In Part 2 I looked at the history of trying to create a Patient Bill of Rights, how the insurance industry has prevented it and what protections it provides us in this new era of government infringement into healthcare decision making. In Part 3 I’ll look at what’s at stake with the loss of civil liberties and increased costs. Specifically addressing chronic pain, what is now limited to this group will soon enough become a standard for attacking other groups with higher costs for medical care.
What’s at Stake?
With the failure of a comprehensive set of laws protecting patients, accessing healthcare is growing increasingly difficult and expensive. In 2019 a family of four could pay on average $18,764.00 per year for top line policies, making this class of healthcare unreachable for more than 1/3 of the population who didn’t have employer sponsored policies before Obamacare. Self-employed family policies cost $12,250.00 annually as of 2017.
With a resurgence in conservatism; government agencies, law enforcement, public health officials, insurance carriers and providers all respond by further restricting benefits, curtailing privacy and basic rights; as well as increase access barriers to healthcare in a variety of ways, while fraud continues to cost taxpayers billions of dollars each year. The Governments response for the most part has been to turn a blind eye to white collar crime and go after those who do the same because they are squeezed to the point of poverty.
What are the threats for the chronic pain community?
- Loss of Community: The ability to be counted with others unique to their common set of problems, needs, attitudes, interests and goals.
- This is most evident in the chronic pain community, where researchers, public health officials, law makers, law enforcement and healthcare providers routinely create laws, policies and rules which group chronic pain patients with drug abusers and addicts.
- Loss of Joy: The right to pursue basic quality of life, unrelated to earned income, one which is productive and happy.
- The pursuit of happiness is one of our constitutional freedoms, yet chronic pain patients are denied the ability to achieve this because of government caps and restriction which prevent doctors from crafting individualized care plans based on body mass, tolerance to medication, unique underlying conditions and other specific issues of the individual.
- While lauded by healthcare providers as the best type of care for chronic pain, a multidisciplinary approach to care can only be found in research centers or for those who have the insurance coverage to allow it, few with chronic pain have such resources due to its devastating effects.
- Loss of Individuality: The quality and physical characteristics of a unique individual or those things that distinguishes them from others of the same kind.
- Doctors have always customized a plan of care built around the mental, emotional and physical make up of an individual, this includes taking into consideration a multitude of conditions unique to the individual.
- Government regulation is not incapable of this nor are they capable of ensuring a medical outcome which provides patient safety and an improved quality of life.
- At best Government can provide a framework for addressing these issues but as it stands today, Government only limits and cap controlled substances, they do not regulate nor insure these other aspects which are part of comprehensive medical care needed to make a person whole, as a result, chronic pain patients suffer needlessly.
- Loss of Peace of Mind: The ability to live day to day without fear from others.
- Chronic pain patients seeking medical care at a doctor office, ER or hospital, should have a reasonable expectation that their pain will be treated absent of the stigma assigned to drug abuse and addicts. The assumption of guilt by the association of opiates used in medical care is both biased and bigoted.
- Chronic pain patients going to an ER should have the right to consult with any specialists appropriate for their medical conditions before any decision is made to deny care. All physicians should be required to document medical reasons for denying care and back such judgments with appropriate diagnostic procedures and a full exam.
- Any healthcare professional in an ER assigning drug seeking behavior to a patient should also require an examination by an addictionologist or mental health professional. Following an exam, if drug seeking behavior is suspected, admission to a treatment center for a 48-72 hours observational period.
- Chronic pain patients are routinely labeled as drug abusers or addicts but denied the same rights that group has for treatment.
- Loss of Self Determination: The process by which a person controls their own life.
- Control of one’s own life is dependent on many things, not the least of which is the patient’s mental and physical abilities. Caps and limits on pain medication treat only the body, unilateral decision making by doctors, lame and ineffective grievance systems and a lack of a patient bill of rights, denies patients of the ability to self-determine their lives.
- Physician should be forced to consider a multidisciplinary approach treating chronic pain. Taking into consideration consequences of forced tapering, termination or inadequate treatment due to prolonged medication tolerance; mental, emotional and physical consequences so the individual has the best chance of exercising self-determination.
- Broad government caps and limits on physician prescribing both threaten and undermine a patient’s ability to practice self-determination by preventing doctors from individualizing a plan of medical care.
- Loss of Due Process: A normalized judicial system as an entitlement, which grants a fair hearing of all parties when complaints are lodged against insurance companies, providers, clinics, hospitals and pharmacies.
- As government regulation places a greater burden on prescribers for outcomes, a patient’s use of medications once prescribed are beyond the control of a prescriber. Prescribers should not be liable for a patient not following medical direction.
- As prescribers react to this threat, scientific judgements are replaced with defensive posturing, personal bias and prejudice, resulting in unfair and unreasonable treatment of patients, violation of civil and HIPAA rights where ethics enforcement is non-existent.
- Forced tapering and termination of medication has resulted in patient deaths, or complications and injuries, which lead to the loss of quality of life, those who have suffered have no recourse available to them under current guidelines.
- Loss of Free Will: The power of acting without the constraint of necessity or fate; the ability to act at one’s own discretion.
- One of the justifications given for caps and limits on opiates is the possibility of overdose resulting in death. What is not acknowledged is the fact that overly cautious treatment, inappropriate and unreasonable reductions in medications lead to the same outcome, only slower, robbing chronic pain patients of the ability to respond due to a system which is now over-burdened, under manned and biased against them.
- The stigma of addiction is assigned to chronic pain patients without proof and they are denied the rights and due process afforded other medical patients by default.
- In both cases, potential overdose or the consequences of forced tapering, there is a level of risk which can’t be quantified except under the most extreme conditions. Chronic pain patients should have the right to participate in risk management decisions on treatment options. This is part of informed consent laws.
- Regulatory changes since 2010 have seen informed consent laws violated through physician-patient contracts. Some contracts deny patients the right to informed consent and participation in medical decisions by granting physicians unilateral power in all decisions. Despite HIPPA regulations some patients are denied access to their medical records by physicians.
- Ethics complaints on such actions go unpunished.
- Loss of Freedom: The absence of subjection to outside influence, action by others or tyrannical governments.
- Freedom includes all of the rights listed above. Absence of any in a disproportionate amount which favors one group over another results in loss of freedom for one and privilege for the other.