September 3, 1999

Here's an interesting item from the AP. Thanks to Robert Field for passing it on. Some of our MD members have occasionally thought about trying to instigate something like this, but we never carried through. Good to know it's now been tried, apparently successfully.

Doctor Disciplined for Lack of Aid

PORTLAND, Ore. (AP) -- A doctor accused of undertreating the pain of six of his patients has been disciplined by the Oregon medical board.

The discipline taken against Dr. Mark Bilder marks the first time a state board in the United States has taken action for giving too little -- rather than too much -- medication, according to the Federation of State Medical Boards.

Bilder, of Roseburg, was accused of using Tylenol to treat an elderly man who was in pain from terminal cancer, refusing morphine for an 82-year-old with congestive heart failure and declining to resume pain medication for a woman on a mechanical ventilator.

Documents also indicate the doctor has had communication lapses with patients and families, and an apparent lack of up-to-date knowledge about proper pain treatment.

Bilder, who declined comment, signed a statement Wednesday acknowledging that his treatment showed unprofessional or dishonorable conduct and negligence.

He must undergo a one-year program in which another doctor works with him to assess his practice, and he must complete a course on doctor-patient communication.

A few state medical boards have investigated complaints of doctors undertreating pain, but Oregon is the first to take action, the federation said.

The case reflects a national shift in policy regarding pain.

Doctors who were once concerned about turning their patients into addicts are now heeding studies showing that most pain patients don't become addicted and many, particular those in their final years, are suffering too much.

"We're still getting surveys that tell us that patients during their dying period are suffering undue pain. We want that to go to zero,'' said Dr. George Porter, chairman of the Oregon Board of Medical Examiners.

Porter acknowledged that 20 years ago, when Bilder was starting as a pulmonary disease specialist, he would not have been brought before the board.

But Porter described a new climate of compassion toward pain, particularly in Oregon, where voters twice approved the nation's only assisted suicide law and where a 1995 law shields doctors from discipline if they administer drugs to treat patients with intractable pain.

A study published last year in the Journal of the American Medical Association found that one in four elderly cancer patients in nursing homes received nothing for their daily pain.

Dr. Susan Tolle, director of the ethics center at Oregon Health Sciences University, praised the board for not throwing the book at Bilder and instead creating a plan for him to learn.

"There's a lot of things we aren't taught in medical school,'' she said. "Medicine keeps changing.''

G. Alan Robison
Executive Director
Drug Policy Forum of Texas
Houston, Texas
713-784-3196; FAX 713-784-0283

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