Pain Management

Chronic Pain Management: Legal And Medical Aspects With Prescription Drug Abuse Prevention

Prescription Drug Abuse Prevention

Prescription Drug Abuse has different effects depending on the severity of the abuse. As such, prescription drug abuse prevention needs to be flexible to deal with this changing severity. Christensen Law is well-versed in healthcare laws of Oklahoma and the history behind chronic pain management. Here’s an article we wrote to explain a little more about this tricky subject.

Written by: Blake Christensen, DO, Adam W. Christensen, JD, MBA, S. Sandy Sanbar, MD, PhD, JD, D. Wade Christensen, JD, J. Clay Christensen, JD, L. Nazette Zuhdi, JD, LLM, Oklahoma City

Controlled substances prescription abuse has been reported to be the fastest growing drug problem in the United States. Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined.* And, for every unintentional overdose death related to an opioid analgesic, nine persons are admitted for substance abuse treatment. In 1914, the Harrison Narcotic Tax Act was the first narcotics law that prohibited doctors from prescribing opioids to addicts. In 1970, the Controlled Substances Act replaced the Harrison Act as the federal U.S. drug policy under which manufacture, importation, possession, use and distribution of certain substances is regulated. In 2005, President George Bush promoted quality pain relief with accountability by signing NASPER (National All Schedules Prescription Electronic Reporting) into law. NASPER was designed to improve patient access and prevent “doctor shopping” and drug diversion.**

In 2007, the Food and Drug Administration Amendments of 2007 gave the FDA the authority to require a Risk Evaluation and Mitigation Strategy (REMS) from manufacturers to ensure the benefits of a drug outweighed its risks through education of providers and the public. In 2009, the FDA announced a “Safe Use Initiative,” a program aimed at decreasing the likelihood of preventable harm from medication use. Finally, in 2011, President Barack Obama’s administration unveiled a Prescription Drug Abuse Prevention Plan, which focuses on four major areas: education, monitoring, enforcement, and disposal. There are also state laws, rules, policies and guidelines that address proper pain management.

The means of narcotic control is found within the federal and state laws currently in place, together with a three step-wise methodological approach to treatment from providers according to their trained skill set.***

1. The first modality is via prevention, patient education and screening. Primary care physicians and other interdisciplinary care providers play a vital role in effective treatment of chronic pain. The chronic-pain patients receiving treatment in this modality are typically the least physically and psychologically impaired. The physician should follow all existing regulations and evidence-based guidelines while having an individualized treatment plan for each patient. This level is typically the most cost-effective modality of treatment for the patient. It is also the modality where most of the laws governing controlled substances apply.

2. The second modality involves physicians who are board-certified in interventional pain management. The patients in this category are complex and display little or no progress using more conservative treatment. Interventional pain procedures can involve high-risk procedures and should only be provided by designated board-certified specialists when stringent objective medical criteria are met. These patients will often require an interdisciplinary care team and manager. They may need the help of a board-certified surgical specialist.

3. The third modality of treatment involves patients with the most physical and psychological impairment. It requires an interdisciplinary team. Psychiatric counseling may be beneficial. The patient should understand all facets of the ailment, have the support of family and friends, and have an established care team manager and interdisciplinary care team. Families need to be good reporters about the patient.

Treatment should focus on ways to manage the disease. The practice of medicine and pain management is based on patient care within the confines of the law. The law protects society from the dangers of narcotic abuse. Public policy exists to protect the public. The crux of the patient, physician, lawmaker, and public interests lies in the efficacy of information exchange. By having a well informed society, effective pain management may be achieved and laws may be understood and followed. Through information exchange of all modalities and the public, a balance may be found between drug control and drug availability.

Prescription drug abuse prevention is the frontline tactic versus the fastest growing drug problem in America. If you have any questions about the legal side of prescription drug abuse, the lawyers at Christensen Law in OKC can help.

* http://www.cdc.gov/nchs/nvss.htm

**http://www.asipp.org/NASPER.htm

*** http://www.healthleadersmedia.com/HOM-75466-4625/Tiered-approachto-chronic-pain-targets-suffering

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Telemedicine: Law and Medicine

Telemedicine: Medical-Legal Aspects

Telemedicine article written by: Adam W. Christensen, JD, MBA, Blake D. Christensen, DO, Nazette Zuhdi, JD, LLM, Jonathon M. Miles, JD, Adrian Maurer, MD, S. Sandy Sanbar, MD, PhD, JD

Of all the professions one could think of to associate with the word precise many would probably list medicine and law among their top associations. It’s important to know what you’re talking about when it comes to these professions, doubly so when the two professions meet. To show that the lawyers at Christensen Law in OKC know their stuff, below we have an article on telemedicine written by Adam W. Christensen for Bulletin.

Telemedicine has come of age both nationally and internationally. In 1997, the Oklahoma Telemedicine Act (OTA) was passed. The OTA states that all health care service plans, disability insurer programs, workers’ compensation programs, or state Medicaid managed care program contracts are to include coverage for telemedicine services, where appropriate, as determined by a health care provider*.

Telemedicine is broadly defined under the OTA as the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education by means of audio, video, or data communications**. It encompasses such issues as emails, physician-patient communications and transfer of patient medical information from clinic to clinic and facility to facility. Telemedicine has demonstrated its potential to offer widespread access to medical care while at the same time reducing health care costs. Doctors can conduct video consultations with others in the same state, in other states and abroad. Telemedicine, however, does not include consultations provided by telephone or fax machine. There is no universal law of telemedicine. States take significantly different approaches to regulating it. Indeed there are many regulatory and legal issues to consider when developing a mobile app that involves exchange of healthcare information, an online health and wellness platform involving healthcare data, or another telemedicine or telehealth project. Regulatory and legal issues include:

• Privacy and Confidentiality

Informed Consent

Malpractice Due To Equipment Failure and General Liability Principles

Jurisdiction and Registration, Jurisdiction and Liability

Malpractice Liability, Negligence, Duty of Care, Standard of Care, and Negligence for Not Using Telemedicine Regulation of Telemedicine and Telehealth by State, Licensing, and Professional Disciplines

Ethical Constraints in a Given Profession (such as medicine, psychology, psychiatry, or counseling)

Insurance Issues Including Insurance Fraud, Billing and Coding, Medicare and Medicaid Fraud/Abuse, FeeSplitting, Kickback Law and Stark, and Healthcare Fraud.

Giving information on the Internet regarding generic health care conditions is legally permissible. However, giving information tailored to a specific patient, considered as diagnosis and treatment of a medical condition, is controlled by the medical licensing statutes. Telemedicine providers who don’t recognize the differences may run afoul of current law and regulation.

In Oklahoma, the health care practitioner who is in physical contact with the patient has the ultimate authority over the care of the patient and needs to obtain informed consent from the patient. If the patient wishes to utilize telemedicine, a detailed explanation of the risks and benefits and potential privacy concerns must be discussed. Telemedicine in Oklahoma is not centralized, but primarily offered through collaborative telemedicine networks and individual providers. Oklahoma supports telemedicine through the state’s high speed intrastate network, OneNet.

One thing is for certain: telemedicine is evolving and will enhance the physician’s ability to deliver medical care. Rural hospitals, not-for-profit hospitals, public health departments, correctional and military facilities and people involved in emergency response situations like the May 20, 2013, tornado, all have need for the utilization of telemedicine.

A fully developed and sophisticated communications infrastructure is needed to transport telemedicine information. However, this infrastructure is absent in many of the area’s most in need. Perhaps in the future, there will be ways to fund the telecommunications infrastructure and site equipment. The good news is the technology is here. Perhaps political forces will team up to find ways to fund the use of telemedicine and eliminate the barriers that are stunting its growth.

Telemedicine can be a powerful tool, but the restrictions on its use are currently governed state-to-state. If you’re in Oklahoma and have any questions about how your state regulates telemedicines; the lawyers at Christensen Law in OKC can help you get the most out of this powerful tool.

*§36-6803. Added by Laws 1997, c. 209, §1, eff. July 1, 1997
** §36-6802. Added by Laws 1997, c. 209, §1, eff. July 1, 1997

Christensen Law- Physicians

Physicians : Plan Well. Live Well.

5 Factors Of Retirement For Physicians 

Doctors are a certainly very special breed. They work long hours, get very little sleep, and endure heartbreaking loss. Doctors spend their entire careers helping others and saving lives, therefore; whenever one retires we know they very well earned it. When one retires, what they may not realize is that there are a few things, in addition to the normal pitfalls, that can hamstring their retirement needs. Christensen Law is here to give some advice on what some of these pitfalls are and what doctors should do. Let’s start with an example:

Dr. Hood is 55 years of age with dreams of retiring when he is 65 and switching from practicing medicine to enjoying golf full-time. Will he be able to fulfill his dream? What issues must Dr. Hood consider now to be able to retire in ten years?

Nearly half of practicing physicians are older than 50 and approaching retirement. Unlike most other professionals, physicians should consider additional factors when planning for retirement. These five main factors are:

1. Retirement Number. Has the physician accumulated sufficient liquid savings to reach his or her proverbial retirement “number”? The “number” is the amount of savings a physician needs to maintain a desired standard of living in retirement. The proper time to set up a plan is as early as possible to capture the benefits of compounding in tax deferred accounts. If Dr. Hood does not already have a plan in place, now is the time to set up a comprehensive investment plan to reach that retirement number.

2. Succession Planning. Physicians must consider their practice exit strategy and plan their transition into retirement with the best chance of success for their patients and themselves. Strategies will differ between physicians based upon personal preferences and whether a physician is a solo practitioner or a member of a group of physicians.

3. Asset Protection. Physicians are subject to claims of malpractice and ensuing lawsuits. Asset protection is critically important. Physicians should seek advice from a licensed attorney regarding the proper use of LLCs, PLLCs, family limited partnerships, irrevocable trusts, offshore trusts, etc. These business vehicles are also useful when transferring ownership of a professional practice.

4. Accident Planning. This begins with sufficient malpractice insurance. There are two major types of malpractice coverage: occurrence-based and claims made. Occurrence-based policies protect a physician while the policy is in effect, no matter when the claim is made. Claims-made policies cover only claims made during the term of the policy and require tail coverage when the policy ends. Other insurance considerations include life and disability insurance and an adequate umbrella policy.

5. Tax Considerations. This over-arching factor should be considered concurrently with the previous four factors and requires the advice of a tax savvy CPA and/or attorney. Successful financial planning for life events and retirement requires not only the accumulation of assets, but also the protection of assets earned during the course of a physician’s career.

It is never too early to examine and implement the five factors presented in this article. The physician’s team should consist of a financial advisor for factors one, two, and possibly three and four; an attorney for factors two and three; a licensed insurance broker for factor four; and, a CPA or tax attorney for factor five. It is important for the advisor, attorney and CPA to work together to ensure all recommendations are consistent with the physician’s personal goals and objectives.

If you’re a doctor looking to retire soon, let the lawyers at Christensen Law in OKC help make sure you have everything on order.

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State Question 777: A Compelling Reason To Vote YES


Why Vote Yes For SQ 777

There are many reasons to vote in November, including one of the least understood, but most crucial pieces of legislation relating to Oklahoma’s agriculture: State Question 777.  It is important to know that this proposed constitutional amendment was drafted by rural Oklahomans for the benefit of ALL Oklahomans and the land we call home. YOUR elected representatives, both Urban and Rural Senators and Representatives, overwhelming passed this proposal by a vote of 124-13.  This is a non-partisan, non-political proposal where the sole interest is to protect Oklahoma’s agriculture.  It is about making sure that Oklahoma encourages and protects all Oklahoma farmers and ranchers while enabling them to continue to have the ability to provide for their families in their chosen line of work and deliver quality, safe and affordable food to fellow Oklahomans and those around the world. S.Q. 777 is designed to benefit Oklahoma farmers and ranchers, whether full-time, part-time or even gardeners and hobbyists.

The actual amendment in full states, Section 38. “To protect agriculture as a vital sector of Oklahoma’s economy, which provides food, energy, health benefits, and security and is the foundation and stabilizing force of Oklahoma’s economy, the rights of citizens and lawful residents of Oklahoma to engage in farming and ranching practices shall be forever guaranteed in this state. The Legislature shall pass no law which abridges the right of citizens and lawful residents of Oklahoma to employ agricultural technology and livestock production and ranching practices without a compelling state interest. Nothing in this section shall be construed to modify any provision of common law or statutes relating to trespass, eminent domain, dominance of mineral interests, easements, rights of way or any other property rights. Nothing in this section shall be construed to modify or affect any statute or ordinance enacted by the Legislature or any political subdivision prior to December 31, 2014.”

Through the commercials and speeches, there is often much “political spin.”  Casting politics aside, what does this proposal really do and not do?

This proposal:
1. does NOT open the door to foreign ownership of agricultural land. (Constitutionally prohibited)
2. does NOT de-regulate puppy mills.  (Statutorily regulated)
3. does NOT legalize cock fighting.  (Statutorily prohibited)
4. does NOT change a single law currently in effect.
5. does NOT pollute our water or change a single water law.
6. does NOT prohibit additional laws to protect our water.
7. does NOT give agriculture any new freedoms.
8. does NOT affect county or municipal laws in any way. (legislative specific language)
9. does NOT allow for any anti-agriculture regulation without a compelling state interest, similar to the constitutional protections that rodeo, hunting and fishing currently have in Oklahoma.

This proposal:
1. does continue to provide for freedom of food choice.
2. does still provide for Oklahomans to make sure our food is safe and our water is protected; farmers and ranchers are the original Stewards of the Land.
3. does help to protect Oklahoma jobs, which is vital to our economy.
4. does protect Oklahoma farmers and ranchers from future adverse legislation from out of state special interest groups that do not care about Oklahomans or their values.
5. does help to continue to encourage future generations of agriculturists to become involved in agriculture by protecting Oklahoma rural values.
6. does restrict harmful, unscientific legislation that does not promote a compelling state interest from being passed by either political party.

Everything in this state question is intended to be in the best interest for all Oklahomans. However, this State Question is garnering a great amount of adverse, political publicity from several special interest groups. Oklahomans must remember, this is about Oklahoma, our food source and our farmers and ranchers, not political out-of-state special interest groups.

Vote YES, to support your local farmers, ranchers and all Oklahomans who enjoy a healthy meal.


Wade Christensen is a fourth generation farmer and rancher from Thomas, Oklahoma and managing Director of Christensen Law in Oklahoma City.  He has served as Chairman of the National Governors Spouses Leadership Committee.  While serving as Chairman, his National platform was entitled “America’s Farms: Feeding and Strengthening Communities.” Christensen highlighted the important role farming and ranching play in providing a safe and healthy food source in the U.S and throughout the world.  He also highlighted the importance of the agricultural sector to the U.S. economy, national security and public health. Oklahoman and American culture celebrates farming and ranching as an important part of our history, but sometimes we don’t remember how important it is to our economy and our way of life today. Whether it is childhood obesity or global hunger, farmers and ranchers are helping to address some of the great issues of our times.