STOP Criminalizing "Patient Centered Care" & End Systemic Health Discrimination

STOP Criminalizing "Patient Centered Care" & End Systemic Health Discrimination

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Samantha Adcock started this petition to Department of Justice and

I made this petition to protect patients and medical professionals, This issue affects the medical community and everyone who has or knows someone with a complex medical history. Overzealous oversight is destroying the practice of medicine and putting the health, safety and lives of patients at risk. We need change now! Please sign and share with others

Physician autonomy has been undermined by insurance companies, politicians, state medical boards, law enforcement, special interest groups, and non-medical administrators at healthcare facilities. Most, if not all use algorithms based on a subjective definition of legitimate medical treatment. Clinicians are being coerced and even paid more/incentivized to not prescribe controlled substances.

This has had a chilling effect on patients' ability to obtain health care. Clinicians are left with the choice of providing individualized care & risking overzealous oversight & prosecution; or violating the ADA by basing decisions to deny/reduce treatment on disability and fear of prosecution rather than the health care needs of their patient. 

Disabled individuals with complex chronic illnesses, multiple diseases and/or disabilities, incurable painful diseases and debilitating injuries are experiencing systemic discrimination which has left them without any good options. Their choices are to exist in agony, attempt to self-medicate via the black market, or suicide.

The climate of fear that is now controlling the practice of medicine must be eliminated to ensure that individuals with disabilities are able to obtain treatment based on their personal health care needs. Medical professionals must feel safe to act in the best interests of their patients, and not fear that doing so will result in unwarranted criminal investigations or charges.

To ensure health equity, reduce discriminatory practices in medicine and improve the quality of life and function to disabled individuals, we respectfully request the following actions be considered to correct this grievous inequity.

  1. The Department of Justice shall prepare and release guidance for "Pain, Policy Modification Requirements & the Americans with Disabilities Act."
  2. The Department of Justice, all federal agencies and federally funded programs shall immediately cease any program that targets clinicians for investigation and/or prosecution that uses a subjective definition of Legitimate Medical Treatment. 
  3. Congressional Hearings shall be scheduled by the House Oversight Committee and the Judiciary Committee to investigate these issues and form a plan for corrective action. 

Background

It's estimated that more than one in three Americans live with Chronic Pain. Approximately 8% experience pain severity that interferes with their ability to function and participate in the activities of daily life most people take for granted; 3% of patients require daily around the clock pain control every 4 hours. There is no single treatment modality that is effective or appropriate for all individuals. Pain management treatment plans have to take into consideration the specific patient's health care needs, as do treatment plans for all other types of illnesses.

Opioid therapy is medically proven to decrease pain intensity and increase function for millions of pain patients. Nonetheless, pain patients are being involuntarily tapered off opioid therapy which often results in a discontinuation of treatment. Disabled individuals are also being forced to choose which medical condition will be left untreated if they have multiple comorbidities that require different classes of medication to manage their health.

Patients reporting pain have sometimes been disbelieved, dismissed, or seen as “drug seeking” for wanting to continue opioid analgesic therapy that has provided relief and maintained or improved function. Patients are also discharged from medical practices based solely on their disability status and/or denied treatment at medical facilities based on their medication regimen. Taking pain medications has become an anathema. Patients are pariahs; accused in pharmacies of being "Drug Seekers" in front of other customers.

Ameliorating a disability with medication was expressly considered by Congress to be a right of disabled people and the person is considered disabled, if the person continues to need the medication to function, but is functional while on the medication. 42 USC §12102(4)(E)(i)(I).

Following reports of severe adverse consequences to patients following the misapplication of the Center for Disease Control Guidelines for Chronic Pain in a Primary Care setting, both the FDA & CDC warned of the harms of continued misapplication of the CDC Guidelines. The warning has had no effect.

In January 2020, the National Council on Disability (NCD) meeting minutes indicate that Opioids for individuals with disabilities was one of the action items discussed. It appears that when COVID hit it was deprioritized and the issue was never readdressed.  The NCD Health Equity Framework released in February, 2022  has no provision for the millions of individuals with pain as a component of their disability.

The Americans With Disabilities Act of 1990, 42 USC Chapter 126 defines a disability as anything that substantially limits a major life activity, including major bodily functions and the performance of various activities such as walking, bending, standing and working. 42 USC §12102.

Pain that substantially interferes with walking, bending, standing, and working, is thus a disability. So is pain that substantially interferes with thinking, sleeping, and brain function. 42 USC §12102(2)(B).

While the DOJ Civil Rights division should be providing assistance when these ADA violations occur and are reported, they have been ignoring the systemic discrimination pain patients are experiencing. We appreciate that the DOJ's OCR has issued Guidance on Protections for People with Opioid Use Disorder under the Americans with Disabilities Act. However, people with pain as a component of their disability are experiencing many of the exact same discriminatory situations and there has been no action taken in spite of this painful disease treatment group  being 10 times larger than the group with Opioid Use Disorder.

Unfortunately, while the DOJ's OCR has failed to act, the DOJ's Criminal Division's activities are fueling these actions by clinicians. The DOJ/Law Enforcement and the Fraud Task Force rely on qlarant data that uses a criteria which is the equivalent of: "Provides treatment based on individual patient health care needs with a risk/benefit analysis and informed consent, or treats patients who live in a health care desert and travels to obtain medical treatment."

Many individuals who travel significant distances for treatment are Rare Painful Disease patients who often have to travel 100's of miles or to another state to locate a clinician who is able to effectively treat their condition. 

Many clinicians are refusing to provide pain treatment to patients who live outside of a specific geographic area to avoid being inappropriately targeted by law enforcement. Unlike when patients travel to obtain specialized medical treatment for any other medical condition, law enforcement agencies are treating  providing pain management treatment to out of state patients as a crime. A 2018 study by the American Academy of Hospice and Palliative Medicine found "Those who apply more liberal legislation and have better medical practice are investigated three to five times more by legal authorities for prescribing morphine to incurable patients than those who do not."

The Drug Enforcement Agency has been repeatedly cautioned that it is inappropriate for DEA officials to apply their subjective definition of legitimate medical treatment in the context of pain management.

New data from the National Survey on Drug Use and Health (NSDUH) provide further evidence to support a counterintuitive conclusion: The dramatic increase in deaths involving prescription analgesics since 2000 cannot be explained by a dramatic increase in misuse or addiction rates, because there was no such increase.  "Nonmedical use of prescription analgesics did not become more common, but it did become more dangerous."  

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