Please refer to Post #1:

Friends,

This is a pretty good article as far as it goes, but it paints too rosy a
picture of the pain crisis, by implying that the current incremental
approach to improving pain management might succeed. This approach is based on education, legislation, guidelines, and actions against doctors who undertreat. After 13 years of this approach, patients with severe pain are stillno better off, as demonstrated by every survey on chronic pain. Simply put,the approach isn't working, and there is no reason to expect that it will.

The under treatment of pain needs to be viewed as a drug war issue. Doctors offices have become the new front in this war, and pain sufferers are thenon-combatant casualties. This story must be told, in order to come to gripswith the problem. (Note from Dr. Myers)

Comment from Snoots: Thank all three of you who responded! One voice is a powerful weapon in this war. The Complaint against my "Board" I filed was ignored. Now, now, this is the South, the vile and corrupt State of Arkansas. I'm writing their attorney to politely request the poper format for complaint. My complaint is that there are no provisions against undertreatment in the rukes and regs, but only against "overtreatment," neither of which word exists. Still there you are. My Complaint is that the Law supercedes an agency rule, whether or not the state enforces the law. The law is the law is the law; God bless the Law. Therefore, my complaint is that the Boatd operates outside the Law by not providing the sanctions against "undertreratment " that it does against "overtreatment," that it is an illegal body in that the conditions set forth in act 1405 (intractable pain) have yet been even discussed. There is supposed to be a well-rounded pamel to assess whether or not a complaint is even bvalid in the area of pain. I keep askeing who is on th epanel. What panerl? I asked for an investigation and the investigator said "I am sartisfied theat the Board is trying to comply with Act 1405," which has been in existence since April. She chastised me for being a pest "I have attempted to decipher the numerous pieces of communications you have sent to the Board;" so she is trying to read but is satisfied that what she can['t undferstand is fine. Welcome to Arkansas. I also requested under FOIA complete bios of Board embers, it is my belief that the Chair is involved in Medical Direction at Tyson Industries, and is therefore anti-worker, anti-worker's comp. anti-pain meds because to give them would be to admit there is pain.

Ladies and gentlemen, it is just that simple.

Ms. Myra Malcom,[email protected], 6th Judicial Prosecutors Office, S. Bway, Little Rock 72201 5013408000, shot back "I am satisfied that no violatution of FOIA has occurred.

OK." I'll be the judge, I'll be the Jury, I'll have a trial and condemn you to death." Fine, Attorney. Great work!
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Doctors face suits for under-medicating
By Alice Dembner, Globe Staff, 11/4/2003

Twenty days of unremitting agony. That's how Lester Tomlinson's family
describes the end of his life.

As the 85-year-old retired refinery worker lay dying in a California nursinghome, his doctor never prescribed enough medicine to ease the pain of hisincurable lung cancer, according to the family. Although Tomlinson signed adirective requesting pain medicine even if it hastened his death, he got nopain pills at all until his daughter begged for help.

So Ginger Tomlinson did something unusual: She sued the doctor and nursing home after her father's death in early 2001, charging elder abuse. She recently won an out-of-court settlement and is awaiting the outcome of disciplinary charges filed against the doctor by the Medical Board of
California.

``He suffered excruciating pain,'' Tomlinson said. ``He was moaning and
grimacing and praying to die because he couldn't take the pain. Nobody
should have to die like that.''

Tomlinson is in the vanguard of a drive to use the courts and medical
licensing boards to punish doctors who undertreat pain. Although the number of cases remains small, regulators and courts alike appear to be taking failure to treat pain seriously. The Oregon Board of Medical Examiners recently reprimanded a doctor for failing to ease the pain of dying patients and the Kansas board is investigating a similar complaint. Meanwhile, aCalifornia jury awarded a family $1.5 million after finding a doctor guiltyof elder abuse for undertreating pain and a North Carolinafamily won asimilar case.

``I get calls from around the country from families seeking attorneys to
bring these cases,'' said Sandra H. Johnson, a law professor at St. Louis
University in Missouri and directer of the Mayday Project on Legal
Constraints on Effective Pain Relief. ``I expect we'll see more.''

Despite national educational campaigns to lessen patients' suffering, half
of dying patients in hospitals report being in moderate to severe pain,
according to recent research. Outside of hospitals, an estimated 50 millionAmericans suffer from chronic pain, even though much of it could be relievedby treatment, according to national surveys.

``It's a major epidemic,'' said Amy Goldstein, coordinator of the
Massachusetts Pain Initiative, a campaign to improve pain care. ``We have alot of pain experts here, but it's a huge problem in Massachusetts as
well.''

Asked to explain undertreatment of pain, doctors frequently say they fear
being prosecuted for overprescribing pain-relievers and causing addiction or hastening death.

``On the one hand you have lawsuits, and on the other Rush Limbaugh and others who are abusing narcotics,'' said Dr. Srdjan Nedeljkovic, a pain
treatment specialist at Brigham and Women's Hospital who helps his
colleagues improve care. ``Doctors are very concerned about the ambiguity of prescribing.''

So far there have been no lawsuits or discipline for undertreatment in
Massachusetts, but the state Board of Registration in Medicine has issued
guidelines stating that effective pain relief is part of good medical
practice.

``We have not seen many complaints coming in on failure to treat intractablepain,'' said Nancy Achin Audesse, the board's executive director. ``But that would be substandard care,'' which could beinvestigated for possiblediscipline.

Discipline for undertreatment of pain is ``an emerging issue'' for medical
boards, said Dr. James N. Thompson, the president of the Federation of StateMedical Boards. Oregon led the way, disciplining Dr. Paul A. Bilder in 1999 and again in April for leaving extremely sick patients in pain. In one case,Bilder stopped the sedatives and pain medicine ordered by another doctor,leaving a patient in such agony that she ripped out her own breathing tube,according to the board, though the patient survived. Bilder was reprimanded,barred from treating hospice patients and ordered to complete a course onprescribing. He did not respond to a request for comment.

While declining to support lawsuits against their colleagues, doctors say
the legal cases are helping raise awareness. ``It's gotten everyone's
attention,'' Nedeljkovic said.

In addition to providing relief for the families, the lawsuits are designed
as a counterweight to doctors' fears of being prosecuted for overprescribing a fear that is out of proportion to reality, said Kathryn Tucker, legal director for the Compassion in Dying Federation, who has spearheaded thesuits.

While some doctors are prosecuted every year for diverting narcotics and a few have been sued for hastening patients' deaths, they say doctors can
avoid problems by following prescribing guidelines and carefully documenting
the care.

The growing number of specialized pain clinics can help, he said. In
addition, 44 states have adopted laws or policies designed to help ease some of the ambiguity by encouraging proper pain control and 22 medical boards,including Massachusetts, have implemented all or most of the federation'smodel guidelines for prescribing narcotics.

The new standards of care have laid the legal groundwork for the suits.
Future cases, Johnson said, are likely to ``not involve run-of-the-mill
undertreatment of pain, but reckless undertreatment.''

Lester Tomlinson's problems began when he was admitted to Mount Diablo Hospital in Contra Costa, Calif., with shortness of breath related to his terminal mesothelioma, a form of lung cancer. Although his pain was
evaluated at 10 on a 1-10 scale, and he'd been taking pain pills around the
clock at home, the hospital doctor would only prescribe pain pills when he asked for them. During five days at the hospital, the nursing staff recordedperiodic spikes of intense pain, suggesting he was not getting enough medication. Hospital officials declined comment.

Transferred to a nursing home, he got no pain relief for the first four
days. Ginger Tomlinson pleaded for help and the nursing home's consultingphysician, Dr. Eugene Whitney, ordered a low dose of pain pills, ``as needed.'' But the family stated that Tomlinson continued to scream in pain. At the family's urging, Whitney finally prescribed liquid morphine - but only one dose every six hours, not hourly as is typical.

``The whole situation was worse than your worst nightmare,'' Ginger
Tomlinson said.

In their settlements, the hospital, nursing home and both doctors agreed to training in pain management in addition to paying damages to the family. Nevertheless, the nursing home, Bayberry Care Center, stated in a release that Tomlinson received ``state-of-the-art analgesia'' as they ``worked veryhard to make sure this resident's certain and impending death was as peaceful and comfortable as possible.'' The home suggested that LesterTomlinson's ``communications ... were open to many possible
interpretations.''

The Medical Board of California charged that Whitney failed to appropriately prescribe liquid morphine and a controlled release pill. Whitney is negotiating a settlement to the allegations, according to a board spokeswoman. The doctor declined to speak with the Globe.
Alice Dembner can be reached at
© Copyright 2003 Globe Newspaper Company.

"Don't give up the fight!"
America's In Pain!
MARCH ON WASHINGTON
Silent No More!

America's In Pain!
MARCH ON WASHINGTON
Silent No More!

April 19, 2004
National Mall - Washington, DC
www. PainReliefNetwork.org

April 19, 2004
National Mall - Washington, DC
www. PainReliefNetwork.org

AMERICAN PAIN INSTITUTE
Rev. Ronald V. Myers, Sr., M.D., Founder & President
202-331-8864 662-247-1471 662-247-1384 Fax
www.AmericanPainInstitute.org

America's In Pain!
MARCH ON WASHINGTON
Silent No More!

April 19, 2004
National Mall - Washington, DC
www. PainReliefNetwork.org

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żES EL FIN DEL MUNDO, O APENAS OTRO DIA?