Poor palliative care outlined
The Oregon Board of Medical Examiners cited a number of instances between 1993 and 1998 that showed Paul A. Bilder, MD, a Roseburg, OR, physician, underprescribed pain medication that allowed his patients to suffer. In some instances, Bilder ignored the recommendations of hospice nurses, patients, and their families.
Incidents in which he failed to properly prescribe pain medication include:
• Used Tylenol to treat an elderly man who was in pain from terminal cancer. The patient’s pain increased and he had to be hospitalized. After returning home, a hospice nurse told Bilder that the patient required a urinary catheter, stronger pain medication, and anti-anxiety medicine. Bilder refused the catheter on the basis that it might cause infection, and ordered inadequate pain medication. The patient died a day later.
• Ordered removal of a urinary catheter from a dying and incontinent cancer patient, which was against the wishes of the patient and his family. Bilder told the hospice nurse to use diapers instead. Bilder ordered 0.25 milligrams of Roxanol every four hours — a fraction of the amount the hospice nurse suggested — and Tylenol for high fever. The 84-year-old man died that evening.
• Stopped giving sedatives and pain medication to a 35-year-old woman with pulmonary disease while she was on a mechanical ventilator. Bilder declined to resume the patient’s pain medication or sedatives when the woman became restless and fought her ventilator. The woman pulled out her breathing tube. Another doctor reinserted it. Bilder then ordered a paralytic agent, which relaxes the throat muscles to accommodate the breathing tube, but did not order sedatives to combat the woman’s anxiety.
• Refused a request to give morphine to treat anxiety in a 63-year-old woman with pulmonary disease and diabetes who was put on a ventilator because of acute respiratory failure. Bilder ordered paralytic agents only.
• Refused morphine or other pain medication to an 82-year-old man hospitalized with congestive heart failure, despite the patient’s assertions that he could not breathe and that he was tired. Bilder ordered Lasix, but again refused to order morphine or a similar pain medication. Another physician treated and stabilized the patient, which helped allow him to be discharged several days later.
• Failed to use narcotic painkillers or anti-anxiety drugs while inserting a breathing tube through the nose of a 33-year-old man with pneumonia. The medical staff at the hospital made several unsuccessful attempts to insert the tube, causing the patient’s nose to bleed. The staff had to restrain the patient to complete the procedure.
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