A CALL FOR COMPASSION

A Group Of Doctors Rallies To Fight Legal And Societal Barriers Keeping
Patients From Getting The Pain Management They Need

Shannon O'Brien, 35, was at the drive-up window of her neighborhood
Walgreens pharmacy in Tacoma, Wash., waiting to pick up her prescription
for Percocet when two police officers dragged her out of her car,
handcuffed her and took her to jail.

"I kept asking, what's going on? What did I do? I had no idea why they were
arresting me," O'Brien says.

When asked about the prescription, O'Brien told the officers that she has
brain cancer and that her medical information card was in her wallet.

"They were going through my purse, but they wouldn't even look at my
medical card," O'Brien said in a telephone interview. "I was in hysterics,
crying, very upset and very embarrassed, shocked and humiliated,"

The pharmacist on duty had called the police when he couldn't reach
O'Brien's doctor at the University of Washington Medical Center to validate
her prescription for the painkiller, according to a lawsuit filed Jan. 23.

Despite the fact that her neurosurgeon faxed her a letter to take to her
arraignment the next day, O'Brien says the judge mandated drug-abuse
education as a condition for her release. The felony fraud charge was
dropped only after her doctor contacted the Pierce County prosecutor's
office directly to verify that she had brain cancer and needed the narcotic
pain reliever.

O'Brien's case illustrates the fact that pain treatment in this country is
a major problem for doctors and their patients -- and it's getting worse,
say experts. Patients are not receiving the best possible pain management
because of a variety of factors, including lack of education on the part of
patients and doctors and legal barriers that sometimes limit doctors'
ability to give patients what they need. As a result, what suffers in our
health care system is compassion.

"Somebody has said the war on drugs has turned into a war on patients, and
I think that's true," says Dr. C. Stratton Hill, founder of the Pain
Service at M.D. Anderson Cancer Center in Houston.

"The DEA is going after physicians just like they are the Medellin cartel
in South America. That's why you hear horror stories about people dying in
pain," says Hill, past president of the Texas Pain Society and current
president of Texas Cancer Pain Initiative, a nonprofit advocacy group.

Hill says that he has twice testified in murder trials in which doctors
were accused of killing their patients by providing them with narcotic pain
relievers (both times the physicians were acquitted) and that his own
practice has been investigated.

"I wrote a lot of prescriptions for narcotic pain relievers when I was in
practice," Hill acknowledges. "They dropped the charges against me, but
they've got doctors so scared now that they are just not prescribing
narcotic analgesics. There are even doctors in the pain community who don't
want to prescribe these drugs. The media and the cops have created an
absolute hysteria -- mostly about OxyContin. The whole thing is a mess."

OxyContin is the time-release form of Oxycodone, the opium derivative found
in Percocet, which O'Brien took to relieve severe headaches caused by two
brain surgeries, extensive radiation and chemotherapy.

"Why put a poor woman with a brain tumor in jail?" asks Hill, one of
several experts who will address "The Ethical Obligation to Treat Pain" at
a conference sponsored by the Tarrant County Academy of Medicine, Tuesday
and Wednesday in Fort Worth.

Hill has led efforts in Texas to do away with the triplicate-prescription
legislation that allows the Department of Public Safety to track how many
prescriptions for amphetamines, barbiturates and narcotics doctors write
and pharmacists fill. He and many other Texas doctors say the legislation
is intimidating and an obstacle to treating severe pain.

There are three major barriers to effective pain management, says Dr. Ira
Byock, an authority on end-of-life care, author of the book Dying Well and
a keynote speaker for this week's seminar.

Barriers include health systems that fail to support pain-management teams,
medical schools that fail to teach doctors to routinely assess pain in an
organized, rational fashion and public attitudes and cultural tendencies
that give patients and families misconceptions about pain treatment.

"Triplicate-prescription laws aimed against prescription drug abuse are
part of the legal barrier," Byock says. "People fear the side effects of
drugs and worry that they may be given too much, even though all studies
show patients are at far more risk of being given too little. They worry
that if they take strong drugs now, their doctor will have nothing to give
them when they get worse or when they develop tolerance and the
effectiveness diminishes."

A recent survey conducted for the Life's End Institute: Missoula
Demonstration Project, which Byock directs for the University of Montana,
found that about one-third of the public believes pain medication should be
taken only when pain becomes severe, 42 percent believe people are often
given too much pain medication and one-third believe that most people
taking pain drugs will become addicted over time.

"All of which is untrue," Byock says.

"The concept of uncontrollable pain is self-fulfilling. Pain only becomes
unmanageable when the clinicians involved give up," Byock says. "You would
think medical schools and residency programs would be teaching doctors and
nurses to competently deal with this most universal of situations, but they
are not."

This week's conference was organized to examine ethical, legal and moral
obligations associated with the treatment of pain, with the goal of
mobilizing health providers to treat pain more effectively in all stages of
a patient's life, says Dr. John Burk, a Fort Worth pulmonologist and
founding member of the Ethics Consortium, a group of physicians, chaplains
and social workers who have organized smaller seminars on related subjects
for the past 10 years.

"When it comes to pain care, and especially end-of-life pain care, the law
is out of step with medical practice," Burk says. "How can we change the
system to meet patient needs? If a doctor is doing his or her best to take
care of the patient and keep the patient out of pain -- doing pain control
and using narcotics to do it -- and then can be nailed for it . . . It's a
scary thing, a frightening thing for everyone in pain management," Burk
says. "The courts are not the place to settle how you treat your patients."

Roy Martin, who was a chaplain at Cook Children's Medical Center for 13
years, says the conference was organized to celebrate the 100th anniversary
of the Tarrant County Medical Society because pain management is such a
critical issue right now, with more people living longer with severe
disease and chronic, intractable pain.

"The triplicate-prescription law really can inhibit physicians from
prescribing narcotics because they know someone is looking over their
shoulders and counting," Martin says. "If a patient is in real pain, he is
not a candidate to become an addict. It's an unscientific mind-set shared
by some physicians and nurses that suggests that."

Martin, who teaches ethics at the University of North Texas Health Science
Center, says he tells student doctors to treat pain as comprehensively and
intelligently as they would treat anything else.

"I really believe they have a moral obligation to relieve the pain and
suffering of their patients, so much as that is possible," Martin says.
"Compassion should be the principal moral feature of every physician."

A recent survey, published in the New England Journal of Medicine, asked
doctors what was the poorest, least-adequate part of their medical
educations, Martin recalls. Eighty-four percent said pain treatment.

To help combat the problem, the health science center has put together a
blue-ribbon committee, led by Dr. Louis Sullivan, former secretary of the
federal Health and Human Services Department, to develop a Web-based
curriculum to teach medical students about pain management.

Dr. Mark Hahn, dean of the health science center and president of the
American Academy of Pain Medicine, is organizing the effort and says the
curriculum will be online and available to all medical schools in the
country within a year.

"There is a significant problem. Patients with true pain are not receiving
appropriate care because of lack of access, lack of physician expertise and
fear of using narcotic painkillers," Hahn says. "In most cases, it is an
irrational fear. Both as dean at UNT and president of AAPM, I am aware of
the lack of formal education at the medical school level."

Pain conference

"The Ethical Obligation to Treat Pain," a conference sponsored by the
Tarrant County Academy of Medicine, Tuesday-Wednesday in Fort Worth.

The University of North Texas Health Science Center is awarding
continuing-education credits for physicians, nurses, social workers and
other health care professionals participating in the conference.

Wednesday evening's session, beginning at 7 at the Fort Worth Botanic
Garden, is free and open to the public.

For more information or to register, call (817) 735-2539.