Administrator rev ronin Posted September 6, 2016 Administrator Share Posted September 6, 2016 As those of you in Washington State know, Seattle Pain Clinic has been shut down for over a month now, based on allegations of misconduct in their prescribing practices, leading to multiple patient deaths. https://fortress.wa.gov/doh/providercredentialsearch/PDF/295739866.pdf I recommend all Washington PAs, or others in pain management, or others prescribing chronic opioids, review it. Some highlights: * Using new graduate PA/ARNPs to see chronic pain patients, and promising to teach them how to do it. * Failure to file an approved delegation agreement for a PA in Spokane. Looks like the PA was not held responsible for this, at least as far as this document goes. * Billing for services rendered by NPs and PAs prior to insurance credentialing. (Obviously, these top three hit us right where we live; the rest apply to all providers) * Billing Medicaid for a 16-drug UDS every visit... but doing very little about those UDS'es. * The same doc owning the lab. * No M&Ms on dead patients. * Poor to no documented physical exams. * Tolerating drug seeking behavior without discharging patients or other corrective actions * Ignoring past substance abuse, incarceration, childhood sexual abuse, physical comorbidities, and other red flags. I'm mulling over how I'm going to further refine and improve my prescribing practices for my chronic pain patients. I haven't ever written "no track marks visible" on a physical exam. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 13, 2016 Share Posted September 13, 2016 Just tried the link - 404 - File or directory not found. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 13, 2016 Author Administrator Share Posted September 13, 2016 Hmm. Try going to: https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx And then search for Frank Li, MD00049251. It looks like he document numbers are just randomly generated and you need to fill out the CAPTCHA to actually get to the documents. Sorry about that. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted September 13, 2016 Share Posted September 13, 2016 I believe pain is very real to people and have seen people with horrible injuries who are obviously not comfortable and have a hard time with daily life. Look at our returning soldiers.... However, I also believe that we have somehow created a fiction in society that there is an entitlement in life to a "pain free" state where all pain has to be eradicated and should not exist. That is not possible and not realistic. Having the pain conversation with any patient is actually painful. Some expect miracles and 100% resolution as well as a 100% definitive diagnosis while others are happy to dwell in their state of disability and their chronic condition becomes their entire identity. The rare few are wanting to live and experience life and continue to get up every morning with the desire to be productive and pain is just a part of them but not who they are. I always ask patients seeking pain meds for a chronic condition what their exit strategy is. They often look at me as though I have grown a horn. I make them answer. If we are going to start meds - what is the plan? Increase activity, PT, specialist eval, MRI, nerve blocks - WHAT? Because pain meds alone are NEVER the answer. What is the patient's perceived timeline to STOP taking narcotics? If they can't answer - no pain meds. Also what are the expectations for pain meds? If the patient expects 100% eradication of all pain then they don't get pain meds. They are not one with reality and have expectations that set them up for complete failure. If they take benzos for any reason more than 3 times a year - no pain meds. If they are already on Soma then I am frankly screwed and we have nowhere to go - sorry to be blunt but this is my experience. So, I am not a Burger King drive thru, I am not a flight attendant handing out peanuts. I am not in any way obligated to dispense medications because the patient paid a copay or made an appointment. Medical decision making rules and it is a combined effort of finding long term interventions - acupuncture, biofeedback, massage, nerve blocks, whatever. Press Ganey scores be damned - I am not a customer service agent. I find the whole concept of a dedicated pain clinic a bit sketchy - particularly a chain of them. I hear dollar signs not success rates. People die from narcotics and keep dying. Mixing them with benzos and illicit drugs and alcohol and advancing age has to stop. We, as humans, are not guaranteed in any way a pain free state and may have to cope with some stuff because the alternatives are worse. If we don't plant this seed of limits, boundaries, consequences and rules then we will continue to lose the battle. And lawyers will rake in the rewards. So, be smart, practice smart, do no harm and speak plainly. soapbox back under desk - for now Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted September 17, 2016 Author Administrator Share Posted September 17, 2016 Another article on this: http://www.seattletimes.com/seattle-news/times-watchdog/immediate-danger-state-knew-for-years-about-problems-with-pain-doctor-times-watchdog/ Link to comment Share on other sites More sharing options...
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