Each month, Dr. Lynette Menefee tackles pressing issues in pain management with one of the nation's leading practitioners. This month, Dr. Menefee speaks with Beverly Bergman. By all accounts, Ms. Bergman is a woman with compassion for others. A social activist with a career in social service, she also possesses a sense of determination for righting social wrongs. So when her 85 year-old father, William Bergman, suffered an excruciatingly painful death from lung cancer in 1998 despite the availability of effective methods of pain management, Ms. Bergman decided that his suffering had been unnecessary. She and other family members resolved to do something about it. With the help of the Compassion in Dying Federation, a non-profit group concerned with improving end-of-life care, they went to court. The result was a precedent-setting verdict against a physician, under the elder-abuse laws in California for the under treatment of pain. Here is her story….

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Questions

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Dr. Lynette Menefee: Ms. Bergman, thank you for being willing to talk about your experiences.

As I understand it, your father had a history of smoking and back pain from an old vertebral compression fracture. He had been taking Vicodin for more than a year. However, in February 1998, you found him crumpled over in a chair in pain and you took him to a local hospital emergency department. What happened there?

Beverly Bergman: We were in the emergency room for 7 hours before he was admitted. He was in a lot of pain. The metal gurney with its thin mattress was hard for him to lay on. He had a lot of edema in his lower legs. He was hungry, so I went to get him some food. He became agitated and kept trying to get off the gurney. He wanted to go home. I called my brother to come help me, and he arrived about 30 minutes later. I asked the nurse to give him something to calm him down and they did.

A physician's assistant was attending him and she ordered lung X-rays taken. She called me out of the room and told me she believed he had lung cancer. I broke down in tears, remembering how my mom died of lung cancer 3 years earlier. I went back into the room, my dad could tell I had been crying and told me to “be strong.” They apparently gave him two shots of morphine in the ER that night and a shot of phenergan for nausea. The doctor came many hours later. He asked my dad some routine questions, examined him then admitted him for testing. He said he was taking the place of my father's regular doctor.

LM: Your father was subsequently hospitalized. How was his pain treated during his hospitalization?

BB: He was having a lot of pain when we weren't there. We were worried about him because he was frail and in a lot of pain. I went to the hospital every day after work and visited him. Every time I visited, I needed to find a nurse to give him pain medication. My brother, sister, nieces and nephew came and visited him, too. After his death, we found out that the charting showed many times his pain level was 7, 8, 9 or 10 on the pain scale. He was treated with Demerol 25 mg P.R.N., once or twice he received 50 mg. Sometimes it would help some and sometimes not. Often, he was not given anything for pain.

LM: What were those initial days like for you and your family members?

BB: We were in shock, this all happened very quickly for us. One day, dad is complaining of severe back pain, the next he is in the ER and a physicians assistant is telling me that she believes he has lung cancer. It was very upsetting. We waited to hear about the test results and when the news came in that he had thee compression fractures and lung cancer, we talked and decided to tell our dad. He said he didn't want any more tests. He didn't want chemotherapy or radiation therapy. He just wanted to go home and be under the care of hospice. We had to make plans to move from Oakland into his house to take care of him.

LM: What led you and your siblings to seek legal action against the attending physician?

BB: We were quite disturbed with the terrible lack of pain management that my father had received during the stay in the hospital and also on discharge from the physician. We didn't want any other person to suffer as our dad did. I called a malpractice attorney and he advised me to call Compassion in Dying in Oregon. With the assistance of Compassion in Dying's legal director, Kathryn Tucker, we filed a complaint with the California Medical Board. Compassion In Dying had an oncologist review the hospital records and write a report that was submitted with the complaint. The California Medical Board's response was that there was a lack of pain management but they weren't going to do anything about it without more complaints against the doctor. We were shocked and angered by this response as we felt that this decision not to do anything was wrong. We felt we needed to pursue this or he would probably continue mistreating patients and we wanted him to learn more about pain management. After consulting with Ms. Tucker, we filed a lawsuit.

LM: What do you believe were the essential facts in the case?

BB: The most important fact is that my father suffered needlessly! He had pain ranging from 7 to 10 on the pain scale regularly, in a hospital setting. When he was discharged, his pain level was 10 -- the worst imaginable pain possible. I had to advocate for him with the discharge nurse to get proper medication for his pain, not just the Vicodin pills the doctor had prescribed. My father was having trouble swallowing anything at that time so pills were not appropriate. After the nurse talked to the doctor, he gave in and prescribed a 50 mg shot of Demerol and a fentanyl patch. We were not told the patch wouldn't start working for hours.

The second fact is that my father's physician hadn’t had a pain management class in over 32 years. He also failed to read the nurse's notes and adjust medications properly. He stated that he just asked the patient “how are you doing” to get his information.

Third, the nurses were apparently not trained in pain management and seemed indifferent to my dad's pain and suffering. The attending doctor failed to let my dad's regular doctor, who was the doctor of coverage, know of his condition at any time, including his admittance or discharge from the hospital. This caused a long delay in his receiving proper medication after his discharge. My dad was only discharged with regular strength Vicodin pills, which he told the doctor were not helping his pain when he was admitted, much less at discharge.

LM: What has the reaction been from various communities following the verdict?

BB: For the most part it has been very positive, except for a few doctors who didn't understand the case. Some doctors have been defensive because we sued, but most understand more about it when they read some of the articles that have been written. Many individuals have congratulated us and we have heard about many others who have suffered in pain. Some people in Europe said that they didn't know how this could have happened. A Japanese reporter said that the treatment of the elderly in Japan is also poor. I have spoken to a few nurses who were empathetic.

LM: How did the under-treatment of your father's pain personally affect you and your family?

BB: Our family felt betrayed. We trusted that the doctors and nurses would give our father competent care. I felt he had been tortured. I was depressed afterwards and had horrible memories of him in agonizing pain at home, laying there saying, “this is awful,” and not being able to help him. I sought counseling after a few months, with the hospice services, which was very helpful. My brother and sister were also deeply affected by what they had witnessed and didn't ever want anyone to have to suffer like our dad did again.

LM: What do you believe are the most important things that health care professionals can know about situations like the one that happened to you?

BB: IT IS PREVENTABLE! Unfortunately, a lack of good pain management is all too common. Since 1998, when my father died, I've been shown studies that show 75 percent of surgery patients and 70 percent of cancer patients received too little pain relief. It is still happening and can be prevented. Education is extremely important for the doctors and patients. A lot of tragedy can be avoided if aggressive pain management is applied. I hope that soon every doctor across the nation will learn about proper methods of pain management so people don't have to needlessly suffer. The family suffers along with the patient as we watch helplessly not knowing what to do to help our loved ones. I'd like to say to health professionals, “Be responsive to your patients, answer their concerns regarding pain medications, educate them about pain. And if you are unable to receive pain management quickly make sure to find an good pain management specialist."

LM: Thank you, Ms. Bergman, for sharing your story.