THE NEED
WHAT IS THE
NEED FOR PAIN PRACTICE LIABILITY INSURANCE?
Coverage: The United States "War on Drugs" puts at risk physicians who prescribe controlled substances to treat pain and its related symptoms. This risk is far from insignificant.
In the United States more than 900,000 practitioners hold licenses from the Federal Drug Enforcement Administration (DEA) to prescribe controlled substances. Untreated, severe, persistent pain is common in the United States. It is estimated that 17 to 40 million Americans suffer significant pain. There is ample evidence in the medical literature that much of that pain could be reduced if physicians were willing to prescribe opioids for patients who have chronic pain conditions. The problem is so significant that the Veterans Administration has required pain assessment and management for every patient and the Joint Commission on Accreditation of Health Care Organizations has made improving assessment and treatment of pain in hospitals and nursing homes a performance standard for the facilities they accredit. Major medical societies have issued standards and guidelines that make it clear that opioids can be safely and effectively used to treat chronic pain. Despite the medical and organizational consensus, American doctors remain unwilling to prescribe opioids.
There are many complex reasons for this failure, but more than half of the doctors who have responded to surveys about under treatment list fear of the DEA and medical board sanctions as a major factor that makes them unwilling to prescribe opioids. They emphasize that if an investigation is begun, whether or not it turns out to be baseless, they have lost time, money and reputation in defending their practices. Although most state medical boards, some state statutes and the DEA officially approve opioid use in appropriate cases, the burden is on the doctor to prove that his or her prescriptions have a "legitimate medical purpose". Doctors are often blamed when their prescriptions are resold and abused even though the original prescription was reasonable. Few attorneys understand the medical issues involved in pain management and doctors rarely get fully effective, informed defense teams.
The Goal: The goal is to address the underlying cause of physician's fears and to improve the standard of pain care by:
(1) Establishing clear and understandable guidelines for patient evaluation and treatment and for maintaining excellent records by treating physicians. Experience demonstrates that many physicians get into trouble because they fail to document their evaluations and treatments involving opioids and do little to document patient compliance and functional improvement.
(2) Providing physicians with clear standards of care for intractable pain that meet all requirements of regulatory and licensing bodies
(3) Providing members with inexpensive, efficient, electronic medical record keeping and prescribing to improve the quality of pain patient care and to maintain a comprehensive electronic record of care
(4) Providing expert proactive consultation and guidance from a 15 member Professional Advisory and Review Committee comprised of physicians with impeccable reputation and credentials in intractable pain management.
(5) Providing the PARC as a source of unimpeachable expertise to assist in the defense for those physician members who do follow the treatment and documentation standards and are nonetheless subjected to investigation and allegations of improper prescribing.
(6) Providing members with the most highly qualified and experienced attorneys with established excellence in the legal area of administrative and criminal defense related to opioid prescription.
(7) Providing a Defense Benefit Program for the Pain Practice Liability Association from a first tier insurer, to provide the Association members with up to $500,000 in legal defense should they be attacked by regulatory agencies or law enforcement.
(8) Providing pain management a strong and well-funded voice in the legislative process.
All physicians who join the Pain Practice Liability Association will enjoy all these benefits of membership. If they choose to take advantage of the Defense Benefit Program they will automatically have protection through the Association, after completion and acceptance of their application.
Subsequent to joining the Association, any physician reporting a new investigation of his or her prescriptive practices will submit the questioned charts to the Professional Advisory and Review Committee, If the PARC panel independently and at arm's length (they will not know the name of the physician whose charts they are reviewing) determines that the physician has followed the evaluation and documentation requirements, and that there is no indisputable proof of substandard practice or criminal intent and behavior, a defense team will be provided. From the outset, a team approach using the Association's experienced medical experts, investigators and attorneys will be used. This highly focused and organized early defense will be far superior to the legal representation of doctors usually provided by administrative and criminal lawyers inexperienced in this highly specialized area of the law.
Improvement in the quality of pain care will be achieved through training of assured physicians in the standards of pain management, and record keeping, and in identifying the aberrations and"red flags" in patient behaviors that reveal abuse instead of legitimate medical care. Further, the existence of the Pain Practice Liability Association will help neutralize the Drug War on Doctors that has paralyzed legitimate pain care. In relation to this goal, the Association will help fund education of law enforcement, state and federal law makers and medical boards regarding the need for better pain management. It will also give pain management a strong, well-funded voice in the legislative process
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