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FINDING THE CORRECT TREATMENT BALANCEUNDER MEDICATING/OVER MEDICATING OR CAPASSION OF MEETING IN THE MIDDLE WITH DIGNITY
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FINDING THE CORRECT TREATMENT BALANCE UNDER MEDICATING/OVER MEDICATING OR CAPASSION OF MEETING IN THE MIDDLE WITH DIGNITY Many medical studies confirm that far too many patients die in pain in our hospitals, and that too many patients who are not terminally ill suffer unnecessarily from painful diseases, conditions, and medical treatments. In the past, courts have dealt with over prescribing and administering lethal doses of pain medication, but now courts are also addressing the issue of under medicating failures by care providers to manage a patient’s pain. Although medical and nursing boards have disciplined physicians and nurses for giving too much medicine, the new trend is being reversed as inadequate pain management is investigated and physicians and nurses are being held responsible and disciplined for under managing pain. Liabilities for under medicating include negligence (medical malpractice) for failure to medicate or failure to refer pain to a pain management specialist. The Joint Commission on Accreditation of Healthcare Organizations has set pain management standards. JCAHO states that healthcare professionals need to “recognize the right of patients to appropriate assessment and management. Assess the existence and, if so, the nature and intensity of pain in all patients. Record the results of the assessment in a way that facilitates regular reasoning and follow-up. Determine and assure staff competency in pain assessment and management. Establish policies and procedures that support the appropriate prescription ordering of effective pain mediations. Educate patients and their families about effective pain management. Address patient needs for symptom management in the discharge planning.” (2) The Oregon board of medical examiners took disciplinary action against Dr. Paul A. Bilder, for improperly managing the treatment of pain in six of his patients between the dates of 1993 and 1999. These cases include; * A 35 year old woman with pulmonary disease, on a mechanical ventilator in which he stopped giving sedatives and pain medication. The woman later became restless and pulled out her ventilator tube. Dr. Bidler did not return to reinsert the endotracheal tube and an emergency room physician performed the task. * Refused to give a 33-year-old pneumonia patient with hypoxemia pain medicine and anxiety medications while inserting a breathing tube. The staff ended up restraining the patient to complete the procedure.
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