Liability for Under-prescribing Opioids in Vulnerable Patients with Severe Pain.

1. Understand the main facts and legal reasoning behind the decisions of the Bergman and Slone cases. 2. Understand the special features of vulnerable populations that place clinicians at increased risk for liability of abuse allegations when undertreating their chronic, severe pain. Clinicians have cut back or avoided opioid prescribing due to concerns about the opioid overdose crisis. Recent court decisions have shown that under-prescribing opioid therapy may increase clinicians' liability or risk for abuse allegations when treating vulnerable populations. Critics have blamed the "opioid overdose epidemic" on overprescribing, prompting clinicians to avoid or reduce opioid prescribing. A Kentucky jury found that a physician groups' undertreatment of a disabled patient's chronic pain contributed to his death by suicide, awarding his widow $7M (Dryda, 2021). This recalled the California case, Bergman vs. Chin, in which a patient's family sued his physician for not treating his cancer pain sufficiently, resulting in a $1.5M award (Kollas, 2008). We seek to raise awareness that under-prescribing opioids for vulnerable patients, including patients receiving palliative care, may increase clinicians' liability or risk for abuse allegations. Case law and analysis of relevant legal reasoning. In Bergman, the plaintiffs argued that under-treating the patient's pain constituted elder abuse under California law. In Slone vs Commonwealth Pain Associates, the plaintiff argued that under-treatment of severe pain caused the patient's suicide. The judge cited the medical community's acknowledgement of harm risks from opioid tapering protocols as influencing his jury instructions. He noted the rapid onset of Slone's suicide ideation as caused by abrupt opioid discontinuation, rather than depression. These cases underscore the risk to clinicians for under-prescribing opioids in a population of vulnerable patients with severe pain. The patients' vulnerable status provided a litigation pathway for their families to recover damages from their deaths. Palliative care clinicians should understand that under-prescribing opioid for severe pain in vulnerable patients may increase their medical liability or constitute abuse. Ethical / Legal Aspects of Care / Diversity, Equity, Inclusion, Belonging, Justice [ABSTRACT FROM AUTHOR]