How the courts are harming pain management

To the pain patients with undertreated pain, you have the courts to thank:

The Massachusetts Supreme Judicial Court has now given physicians another reason to pause before prescribing painkillers. The state’s highest court allowed a lower court to hear a lawsuit resulting from a car accident in which a 75-year-old man, who was on various medications for medical ailments, killed a 10-year-old boy. The man, who had cancer, has since died, but the boy’s family sued the man’s physician because he had prescribed the medications without adequate (according to the lawsuit) instructions about driving . . .

. . . Can we continue to treat patients for pain without worrying that they might get behind the wheel? Should we overreact and tell all of our patients on pain medications that they had better stick to sidewalks and mass transit?

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  • Anonymous

    LYN-ANN COOMBES, administratrix, vs. ROLAND J. FLORIO.

    You could google this, or Coombes v. Florio.

    The boy was Kevin Coombes. Elderly driver was David Sacca. Physician was Roland Florio MD.

    Read the decision. I think it’s worse than KevinMD describes.

    Sacca had multiple illnesses. He was under the care of multiple specialists. Florio was primary care, prescribed the medicines and took the liability for them. Specialists involved aren’t named.

    “….asbestosis, chronic bronchitis, emphysema, high blood pressure, and metastatic lung cancer that had spread to his lymph nodes. As the primary care physician, Dr. Florio coordinated the multiple specialists who were involved in Sacca’s care, and was responsible for all of the prescription medication that Sacca used….”

    At the time of the accident, Sacca was on “…Oxycodone, Zaroxolyn,
    Prednisone, Flomax, Potassium, Paxil, Oxazepam, and Furosemide….” The argument is not that the pain medicine or anxiolytic could cause drowsiness or dizziness, but that any or all of these medicines could do it.

    Take home lesson. The primary care doc is on the hook for any specialist recommendations. Subtract the oxycodone and oxazepam, the doc could have been blamed for the antihypertensives or the prednisone or the antidepressant.

    Florio had warned Sacca about driving while he was on the chemo, but said he could drive after the chemo was over.

    “……I begin by clarifying the nature of the plaintiff’s claim. It is not a malpractice claim because it lacks a
    physician-patient relationship between plaintiff and defendant, an essential element of any
    malpractice claim. See St. Germain v. Pfeifer, 418 Mass. 511, 520 (1994). Instead, the plaintiff
    presents an ordinary negligence claim…..”

    I wonder if his malpractice insurance covered this….?

    Personally, I feel worse after reading the details of this case.

  • Anonymous

    Dizziness and lightheadedness are side effects possible with a substantial number of your medicines, you should be warning most of your patients not to drive.

    All of your COPD patients, your hypertensives, your depressed patients on SSRI’s.

    A lot of people walking. I wonder if Sacca passed out crossing the street and a driver swerved to miss him and hit the kid. I wonder if they’d blame the doctor for that as well.

    But hey, lawyers were enriched, so “justice” was done. Jackpot.

  • Anonymous

    So are you doctors arguing that the physician does NOT have a duty to communicate the warnings to the patient? Because that’s all this decision is about at this point. It simply affirms that such a duty exists, not whether or not the physicians gave it.

    I wonder if Kevin Coombes thinks he won a “jackpot”?

  • Chris, Pharm.D.

    Almost every prescription processing program on the market would have printed a sticker to place on the bottle that states “May cause drowsiness. Use caution when driving.” or “Do not drive while on this medication.” I would like to know if the sticker was placed on the bottle. If so, the doc should be off the hook. Doesn’t the pharmacist have a role in this case?
    Here’s what I was taught in pharmacy school. “Sometimes the physician will forget/not have time to counsel the patient on the use of his/her meds. Make sure you properly counsel each patient on how to properly use their medication.”

  • ERMurse

    What business did this patient have driving given his complicated medical history and multiple meds, including oxycodone. His healthcare providers should have made that clear that driving with so many problems and meds was unsafe and documented they told him not to drive. The same problem occurs in the ED where patients self present with a pain condition expect to be medicated and drive home. I personally refuse to carry out an order for sedating medications on a patient who will be discharged until the issue of who’s driving is addressed and verified. I get grief from some of the ED MD’s and administration for making such a big deal of it because everyone is so obsessed with their patient satisfaction scores and not doing anything to upset the patient.

  • Supremacy Claus

    This discussion of the case lays out the argument that the internet has ended all claims of lack of informed consent. Prof. Childs does defense work. Be kind. As to me, flail away.

  • Anonymous

    No, curious 6:57 PM Kevin Coombes does not think he won a jackpot.

    The lawyer won the jackpot. In your line of work, that’s all that counts, after all. Not only that, but he found a new ambulance to chase. Now when there’s a car accident, find a way to sue a doctor somewhere.

  • Anonymous

    ERMurse the problem is not just the oxycodone, the problem was any and all of the meds. Imagine the person had no pain and was just on the antihypertensives and prednisone. Imagine he got orthostatic, drove off the road and had the accident. They’d still be blaming the doctor. Do you check for drivers for everyone who got medications adjusted in the ER? The pain literature I’ve read on the subject tends to be supportive of driving if the patient is STABLE on pain meds. Not acute like in the ER, but chronic like in a cancer patient in remission, which this guy was.

    No the man got into an accident. He knew of medical conditions interfering with driving. The jury was led to believe that no doctor ever said anything again. Can’t say he wasn’t warned about medical conditions and driving, the record shows the doc explained that during chemo. The chemo ended.

    Apparently that means the patient can drive the rest of his life and never ever has to worry about driving imapirment again. Apparently he never ever read the warnings on the prescription bottle about dizziness and driving.

    Neither the primary care doctor, nor specialists, nor pharmacists, nor family, no one ever said anything about driving impairment. The thought that if he was feeling dizzy, from medicine or from disease, he shouldn’t drive. Only physicians are in posession of this knowledge.

    Of course, chris pharm d. — you know the patient was counseled by multiple individuals along the line. This isn’t about justice, this is about finding someone to blame so the lawyer can get his jackpot.

  • Anonymous

    No, Kevin is dead so I don’t think he nor his family thinks they won a jackpot. The point is to make the doctor responsible for letting the patient aware tat he can NOT drive when there on 100 different drugs. Someone needs to report the patient and make them fully aware of the side effects of the drug i.e. passing out and killing an innocent little boy. It’s a shame that people don’t understand the point of the case!

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