Most lawyers handling cases involving permanent injuries and ongoing complaints of pain are familiar with the medical sub-specialty known as “pain management.” These doctors (often with experience in anesthesiology) concentrate in the management of long-term chronic pain. This is done by medication management and other methods. This is a legitimate medical specialty with its own certifying boards.
This kind of treatment is often viewed with some skepticism by insurers and juries. Anecdotally, I think this is because this treatment cannot result in a “cure” for whatever is wrong. Instead, it concentrates on making the patient as comfortable as possible by ameliorating the effects of painful permanent conditions. This leads to concerns that pain management treatment is not medically neccessary, or that it encourages drug-seeking behavior in patients.
Legitimate pain management doctors go to great lengths to establish medical neccessity, and to control concerns about drug-seeking by patients. They obtain records of past medical history, keep meticulate prescribing records, make patients sign treatment contracts, and often use urinalysis to monitor compliance. On the other hand, illegitimate pill-mill doctors have been known to omit these precautions, and will write endless streams of prescriptions for powerful narcotics, often based on nothign more than the patient’s say-so that it hurts. Most experienced personal injury lawyers have run into both kinds of pain management doctors. At least, I have.
Here is an order from the Maryland Board of Physicians summarily suspending a (not board-certified) pain management doctor. This doctor is alleged to have engaged in some of the unprofessional practices noted above.
What’s interesting is the source of the complaint- an investigator from Travelers Insurance Company.
Apparently, two injured workers in Travelers’ cases were being trated by this doctor. Travelers discovered that the doctor was not actually seeing the patients, the prescriptions were written based on the patients’ responses on a mailed form, and the payments for the services were mailed to the doctor’s home address. This was enough to get the Board to investigate, ultimately finding enough evidence about the treatment of 12 patients to justify a summary suspension.
I have never seen something like this before. Now that I think about it, I am surpised I haven’t. If you think about the volume of claims for pain management that workers compensation insurers see, you would think that it would be enough for patterns to emerge for some doctors. And it would be in the insurer’s interest to a) not pay for these claims, and b) ensure that injured workers are seen by competent doctors. Of course, it will be a cold day in hell before Travelers makes a complaint about one of the doctors it hires to evaluate injured workers giving an unsupported opinion.