DISCLAIMER. The information
provided is not intended as legal or medical advice, but are written for
educational purposes only. The information may have changed or been amended. You
should consult a qualified and licensed attorney with specific questions. Any
references to any specific professional is not an endorsement of their services,
products or qualifications.
