Civil Rights Case Gives Hope to Pain Patients

By Richard Dobson, MD, Guest Columnist

People with chronic disabling pain frequently complain that doctors discharge them from their practice because of the medications they take. Sometimes doctors refuse to accept patients who are taking opioid pain medications, even though the medications treat a legitimate medical condition.

There may be hope that such actions will be considered violations of the civil rights of patients.

This week the Civil Rights Division of the Department of Justice (DOJ) signed a formal agreement with Selma Medical Associates, a large primary care practice in Virginia, that may open the door for people with chronic pain to regain their full access to medical care.

Selma Medical refused to schedule a new patient appointment for a man who was taking the addiction treatment drug Suboxone. He filed a civil rights complaint asserting that his rights were violated because has a disability.

According to the complaint, Selma Medical “regularly turns away prospective new patients who are treated with narcotic controlled substances such as Suboxone.”

The DOJ and Selma Medical settled the complaint out-of-court. The full agreement can be read here.

In essence, Selma Medical agreed to stop discriminating on the basis of disability, including opioid use disorder (OUD). The settlement identifies several specific ways that Selma Medical was violating the civil rights of people with disabilities.

“By refusing to accept the Complainant for a new family practice appointment solely because he takes Suboxone, Selma Medical discriminated against him by denying him the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of Selma Medical.

By turning away the Complainant and other prospective patients who are treated with narcotic controlled substances, including Suboxone, Selma Medical imposed eligibility criteria that screen out or tend to screen out individuals with OUD.

Further, Selma Medical failed to make reasonable modifications to policies, practices, or procedures, when such modifications are necessary to afford such goods, services, facilities, privileges, advantages, or accommodations to individuals with disabilities.”

In the agreement, Selma Medical agreed to stop discriminating now and in the future. The staff and administration are also required to undergo intensive training on the implementation of the Americans With Disabilities Act (ADA).

Importantly for pain patients, the agreement applies to people taking “narcotic medications” for any reason and is not limited to people who are taking Suboxone for OUD. The agreement does seem to imply that people taking opioid medications also have their civil rights violated if they are refused medical care on the basis of their diagnosis and their use of opioids.

A former staff attorney in the DOJ’s Civil Rights Division agrees.

“This formal settlement agreement from DOJ affirms that discrimination in access to medical treatment based solely on an individual’s use of a particular medication — in this case, a narcotic controlled substance — may violate the law,” says Kate Nicholson, a pain patient and civil rights attorney who helped draft federal regulations under the ADA.

Anyone who has chronic pain and who is discharged from a practice or refused admission to a medical practice should let the medical staff know that this is a violation of the ADA. Show them the agreement between Selma Medical and the DOJ. Then if the medical practice still refuses care, file a formal complaint with the Office of Civil Rights. Instructions on filing can be found here.

As part of the settlement agreement, Selma Medical had to pay $30,000 to the complainant for “the discrimination and the harm he has endured, including, but not limited to, emotional distress and pain and suffering.” Selma Medical also had to pay a civil penalty of $10,000.

It seems to me that the substance of this agreement gives real hope to the chronic pain community that discrimination based on disability, even if the disability is based on pain, is illegal and violates their civil rights.

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Richard Dobson, MD, worked as a physician in the Rochester, New York area for over 30 years, treating and rehabilitating people suffering from chronic pain, mostly as the result of work or motor vehicle accidents. He is now retired.

In reading between the lines of this article, it does not say that this pt was a chronic pain pt or a substance abuse pt in treatment. I have stated many time that I had concerns that chronic pain pts being treated with Suboxone for pain that at some time down the path that someone would jump to the conclusion that the pt was a substance abuser or a substance abuser in recovery… when in reality they were being treated with Suboxone for chronic pain. It has been reported that not every chronic pain pt will have adequate pain management using Suboxone.

Just like we seen healthcare professional will take the 90 odd pages of the CDC opiates dosing guidelines and find a favorite sentence, paragraph or page …typically evolving around the 90 MME daily limit and don’t ready any further, but adopt that daily MME limit and profess that they are following the CDC guidelines.

This article also doesn’t clarify if the pt is in substance abuse treatment/recovery or a chronic pain pt.. just automatically LABELED as a pt dealing with OUD – OPIATE USE DISORDER.. which many likes to define as a pt taking opiates (legally/illegally) for > 90 days. It would seem no more labels as a substance abuser/addict or a pt being legally treated with one or more controlled substances that will create a physical dependency. Everyone seems to be lumped into just one classification…

Just like we seldom see the use of a accidental opiate OD… but rather a broader term – opiate related death… whereas anyone whose toxicology shows a opiate or controlled substance in their toxicology … one of the causes of their death will be “opiate use disorder” and most likely will be the first listed cause of death.

One can only come to the conclusion that these new terms serves the agenda of certain parts of our bureaucracy… basically falsely creating LARGER NUMBERS … just like they like to report the 72k DRUG OVERDOSE DEATHS and then imply that they are all caused by opiates.. and fail to acknowledge that within that number 15K are caused by NSAIDS. They also just state that FENTANYL is involved in more and more OD’s but they fail to acknowledge that there are some 1400 different Fentanyl analogs and the only one that is legal for human use in the USA is Fentanyl Citrate.


Civil Rights Case Gives Hope to Pain Patients

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