Alleged breaches of "standards of medical care" in a patient overdose death possibly related to chronic opioid analgesic therapy, application of the controlled substances model guidelines: Case report

David A. Fishbain, John E. Lewis, Jinrun Gao, Brandly Cole, Rennée Steele Rosomoff

Research output: Contribution to journalArticle

7 Scopus citations


Objectives. The objectives of this medicolegal case report are the following: 1) to present details of a chronic pain patient (CPP) who was placed on chronic opioid analgesic therapy (COAT), and subsequently overdosed on multiple drugs, some of which were not prescribed by his COAT physician; 2) to present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation that COAT prescribing was the cause of death; and 3) based on these opinions, to develop some recommendations on how pain physicians can utilize the use of Controlled Substances Model Guidelines in order to protect the patient and themselves from such an occurrence. Methods. This is a casereport of a CPP treated by a pain physician. Results. Differences between the plaintiff's and defendant's expert's opinions are explained utilizing the Controlled Substances Model Guidelines. Conclusions. Some CPPs may withhold information critical to their COAT treatment. Application of the Controlled Substances Model Guidelines and the newer Federation of State Medical Boards' policy on opioid prescribing can be helpful in improving patient care and may be helpful in protecting the physician medicolegally.

Original languageEnglish (US)
Pages (from-to)565-572
Number of pages8
JournalPain Medicine
Issue number3
StatePublished - Apr 30 2009



  • Breaches of standards
  • Chronic opioid analgesic therapy
  • Chronic pain
  • Daubert case
  • Death
  • Federal state medical board model guidelines
  • Federation of state medical board model policy
  • Informed consent
  • Intractable pain
  • Medical expert
  • Medicolegal
  • Opioids
  • Overdose
  • Standards of medical care

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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