Doctor disciplined for 'grossly undertreating' pain

In what seems to be the first such action in the United States, the Oregon Board of Medical Examiners has approved a disciplinary plan for a doctor who "grossly undertreated" pain in six patients between 1993 and 1998.

The board is made up of nine doctors and two public members appointed by the governor of the state of Oregon to oversee the practice of medicine.

Dr Paul Bilder, aged 55, a pulmonary diseases specialist of Roseburg, Oregon, signed a stipulated order approved by the board acknowledging that his treatment of six patients showed unprofessional or dishonourable conduct and gross or repeated acts of negligence.

Dr Bilder must complete a one year "physician's evaluation education renewal" programme and a course on doctor-patient communication. He must also continue meeting with a psychiatrist, who will report to the board for at least a year. Dr Bilder and his lawyer declined to comment.

In one case, Dr Bilder was treating an 82 year old man in hospital with congestive cardiac failure. The patient told a nurse, "I can't breathe, and I'm getting tired." The patient became increasingly agitated, and his breathing and heart rates increased. Dr Bilder ordered frusemide (furosemide).

The patient's symptoms continued, but Dr Bilder refused to give morphine or similar analgesics. Another doctor treated and stabilised the patient, who was discharged several days later.

Dr David Sibell, a pain specialist at Oregon Health Sciences University, said, "I don't believe in witch hunts or persecution of doctors. I am a doctor. But quality medical care includes appropriate pain management."

"I think they are going to end up driving doctors crazy," said Dr Leigh Dolin, a Portland internist and former president of the Oregon Medical Association, noting that a decade ago the board was questioning doctors for overprescribing drugs.

Fred Charatan, Florida


studentBMJ 1999;07:394-436 November ISSN 0966-6494