State board approves new pain plan

Friday, May 5, 2000 | 11:04 a.m.

RENO -- A regulation that would ensure that patients receive adequate drugs to ease their persistent and extreme pain and at the same time protect doctors from sanctions was unanimously adopted by the state Board of Medical Examiners Thursday.

Larry Lessly, executive director of the board, said some doctors have been "gun shy" about prescribing drugs for patients in serious pain for fear of being disciplined. This regulation, he said, will "encourage adequate prescribing."

Its two-fold purpose is to help both the patient and the doctor, he said.

The regulation mirrors the guidelines promulgated by the Federation of State Medical Boards of the United States, which say, "Pain should be assessed and treated promptly, and the quantity and frequency of doses should be adjusted according to the intensity and duration of the pain."

There was a question over whether a physician who prescribed pain drugs sparingly could be disciplined. Richard Legarza, legal counsel for the medical board, said, "If you under-prescribe, it is grounds for disciplinary action."

Legarza said some people feel the board was backing away from a previous strong statement calling for sanctions against those who don't give their patients sufficient drugs to relieve their pain. That isn't the case, he said.

This regulation, Legarza said, offers a "safe harbor" for those who follow the guidelines. If the doctors comply, "they will not be in trouble with the Nevada State Board of Medical Examiners."

The regulation has been five years in the making. The 1995 Legislature approved a law on doctors treating intractable pain. Larry Matheis, executive director of the Nevada State Medical Association, which represents doctors, said a national committee was formed in 1996 to come up with guidelines. And it wasn't until May 1998 the committee reached agreement.

Then there was trouble putting the consensus guidelines into regulations on which doctors and lawyers could both agree. The board earlier this year agreed to adopt the federation's language into the regulations.

Matheis said Nevada was at the "forefront" in adopting these regulations.

Lessly said he can't remember any case where a doctor has been called on the carpet by the board for excessive prescription of drugs.

Failure to follow these new regulations is cause for sanctions, up to revocation of the medical license. The board would look at the condition of the patient and other things and not just the amount of drugs and their strength.

The regulation says, "Physicians should not fear disciplinary action from the board or other state regulatory or enforcement agency for prescribing, dispensing or administering controlled substances, including opiod analgesics, for legitimate medical purpose and in the usual course of professional practice."