Pre-printed form not enough to document pain medication Rx

A Texas appellate court, in an August 21 decision, upheld a discipline ruling against a physician who had, among other things, documented his patient goals during visits for pain medication by using a pre-printed form to be filled out by those patients, often with only a "Y" or "N" to indicate whether a goal was being met.

(Swate v. Texas Medical Board).

The Texas Medical Board revoked physician Tommy Swate’s license in 2011, alleging that he improperly prescribed pain medications for a number of patients. Swate appealed, and the case eventually rose to the Court of Appeals.

On appeal, Swate argued that the board had incorrectly concluded that he had inadequately documented his treatment of patients. Among the board’s complaints was that, instead of creating and documenting individualized treatment plans for his patients, Swate instead used two pre-printed forms which were filled out by his patients during visits.

The forms contained a list of 16 elements of a treatment plan, including a pain-level section in which the patient rated pain from 1 to 10, and a series of suggested treatment goals, such as “reduce pain,” which the patient was to circle “Y” or “N.”

The board and its expert witness maintained that this system was inadequate, as it lacked Swate’s own stated goals for the patients, as well as a periodic review, by the physician, of progress towards those goals.

Moreover, information on several of these filled-out forms contradicted information in other parts of the patients’ records, including compliance with dosing schedules of pain medications, and several of the forms and other patient records were simply incomplete in many areas.

The court upheld the board’s holding on the issue of adequate treatment documentation, finding that the evidence in the record provided a reasonable basis for the board to conclude that Swate “failed to appropriately document treatment goals, objectives, or progress” for his patients.

“Treatment plans were not documented for every visit,” wrote Justice Cindy Bouchard for the court, “and where they were documented, they were regularly incomplete, inconsistent, or lacking information required by Board rules.”

The court also upheld the board’s finding that Swate, while appearing to monitor his patients’ non-compliance with dosing schedules and other aberrant opioid behavior, nonetheless failed to take any action on those findings. And it rejected several arguments by Swate regarding the board’s treatment of expert witnesses.