Pain Management Contract Question
September 13, 2014 6:36 AM   Subscribe

Hi all, I had my first appointment with a pain management doctor last week that did not go well. I am curious about the legality of the contract that I was required to sign in order to receive care.

The doctor told me that by signing I was agreeing to see only this doctor and no one else. I was to cancel all upcoming visits with other doctors. All testing such as blood tests and imaging would now be done in this person's office. Is this legal?

YANML
YANMD

I am in the US. Thank you.
posted by anonymous to Health & Fitness (20 answers total)
 
I don't know about legal, but what the doctor is trying to prevent, besides losing a patient to another doctor, is to keep you from doctor shopping for pain medications. They do not want you getting a prescription from them and another one from another doctor and then selling or abusing the medications.
posted by 724A at 6:44 AM on September 13, 2014 [5 favorites]


That's stupid. Ignore it.

They probably do that in order to make sure you're not skipping around town getting oxy scripts from 10 different people or getting other drugs/treatments that might interfere with whatever care they give you, but no, they don't get to dictate what other doctors you see.

Since it didn't go well I imagine you won't be going back to them anyway, so who cares?
posted by phunniemee at 6:44 AM on September 13, 2014


Did it really say that he was the only doctor you could see, period? Because I imagine the point of the contract is to prevent people from getting painkillers from multiple doctors, and I'm curious about the exact language of the contract. Typically pain management doctors are seen in conjunction with other specialists (say an orthopedic surgeon for example), so I tend to doubt that it really says you can't see other doctors.
posted by amro at 6:47 AM on September 13, 2014 [2 favorites]


My mother goes to a pain clinic but they work together with her primary care physician and her orthopedist. She's not forbidden to see other doctors and if she needed another specialist, they would work with that one, too.
posted by cooker girl at 6:48 AM on September 13, 2014


Good heavens, anonymous...I am not a legal expert - and look forward to hearing what those with this expertise have to say...but this sounds unethical, violating your rights as a patient (to a second opinion for example). In the U.S., patients are entitled to a series of privileges and rights, enshrined in the 'Patients' Bill of Rights', but not yet enshrined in law. To quote Wikipedia:

"A patient's bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights. In the United States there have been a number of attempts to enshrine a patient's bill of rights in law, including a bill rejected by Congress in 2001.visible on the walls of most medical offices. It is non-binding "

What you have signed sounds like a 'contract' that falls, if not into the 'illegal' category, then into the 'legally meaningless' category - I would imagine that the Patients' Bill of Rights supersedes it (let the legal specialists weigh in on this...). Your doctor has the right to request that you follow his / her protocols, and perhaps to base continued / ongoing treatment on compliance (making this clear to you). But this sounds unethical. Have you felt free to question this with your doctor? How your doctor responds to your questions, and how comfortable you are with his / her responses, could give you a 'gut sense' of how comfortable you feel being treated by him / her. Trust your comfort level. A sense of sound comfort with your doctor - based on trust in both skills and ethics - plays a major role in good medical outcome.
posted by ferkit at 7:03 AM on September 13, 2014


This guy is selling Oxy prescriptions and the bullshit contract is in case he's called into court for doing so. He can produce this document and say, "I'm VERY strict about keeping my patients from seeking drugs from other docs."

It's not worth the paper it's printed on. For example a real contract has a penalty for breaching, what's the penalty associated with your going to other doctors?

If you didn't like this doctor, cancel future appointments and find someone else.

Pain management isn't getting unlimited Oxy prescriptions. It's a combination of physical therapy, biofeedback and other methods.

I'd like to give a shout out to my buddy who is in Detox from Oxy as we speak, and who will be going into rehab shortly. That shit is the WORST!
posted by Ruthless Bunny at 7:04 AM on September 13, 2014


...small 'oops' - I notice that the link I posted was for a hospital patient's bill of rights...there is one for outpatient - which better pertains to your situation. Worth looking at, if we can find it.
posted by ferkit at 7:35 AM on September 13, 2014


It could be they'll stop seeing you at the pain management clinic if they find any other doctor is prescribing pain medicines, in fact I'm pretty sure that's what happens. As a student we were told to be completely hands-off with pain-related issues with our patients who also saw PM, just in case anything we did would mess with the patients PM contract.

I would clarify whether all the tests etc you are to be getting through PM and nowhere else are related to your pain. I would still expect to be able to see a GP for things like wellness exams and cholesterol screens, for example.
posted by eldiem at 7:50 AM on September 13, 2014 [2 favorites]


Presumably this pain management clinic has been advised by its legal counsel that it needs to protect itself by having patients sign this contract. If you do not like the contract or its terms either negotiate different terms or seek a different doctor/pain management clinic.
posted by dfriedman at 8:36 AM on September 13, 2014


Ruthless Bunny, the penalty for breaching is that he drops OP as a patient. I have never seen a pain management doctor NOT drop a patient after discovering he's getting pain meds from other docs. Also, not sure why the hate on pain management. The OP hasn't told us anything about the treatment plan and not everyone who is prescribed Oxy becomes an addict.
posted by amro at 8:56 AM on September 13, 2014 [8 favorites]


Never heard of a contract like that but the doctors I see now do routine drug tests on all patients who come in complaining of pain. They do this to ensure that their patients aren't taking anything else before they prescribe them medications. So this contract thing might be part of the general trend of doctors treating all pain patients with suspicion these days.
posted by Jacqueline at 10:05 AM on September 13, 2014


I've been going for pain management for almost 2 years now and no one has asked me to sign anything like this, and I would laugh at a request to do so.
posted by poffin boffin at 10:15 AM on September 13, 2014


doctors are afraid of the DEA going after them for prescribing pain meds and unfortunately, this is a thing that has evolved from the drug war. it's total bullshit, but you have to sign it if you want the script to relieve your agony. for comic relief, if you're of a lawyerly bent (or just a bent lawyer, ahem), you can try to negotiate the terms of the contract.

so what are the consequences of breaking this contract? can he sue you for damages, and what would those damages be?

i have HEARD that opium poppies are easy to grow, and that seeds are readily available in nurseries, i have never done this myself; i have all the drugs i need, thank you very much. "papaver somniferum" is another thing that has existed since long before the drug war began.
posted by bruce at 10:15 AM on September 13, 2014 [1 favorite]


I'm a medical student, not a doctor or other health care provider, but I was actually under the impression that Pain Management Agreements are fairly common. I'm not sure if the stipulations of the one you signed are typical, however. I do know doctors who have declined to continue prescribing pain medications to patients who have violated the conditions of their treatment.

Also, I think that implying that OP's doctor is doing this for personal gain or to cover his/her butt is pretty cynical. Of course not all people with chronic pain are drug seeking addicts, but addiction to prescription medication is an enormous problem.
posted by i_am_a_fiesta at 11:57 AM on September 13, 2014 [2 favorites]


This is a terrible contract.

The "all imaging to be done in his office thing" is so hinky. What is he going to do, drop you as a patient if you go to the ER with a potentially life threatening illness or injury? Does he even have the appropriate equipment and staff to do stuff like a colonoscopy (I take it dude is not a GI)?

With respect to meds, is the man up to date with advancements in treatment protocols for cancer and mental illness?

If I ever went into pain management I would refuse to stop seeing specialists beyond the scope of what pain management can reasonably manage. Off the top of my head, psychiatrist, oncologist, gastroenterologist, orthopedic surgeon, neurologist are experts that are irreplaceable by a pain management doc and would reasonably be involved in any condition associated with pain. I would include physiatrist if the centre doesn't have rehab and likely also rheumatologist.

Then there's all the other associated professionals for medical conditions that pop up in everyday life - you bet I want an OB/GYN to do my colposcopy if I have an abnormal pap smear, an opthamologist to do eyes, etc etc.

I would find another pain management doc that will work with your pre-existing health care team and let you access care by the most skilled and qualified people in any discipline.
posted by crazycanuck at 12:17 PM on September 13, 2014


I am a doctor who deals with a lot of chronic pain patients. Pain management contracts are becoming more and more common, and they are actually extremely useful for doctors and patients.

They are generally not about pursuing legal action, either for physicians to legally enforce or for physicians to cover themselves against litigation. They wouldn't be very useful for either of those things.

Their main use is laying out the boundaries of the relationship between to doctor prescribing controlled substances and the patient. The contracts make quite clear what patients need to do in order to keep up their side of the bargain and continue to receive prescriptions for controlled substances, like passing drug tests to prove they are not abusing other substances, not getting prescriptions from other doctors. These contracts are extremely helpful to me as an emergency medicine physician when chronic pain patients come to the emergency department asking for more of their prescription pain meds. There is no bargaining, no argument, it's not about whether I'm nice or mean or a bad doctor or a good doctor (all things that drug seeking patients use as manipulation tactics). You have agreed to a contract, if you break your contract, you won't be able to see your pain med prescriber anymore, it is simple.

I have never heard of a pain management contract that prohibits seeing other doctors, and I also wonder if this may be a misunderstanding. If it truly does say what you describe, it is certainly not legally binding, but no one would try to sue you for breaking it anyway, you'd just have to find a new pain doctor, either way.

Also, most pain specialists who use these contracts are generally trying to get patients OFF narcotics or to use them only in a responsible manner - not to dispense them left and right with this as their legal protection - try to imagine anyone presenting this in front of a jury after a patient had died of a narcotic overdose under a doctor's care and you'll see how foolish that would be.
posted by treehorn+bunny at 12:25 PM on September 13, 2014 [11 favorites]


Treehorn+bunny provides the definitive answer as usual -- pain management contracts are pretty much standard for patients being treated by pain management docs, and many primary care physicians also use them for chronic pain patients. They're generally a prerequisite to treatment when there's a risk that the prescribed meds could be misused or diverted.
posted by killdevil at 1:42 PM on September 13, 2014


Mod note: From the OP:
Thanks for the responses so far. I am currently prescribed Norco 10-325 x 5 per day and still in a great deal of pain due to several failed joint surgeries. He wants me to cancel my ortho appointments and cut my Norco to 3 x per day same dosage. I have honestly been in tears since I left his office. In my state there is a database to keep people from doctor shopping.

He also told me that smoking cigs (yes, I want to quit) negated the effectiveness of opiods so it was pointless to prescribe me anything. I have googled to fact check this and can't find anything.

He is the only pain doc on my insurance plan. I did not sign the pain contract so now I am probably a pariah.

How can he say smoking negates the uptake of opiods and then try to prescribe me some anyway? And if he wants to lower my dose wouldn't the responsible thing to do is set up a taper schedule?

I left his office with a back brace that I don't need. His face lit up when he found out I had medicaid ins. The whole situation felt like a scam and he has a monopoly in a several county-wide area. I googled him after my appointment and discovered that he has lost his license twice. Once for a pill mill operation and the other for using a phony medical device to fleece patients (trying not to be too specific). And his youtube videos are bonkers "healing with spirituality" type videos.

He is also only accepts cash payment. No debit or credit which I found odd.
posted by mathowie (staff) at 1:46 PM on September 13, 2014


Holy shit, run like hell and do not look back. If there is literally any other option than dealing with this crank then take that one and be glad you're free of that bullshit.
posted by poffin boffin at 2:37 PM on September 13, 2014 [6 favorites]


I would also report him to the state medical board, OP. That's just not right.
posted by Arrrgyle at 2:41 AM on September 17, 2014


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