ELDER-ABUSE VERDICT CHALLENGES PHYSICIANS ON PAIN

Doctors Must Balance Relief Against Addiction

A landmark verdict of elder abuse against an East Bay internist for not
giving enough painkillers to a dying man has grabbed the attention of
physicians already under pressure to make treatment decisions based on
subjective evidence.

"How do you define a satisfactory amount of (pain) medication?" said
Berkeley pain specialist Dr. Michael H. Park. "When (the patient) says it's
OK? If the patient says I don't feel OK, do you just simply give more?"

Treating pain, he said, is a fine art that combines what the patient says
he feels with the doctor's medical knowledge and past experience.
Treatmentisn't something that should be dictated by fears of malpractice
lawsuits, he said.

"I think it's dangerous for (lawyers and courts) to decide what doctors
need to do," said Park, who has been practicing for a decade.

An Alameda County jury on Wednesday found Dr. Wing Chin committed elder
abuse and reckless negligence for not giving enough pain medication to lung
cancer patient William Bergman, 85, who was admitted to Eden Medical Center
in Castro Valley in February 1998. He died later that month at his home in
Hayward.

The jury also awarded $1.5 million to the Bergman family, although state
law puts a cap of $250,000 on pain and suffering damages, attorneys
on both sides said yesterday. Alameda County Superior Court Judge David E.
Hunter is expected to rule on the final figure later this month.

Dr. Jeffrey Randall, president of the hospital's medical staff, said
yesterday he's unsure how the ruling will affect pain treatment at Eden.

"I think it's too soon to know what the long-term ramification is going to
be," he said. "But I think it's worrisome that something like this can
happen to someone of Dr. Chin's caliber. . . . He's well regarded by his
colleagues, and he's treated many physicians and their families."

However, the message of the verdict is clear, said Dr. Russell Portenoy,
former president of the American Pain Society and head of the pain
management department of Beth Israel Medical Center in New York.

"It begins to create the reality of (punishment) . . . for physicians who
don't respond to patients who have severe pain," Portenoy said.

In the past, most doctors erred on the side of undermedication, fearing
malpractice suits from possible addiction to painkillers, leading some
physicians to be too lax about pain treatment, he said.

In fact, structured guidelines on pain management are relatively new and
still evolving.

The Joint Commission on Accreditation of Healthcare Organizations, which
accredits most hospitals and nursing homes in the United States, just this
year incorporated standards for pain management, Portenoy said.

The number of state medical boards that have explicit guidelines on
treating pain is growing but still in the minority, said David Joranson,
director of the Pain and Policy Studies Group at the University of
Wisconsin's Comprehensive Cancer Center.

His research group recently came up with pain management guidelines, which
have been adopted by medical boards in 15 states.

"We had 11 workshops around the country on the subject, and it led to an
unprecedented increase in the number of state boards coming up with
guidelines on pain management," he said. .

Not Here

But California isn't one of them. That's because the Golden State's medical
board instituted its own rules in 1994. Three years later, the state
Legislature also passed the Pain Patient's Bill of Rights, allowing
patients to ask for painkillers of their choice.

This year, the state Assembly approved a bill, which is now in the Senate,
that would require doctors to take pain management courses and the state
medical board to keep statistics on under-treatment complaints.

The Bergman family filed a complaint with the California Medical Board, but
it refused to take action against Chin.

Board spokeswoman Candis Cohen admitted the organization doesn't keep an
accurate count.

"However, historically, complaints regarding the undertreatment of pain
have been nearly nonexistent. That is the experience of our board," she
saidyesterday.