The state of Washington has recently adopted new rules, or “standards of practice,” relating to pain management that apply to all physicians within the state. These new rules are in response to the rising statistics regarding prescription drug abuse involving opioids, the costs of such medications, a belief that the lack of guidance among physicians is contributing to the drug abuse problem in our society, and the belief that there should be a more coherent approach to pain medicine in the non-cancer, non-palliative setting.
Each governing medical board or commission was delegated to create its own rules. The new rules applying to primary care physicians are codified in WAC 246-919-850 through 246-919-863 and are scheduled to become effective January 2, 20121. Violation of these rules may lead to charges by the Medical Quality Assurance Commission (“MQAC”) for deviation from the standard of care and unprofessional conduct. The rules should be closely read, and protocols and procedures implemented in clinical practice to ensure their observance. It is also important to document instances where the provider elects to deviate from these rules. While the rules state in their preamble that they are not meant to be “inflexible,” and that there may be exceptions to the rules based upon “sound clinical judgment,” there is no doubt that the rules set forth a standard of care meant to be followed. (WAC 246-919-850)
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