December 17, 2002

Dear Long Term Care Ombudsman Network,

The Citizen Advocacy Center (CAC) is undertaking a new initiative designed to improve the way we treat and manage pain in this country. We would like to enlist the support of ombudsmen (state and local) for one aspect of the initiative as explained below.

One of the elements of our new pain management initiative is to try to get the state health licensing boards (especially boards of medicine, but also boards of nursing, pharmacy , social work and physical therapy) to be more aggressive in dealing with pain management issues, especially undertreatment of pain. Consider this fact: in the United States, only one case (in Oregon) has ever been prosecuted against a physician for the undertreatment of pain! Yet medical boards bring licensing actions against physicians alleging overprescribing hundreds of times each year.

The boards tell us that they don’t receive complaints alleging undertreatment of pain when they defend their lack of action in this area. And this is where we hope we can get ombudsmen to help. Certainly in long term care settings, especially nursing homes, it is obvious that residents suffer pain unnecessarily. The latest information published by CMS shows many nursing homes around the country where as many as thirty five percent (35%) of the residents, or their caretakers, indicate they experience severe pain.

It is our hope that we can enlist ombudsmen to urge residents and their loved ones to file complaints that pain is being undertreated in specific cases with state boards of medicine especially, but also with boards of nursing in appropriate cases. And we would like to talk with ombudsmen about filing these complaints themselves in appropriate cases. At CAC, we do not need to know the names of the residents who file these complaints, or who are the victims of undertreatment when cases are filed by ombudsmen. All we need to know is that cases have been filed (name of the state, name of the board where the complaint was filed, and month and year when the complaint was filed). We will then follow up with the appropriate boards and ask for status reports.

As part of this initiative, we are working with the board attorneys and board investigators by having some of the nation’s better know pain management advocate groups (especially Compassion in Dying - See their website at http://compassionindying.org, especially their pain project.) to provide names of experts to these boards that might utilize in evaluating these complaints and in preparing cases for licensing actions. We are also working with the boards, and with citizen advocacy groups in selected states, to enact laws to improve the education of licensed health professionals in pain treatment. For example, in 2002, a law was enacted in California requiring all physicians to take continuing education courses in pain management as a condition of license renewal. And still another part of our initiative is to work to have the Federation of State Medical Boards (FSMB) revise their current model guideline on pain management to deal with the issue of undertreatment of pain-it currently deals primarily with overprescribing issues only, and is therefore rather badly skewed. (FSMB is their umbrella organization of all the state medical boards.) We are working with the National Council of State Boards of Nursing (NCSBN)-the umbrella organization composed of all state boards of nursing-to develop a policy statement dealing with undertreatment of pain relating to nurses. (Recent studies for example have shown that while nursing as a profession is sensitized to the issue of unnecessary pain, there exists much information among nurses (one study called it myths) that narcotics usually leads to chemical dependency, which is not true.)

Thank you for your interest.

David Swankin, President, CAC

Rebecca LeBuhn, Board Chair, CAC