Introduction: L. Jean Dunegan, MD, JD, FCLM

Thank you very much, good afternoon everyone. It's my pleasure to join this distinguished group of panelists. I am a board certified general surgeon and an attorney barred to practice law in my home state of Michigan. My interests lie in the legal and ethical issues in pain treatment as they relate to risk management in the health care setting. I am especially intrigued by the newest clash of law and medicine, as the war on drugs meets mandated pain management.

Now from a surgeon's perspective I have a passion to promote critical pathways for fast tracking surgical patients for early discharge after major operation. These pathways were developed some three years ago and as they've become implemented across the nation the key to successful outcomes has been identified as having everything to do with adequate pain management. That is to say it's a smooth transition for pain care across the perioperative phases in the pre-, intra- and post-op period.

If we carry that out by a team of professionals, then the surgical stress response is minimized in each patient, and their discharge and rehabilitation is much more quickly achieved. As the standard for pain management improves in quality and outcomes are shown to be directly related to optimal pain care, I predict that an emerging liability issue will be failure to adequately treat pain resulting in less than acceptable rehabilitation.

Now from an attorney's perspective, there are very good reasons why pain management was mandated. In order to solve the burden we now have of untreated pain across our nation. This is a burden not just for the sufferer, but for the nation as a whole. There is also liability for not adequately assessing and managing pain, not just from a licensing standpoint but also in the court systems as well. And I hope Dr. Sinatra just to discuss these as we go along today.