Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T22:38:34.303Z Has data issue: false hasContentIssue false

Physician Liability for Suicide after Negligent Tapering of Opioids

Published online by Cambridge University Press:  04 March 2022

Abstract

The precipitous and medically contraindicated reduction or “tapering” of opioids for patients with chronic pain due to serious medical conditions has caused needless suffering and, increasingly, suicide. Physicians could be liable for wrongful death based on negligent tapering of opioids.

Type
Columns: Currents in Contemporary Bioethics
Copyright
© 2022 The Author(s)

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

About This Column

Mark A. Rothstein serves as the section editor for Currents in Contemporary Bioethics. Professor Rothstein is the Herbert F. Boehl Chair of Law and Medicine and the Director of the Institute for Bioethics, Health Policy and Law at the University of Louisville School of Medicine in Kentucky. ([email protected])

References

Centers for Disease Control and Prevention, Three Waves of Opioid Overdose Deaths, available at <cdc.gov/opioids/basics/epidemic.htm> (last visited Dec. 6, 2021).+(last+visited+Dec.+6,+2021).>Google Scholar
Ahmad, F.B., Rossen, L.M., and Sutton, P., “Provisional Drug Overdose Death Count, National Center for Health Statistics,” Nov. 7, 2021, available at <cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm#data-tables> (last visited Dec. 6, 2021).+(last+visited+Dec.+6,+2021).>Google Scholar
See generally Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse, National Academies of Sciences, Engineering, and Medicine, Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use (R.J. Bonnie, M.A. Ford, and J.K. Phillips, eds., Washington, D.C.: The National Academies Press, 2017).Google Scholar
See generally Keefe, P.R., Empire of Pain: The Secret History of the Sackler Dynasty (New York: Doubleday, 2021).Google Scholar
See Rothstein, M.A., “Ethical Responsibilities of Physicians in the Opioid Crisis,” Journal of Law, Medicine & Ethics 45, no. 2 (2017): 682687.CrossRefGoogle Scholar
See Hoffman, J., “CVS, Walgreens and Walmart Fueled Opioid Crisis, Jury Finds,” The New York Times, Nov. 23, 2021, available at <https://www.nytimes.com/2021/11/23/health/walmart-cvs-opioid-lawsuit-verdict.html> (last visited Dec. 9, 2021).+(last+visited+Dec.+9,+2021).>Google Scholar
See Weedn, V.W. et al., “Fentanyl-Related Substance Scheduling as an Effective Drug Control Strategy,” Journal of Forensic Sciences 66 (2021): 11861200, doi: 10.1111/1556-4029.14712.CrossRefGoogle ScholarPubMed
Madras, B.K. et al., Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers within the Treatment System, National Academy of Medicine Discussion Paper (April 27, 2020), available at <https://www.rcorp-ta.org/sites/default/files/2020-06/Improving-Access-to-Evidence-Based-Medical-Treatment-for-OUD_FINAL.pdf> (last visited Dec. 9, 2021).CrossRef+(last+visited+Dec.+9,+2021).>Google Scholar
See Case, A. and Deaton, A., “Rising Morbidity and Mortality among White Non-Hispanic Americans in the 21st Century,” Proceedings of the National Academy of Sciences USA 112, no. 49 (2015): 1507815083.Google Scholar
Although beyond the scope of this article, another possible source of related litigation is an action against a pharmacy for failure to fill an opioid prescription in violation of Title III of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. See Fuog v. CVS Pharmacy, Inc., 2021 WL 4355401 (D.R.I. 2021).Google Scholar
Lanser, P. and Gesell, S., “Pain Management: The Fifth Vital Sign,” Healthcare Benchmarks 8, no. 6 (2001): 6870.Google ScholarPubMed
See Keefe, P.R., supra note 4, at 194.Google Scholar
Id. at 195.Google Scholar
See Van Zee, A., “The Promotion of OxyContin: Commercial Triumph, Public Health Tragedy,” American Journal of Public Health 99, no. 2 (1999): 221227.CrossRefGoogle Scholar
Levy, B. et al., “Trends in Opioid Analgesic-Prescribing Rates by Specialty, U.S., 2007-2012,” American Journal of Preventive Medicine 49, no. 3 (2015): 409413.CrossRefGoogle ScholarPubMed
Paulozzi, L.J., Mack, K.A., and Hockenberry, J.M., “Vital Signs: Variation among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012,” Morbidity and Mortality Weekly Report 63 (2014): 563568. See also Centers for Disease Control and Prevention, U.S. Opioid Dispensing Rate Maps, available at <https://www.cdc.gov/drugoverdose/rxrate-maps/index.html> (last visited Dec. 7, 2021).Google ScholarPubMed
Centers for Disease Control and Prevention, Annual Surveillance Report of Drug-Related Risks and Outcomes: United States, 2017, at 9 (2017).Google Scholar
Han, B. et al., “Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health,” Annals of Internal Medicine 167, no. 5 (2017): 293302.CrossRefGoogle ScholarPubMed
U.S. Department of Health and Human Services, Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (2016), HHS Publication SMA 16-4984, NSDUH Series H-51 (Rockville, MD: SAMHSA).Google Scholar
Dowell, D., Haegerich, T.M., and Chou, R., “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016,” Morbidity and Mortality Weekly Reports Recommendation Reports 65, no. 1 (2016): 1-49.Google Scholar
Rothstein, M.A. and Irzyk, J., “The Opioid Crackdown Leaves Chronic Pain Patients in Limbo,” The Hill, Nov. 29, 2021, available at <https://thehill.com/opinion/healthcare/583332-the-opioid-crackdown-leaves-chronic-pain-patients-in-limbo> (last accessed Dec. 7, 2021).Google Scholar
American Medical Association, Comments on the CDC Guideline for Prescribing Opioids for Chronic Pain (June 16, 2020), available at < https://searchlf.ama-assn.org/finder/letter/search/opioid/relevant/1/> (last visited Dec. 7, 2021).+(last+visited+Dec.+7,+2021).>Google Scholar
. D. Dowell et al., supra note 20, at 16.Google Scholar
Volkow, See N., Benveniste, H., and McLellan, A.T., “Use and Misuse of Opioids in Chronic Pain,” Annual Review of Medicine 69 (2018): 451465.CrossRefGoogle ScholarPubMed
Nadeau, S.E., Wu, J.K., and Lawhern, R.A., “Opioids and Chronic Pain: An Analytical Review of the Clinical Evidence,” Frontiers in Pain Research 2 (2021), art. 721357, doi: 10.3389/fpain.2021.721357.CrossRefGoogle ScholarPubMed
D. Dowell et al., supra note 20, at 16.Google Scholar
Kroenke, K. and Cheville, A., “Management of Chronic Pain in the Aftermath of the Opioid Backlash,” Journal of the American Medical Association 317, no. 23 (2017): 23652366, 2366.CrossRefGoogle ScholarPubMed
Nadeau, Wu, and Lawhern, supra note 26, citing Rose, M.E., “Are Prescription Opioids Driving the Opioid Crisis? Assumptions vs. Facts,” Pain Medicine 19 (2018): 793807, doi: 10.1093/pm/pnx048.CrossRefGoogle ScholarPubMed
National Conference of State Legislatures, Prescribing Policies: States Confront Opioid Overdose Epidemic (June 30, 2019), available at <https://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx> (last visited Nov. 11, 2021). See also Guevremont, N., Barnes, M., and Haupt, C.E., “Physician Autonomy and the Opioid Crisis,” Journal of Law, Medicine & Ethics 46, no. 1 (2018): 203219; M.E. Schatman and H. Shapiro, “Damaging State Legislation Regarding Opioids: The Need to Scrutinize Sources of Inaccurate Information Provided to Lawmakers,” Journal of Pain Research 12 (2019): 3049-3053, doi: 10.2147/JPR.S235366.CrossRefGoogle ScholarPubMed
Enzinger, A.C. et al., “US Trends in Opioid Access among Patients with Poor Prognosis Cancer Near the End-of-Life,” Journal of Clinical Oncology 39, no. 26 (2021): 29482958.CrossRefGoogle ScholarPubMed
Rieder, T.N., “Is Nonconsensual Tapering of High-Dose Opioid Therapy Justifiable?AMA Journal of Ethics 22, no. 8 (2020): E651657.Google ScholarPubMed
D. Dowell et al., supra note 20, at 26.Google Scholar
Agnoli, A. et al., “Association of Dose Tapering with Overdose or Mental Health Crisis among Patients Prescribed Long-Term Opioids,” Journal of the American Medical Association (August 3, 2021), doi: 10.1001/jama.2021.11118.CrossRefGoogle Scholar
Oquendo, M.A. and Volkow, N.D., “Suicide: A Silent Contributor to Opioid-Overdose Deaths,” New England Journal of Medicine 378, no. 17 (2018): 15671569.CrossRefGoogle ScholarPubMed
The facts of the case have been drawn from A. Joseph, “Her Husband Died by Suicide. She Sued His Pain Doctors — A Rare Challenge Over an Opioid Reduction,” STAT, Nov. 22, 2021, available at <https://www.statnews.com/2021/11/22/her-husband-died-by-suicide-she-sued-his-pain-doctors-a-rare-challenge-over-an-opioid-dose-reduction/?utm_content=buffera5bdd&utm_medium=social&utm_source=twitter&utm_campaign=twitter_organic> (last visited Nov. 24, 2021), and Slone v. Commonwealth Pain & Spine (Jefferson Cty. Cir. Ct., Aug. 27, 2021), 2021 Ky. Trial Ct. Rev. LEXIS 37, available at <http://plus.lexis.com/api/permalink/9064c0ff-dfcc-4b51-9bca-d0c6f9a7ba29/?context=1530671> (Plaintiff’s Response in Opposition to Defendants’ Motion for Summary Judgment).+(last+visited+Nov.+24,+2021),+and+Slone+v.+Commonwealth+Pain+&+Spine+(Jefferson+Cty.+Cir.+Ct.,+Aug.+27,+2021),+2021+Ky.+Trial+Ct.+Rev.+LEXIS+37,+available+at++(Plaintiff’s+Response+in+Opposition+to+Defendants’+Motion+for+Summary+Judgment).>Google Scholar
D. Dowell et al., supra note 20, at 16.Google Scholar
Slone v. Commonwealth Pain & Spine (Jefferson Cty. Cir. Ct., Aug. 27, 2021), 2021 Ky. Trial Ct. Rev. LEXIS 37, available at <http://plus.lexis.com/api/permalink/9064c0ff-dfcc-4b51-9bca-d0c6f9a7ba29/?context=1530671> (last visited January 4, 2022).+(last+visited+January+4,+2022).>Google Scholar
Interview by Mark A. Rothstein with Hans Poppe, Dec. 2, 2021.Google Scholar
Keeton, W. Page et al., Prosser and Keeton on the Law of Torts § 30 (5th ed. 1984), at 164-165.Google Scholar
See id. at §§ 126-127.Google Scholar
American Law Institute, Restatement (Third) of the Law of Torts § 3 (2010).Google Scholar
W. Page Keeton et al., supra note 40, at 164.Google Scholar
Id. at 187.Google Scholar
American Medical Association, Code of Medical Ethics of the American Medical Association (2017), at 7.Google Scholar
See De Ruddere, L. and Craig, K., “Understanding Stigma and Chronic Pain: A State-of-the-Art Review,” Pain 157, no. 8 (2016): 16071610; Y. Olsen and J.M. Sharfstein, “Confronting the Stigma of Opioid Use Disorder — and Its Treatment,” Journal of the American Medical Association 311, no. 4 (2014): 1393-1394.CrossRefGoogle ScholarPubMed
See Collen, M., “Opioid Contracts and Random Drug Testing for People with Chronic Pain — Think Twice,” Journal of Law, Medicine & Ethics 40, no. 4 (2009): 841845.CrossRefGoogle Scholar
The CDC Guideline labels its recommendation for initial and periodic urine drug testing as a category B recommendation, meaning that “individual decision making” by the clinician is required. See D. Dowell et al., supra note 20, at 16, recommendation 10. Drug testing, however, is often an across-the-board policy of institutions or clinicians.Google Scholar
See Rapoport, A.B. and Rowley, C.F., “Stretching the Scope — Becoming Frontline Addiction-Medicine Providers,” New England Journal of Medicine 377, no. 8 (2017): 705707, 706 (“At some point, it became culturally acceptable to treat all conditions in a patient except addiction.”).CrossRefGoogle ScholarPubMed
See Singing River Health System v. Vermilyea, 242 So.3d 74 (Miss. 2018); Komlodi v. Picciano, 89 A.3d 1234 (N.J. 2014).CrossRefGoogle Scholar
966 N.W.2d 460 (Mich. Ct. App. 2020).Google Scholar
Other elements in the case against the physician, such as prescribing and injecting a relative without a sufficient medical evaluation, might have justified sanctions, but relying on the CDC Guideline as the standard of care is a troubling precedent.Google Scholar
American Law Institute, Restatement (Third) of the Law of Torts § 26, comment l (2010).Google Scholar
The Restatement (Third) of the Law of Torts uses neither the term “legal cause” nor “proximate cause,” instead using “scope of liability” to address the issue of how far liability should extend as a matter of policy. See id. at ch. 6.Google Scholar
Rollins v. Wackenhut Servs., 703 F.3d 122 (D.C. Cir. 2012); Riesbeck Drug Co. v. Wray, 39 N.E.2d 776 (Ind. Ct. App. 1942); Sindler v. Litman, 887 A.2d 97 (Md. Ct. App. 2005); Wickersham v. Ford Motor Co., 853 S.E.2d 329 (S.C. 2020); Cotton v. Wilson, 576 S.W.3d 626 (Tenn. 2019). See generally Long, A.B., “Abolishing the Suicide Rule,” Northwestern University Law Review 113, no. 4 (2019): 767824.Google Scholar
Parton v. Jeans, 2019 WL 6608750 (Ariz. Ct. App. 2019); Porter v. Murphy, 792 A.2d 1009 (Del. Super. Ct. 2009); Crumpton v. Walgreen Co., 871 N.E.2d 905 (Ill. 2007); Bertrand v. Air Logistics, Inc., 820 So. 2d 1228 (La. Ct. App. 2002); Truddle v. Baptist Mem’l Hosp.-Desoto, Inc., 150 So. 3d 692 (Miss. 2014); Lenoci v. Leonard, 21 A.3d 694 (Vt. 2011); Arsnow v. Red Top Cab Co., 292 P. 436 (Wash. 1930); McMahon v. St. Croix Falls School Dist., 596 N.W.2d 875 (Wis. Ct. App. 1999); R.D. v. W.H., 875 P.2d 26 (Wyo. 1994). See generally Restatement (Second) of the Law of Torts § 445 (1958). This exception has been criticized as being medically and legally defective and stigmatizing mental illness with rhetoric from the Middle Ages. See Long, supra note 55, at 811-812.Google Scholar
Gilmore v. Shell Oil Co., 613 So.2d 1272 (Ala. 1993); Joseph v. State, 26 P.3d 459 (Alaska 2001); Meils v. Northwestern Bell Tel. Co., 355 N.W.2d 710 (Minn. 1984); McPeake v. Cannon, 553 A.2d 439 (Pa. Super. Ct. 1989. (Worsham v. Nix, 83 P.3d 879 (Okla. Civ. App. 2003); Moats v. Preston County Comm’n, 521 S.E.2d 180 (W. Va. 1999).Google Scholar
Kockelman v. Segal, 61 Cal. App.4th 491 (Cal. App. 1998); Lee v. Corregedore, 925 P.2d 324 (Haw. 1996); Costigan v. Plets, 2011 WL 6376016 (Mich. Ct. App. 2011).Google Scholar
Wyke v. Polk County School Board, 129 F.3d 560 (11th Cir. 1997).Google Scholar
Schiezler v. Ferrum College, 236 F. Supp. 2d 602 (W.D. Va. 2002).Google Scholar
Patton v. Bickford, 529 S.W.3d 717 (Ky. 2016).Google Scholar
See, e.g., Meir v. Ross General Hospital, 445 P.2d 519 (Cal. 1968); Wozniak v. Lipoff, 750 P.2d 971 (Kan. 1988); Champagne v. United States, 513 N.W.2d 75 (N.D. 1994).Google Scholar
Kivland v. Columbia Orthopaedic Group LLP, 331 S.W.3d 299 (Mo. 2011).Google Scholar
White v. Lawrence, 975 S.W.2d 525 (Tenn. 1998).Google Scholar
692 A.2d 1266 (Conn. 1997).Google Scholar
Id., at 1270.Google Scholar
Slone v. Commonwealth Pain & Spine, supra note 38 (Instruction No. 6).Google Scholar
See Centers for Disease Control and Prevention, supra note 17.Google Scholar
National Center for Health Statistics, Centers for Disease Control and Prevention, Drug Overdose Deaths in US Top 100,000 Annually (Nov. 17, 2021), available at <https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/2021117.htm> (last visited Dec. 12, 2021).+(last+visited+Dec.+12,+2021).>Google Scholar
See Oquendo and Volkow, supra note 35.Google Scholar
See, e.g., Koon v. Walden, 539 S.W.3d 752 (Mo. Ct. App. 2017) (affirming multi-million-dollar damage award for overprescribing opioids, which resulted in the plaintiff’s addiction). See also Slat, S. et al., “Opioid Policy and Chronic Pain Treatment Access Experiences: A Multi-Stakeholder Qualitative Analysis and Conceptual Model,” Journal of Pain Research 14 (2021): 11611169, (“fear of litigation as justification for decreasing opioid prescribing”).CrossRefGoogle ScholarPubMed