Wyoming State Board of Medical Examiners --------------------------------- Source: Letter to Wyoming physicians dated March 11, 1996 --------------------------------- Provided by the Wyoming State Board to the PPSG
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Board of Medicine ---------------------------------
-- --------------------------------- COLONY BUILDING 211 WEST 19TH STREET 2ND FLOOR CHEYENNE, WYOMING 82002TELEPHONE: (307) 778-7053
March 11, 1996
Dear Wyoming Physicians:
Over the last few years some Wyoming physicians have voiced concerns about the Board's position concerning the management of patients with intractable pain. A few physicians have indicated that they fear Board sanctions should they treat patients over the long term or with high doses of controlled substances.
Please note the Board has NEVER sanctioned a physician for appropriate pain management. We have investigated cases that involve extraordinary amounts of controlled substances. However, in all cases, the physicians involved presented an adequate diagnostic basis for the therapy and extensive records in support of their treatment and the investigations were closed without further action.
Recently some physicians suggested the Board pursue amendment to the Wyoming Medical Practice Act specifically and explicitly allowing appropriate treatment for patients with intractable pain. The Board believes this approach is both unnecessary and potentially problematic. The existing statute speaks to this issue by noting that disciplinary action may be taken against licensees who willfully or consistently utilize "medical service or treatment which is inappropriate or unnecessary." W.S. 33-26-402(a) (xviii).
The Board believes any amendment is unnecessary because the existing statute already allows appropriate and necessary treatment implicitly including use of controlled substances for pain.
In determining the appropriateness and necessity of long term prescriptions of controlled substances the Board may consider the following factors:
1. Does the record contain an ADEQUATE HISTORY and PHYSICAL including an assessment of pain, physical and psychological function? An inquiry into substance abuse history, if any, is helpful as is an assessment of underlying and co-existing diseases and conditions, and a review of any recognized medical indication for controlled substances. Additionally, the Board would look to whether attempts had been made to maintain the patient on the lowest dose possible to achieve relief and improve function.
2. Is there a TREATMENT PLAN WITH OBJECTIVE CRITERIA by which progress, if any, can be measured? Though physicians should tailor pain relief to the individual needs of each patient, goals such as pain relief and/or improved physical and psychosocial function should be included and progress toward these goals monitored.
3. Have you thoroughly discussed and DOCUMENTED the risks and benefits of controlled substance usage?
4. Have you PERIODICALLY REVIEWED the course of treatment? Any new information should be added to the record as should appropriate assessment of continued treatment and necessity of trial of other modalities.
5. Has there been a DOCUMENTED CONSULTATION WHERE APPROPRIATE? The treating physician should be willing to refer the patient for necessary evaluation and treatment to achieve goals of the treatment plan. Physicians should also pay special attention to patients at risk of misuse, diversion and/or past or potential substance abuse disorders. Physicians should also ascertain, if possible, if the patient is currently receiving prescriptions for controlled substances from any other physician.
6. DOCUMENT, DOCUMENT, DOCUMENT. The more thorough and detailed the record keeping on these patients, the more easily a physician may respond to any inquiry.
7. Assure yourself that you are in COMPLIANCE WITH FEDERAL AND STATE SUBSTANCE LAWS AND REGULATIONS. To prescribe controlled substances the physician must hold a current valid license in Wyoming, possess a controlled substance registration and comply with all Federal and State regulations for issuing controlled substances prescriptions.
A Wyoming physician keeping these seven (7) check points in mind should encounter no difficulty with the Board of Medicine arising from prolonged prescribing of controlled substances for patients.
Please let us know if you have questions or comments.
Yours truly,
Howard Mussell, M.D.
President