Pain Relief Network Sues State of WA



See also:
PRN Files State Tort Claim vs. WA State; L. Cooper
Summary of the Complaint, submitted to the Defendents: 2008/07/08.

Complaint for Declaratory and Injunctive Relief, Damages
a class action lawsuit by Laura Cooper (lead attorney) et al., Filed: 2008-06-24

Exhibit 1: The WA state Opioid Dosing “Guidelines”
by Agency Medical Directors Group (AMDG); Mar. 2007; Filed 2008-06-24

Exhibit 2: Findings of Fact
Laura Cooper, Esq.; Filed 2008-06-24

The nonprofit Pain Relief Network says the guidelines for prescribing narcotics, written by the Washington state Department of Health and published in March 2007, have influenced pain treatment across the country and have made doctors afraid to give opiate prescriptions.

Siobhan Reynolds, president of the Pain Relief Network, says the group decided to target Washington because the state has been a leader both in pain treatment and in restricting doctors’ prescriptions of pain relief medication.

The guidelines, which apply only to treatment of chronic pain, not acute pain, cancer pain or hospice care, recommend a total daily dose of opioids should not exceed 120 milligrams of morphine or its equivalent if both pain and physical function are not improving.

Reynolds said such guidelines do not take into account the needs of individuals and make doctors afraid to give larger doses when necessary.

Laura D. Cooper, a Eugene, Ore., attorney representing Dr. Merle Janes, a board-certified pain specialist, and a (class action) group of Washington residents being treated for pain, compared the prescription guidelines to setting a limit on how much insulin a diabetic could be prescribed.

Although the guidelines apply only to Washington state, they have been used by insurance companies, prisons, worker’s compensation boards and other agencies all over the country as a starting point for their own rules, Cooper said, claiming that Washington’s guidelines have become defacto regulations across the nation.

The lawsuit offers several legal arguments, based on civil rights laws, the Americans With Disabilities Act, and other federal and state laws. It contends Washington’s guidelines violate both state and federal law and should be changed or discarded.

The Washington state attorney general’s office was unable to comment on the lawsuit Wednesday because the lawyers on staff had yet reviewed the case, spokeswoman Janelle Guthrie said.

The medical directors from six state agencies wrote the guidelines as the Agency Medical Directors Group. They are all named in the lawsuit as representatives of their agencies.

Dr. Gary Franklin, chairman of the group and medical director of the state Department of Labor and Industries, explained at the time the guidelines were issued that they were the state’s effort to improve patient care and safety.

Franklin, who is one of the doctors named in the suit, said in a news release there were 32 deaths among injured workers where an accidental overdose of prescription opioids was confirmed between 1996 and 2002.

“Because prolonged, high-dose opioid therapy can be unsafe or can become less effective, we want to provide clear guidance in this area for primary-care providers,” Franklin said.

Reynolds said the guidelines set the interests of ill people against the self-preservation interests of doctors.

“The ramifications are enormous,” Reynolds said. “You never see on a death certificate that people died of pain, but people die of pain all the time.”

This is the Pain Relief Network’s first lawsuit against a state; previous efforts have focused on defending doctors in criminal cases, Reynolds said. The network considers itself Internet-based, and its lawyers are from various states, she added.



  1. So what are we supposed to do now? I bet suicides rise because of this insane, intrusive ,big brother law. I have been in chronic pain for yrs. cant take NSAIDS , Heart problems. Dont know how much longer I can stand the pain.THIS LAW IS INSANE!!!! I am currently on 50 mg of Tramadol 2 times a day. IT IS NOT CUTTING I!!!!

  2. […] wildfire. (Ex. Washington State’s new pain medication prescribing limit of 120 mg per day impacted patients nationwide.) This 30-day policy may be used unofficially by other insurers. Some companies are probably […]

  3. My God!!! Where is the Hippocratic oath and where do we come from on a human perspective when we make judgements on an indescernible thing like someone else's pain? Oh that's right…Washington state….Joy

  4. Is health care ran by the legeslators they dont have there md or title of pain dr &they never went to pain school,&i thot we voted that everything had to be voted apone,or have so much of the senets votes be for any law could be put in place,since that theres alot of laws been passed and we didnt get to vote on them,goverment shudnt trump a doctors field of knowlage?

    unless theres consperacys that they do no more mayb they have cure for cancer they just dont want to cure it or thed lose alot of money,billions on cancer,just like when theres a new thing for gas gas companys pay to keep the new knolage off market by byeing the idea so it cant be used so they dont lose there gas money to the new invention so they pay to keep it off market.same goes now with health care?if there was a cure to cancer they wudnt tell us they make too much money off it,is the goverment becoming dicktators,well this law is crazzzy!

    We have doctors quiting over this,there to scared to work in washington,one dr said washington is the worst state to practice&be a dr.and some are quiting or moving,soon we wont have any pain drs willing to stick there neck out for a patient if washington is charging them years in prision,wud you give out a script if you were threatened with guidlines check ups&prision time if you did,but then theres a oth you take to be a doctor,pretty soon well have no pain drs in washington2of mine left one retired to only nursing home so he can still do wat he thinks is medicaly right,is r goverment going to dicktake everything thats just like having a dictator but we have a group of dictators,i thot we got to vote on everything,why wasnt this put on ballett.or someone go over the consequences of this law first&look at how it would hurt peoples lives first,&the conseqences this law wud have,positives&nagetives,its going to be hard for washington to have doctors now,doctors dont like to be told what to do how did this pass without looking at all kinds of of people&situations.

    its the drs call not the Senate to no how much pain a person can have&regulate what a doctor can do its not fair they dont study pain!How did this go threw without even being brought up in the news or anything this is a big deal!so shouldnt we have none or had a say,or even drs vote or patients, there telling us we have to take meds at store is all we can count on&thats bad for us&one day will be off the shelf like tylinol.i saw that artical were they were taking over the counter pain aids because of something bad,so how cud they not tell patients or doctors about the law&exsaclly what it is&means cause doctors are confused&each have a different way they interperted the law every doctor had there own version of the new law,each was a different one says a pain dr referal of what he wants you on is good cause some pain doctors dont write too they refer it back to doctor&some dr wernt sure it was ok&some did but thats how some pain drs do meds they refer it back to your primary care,but new law pain docs some are still doing it that way when it dont wrk cus primary care cant write over this,

    some i read if its working its ok,some say no,some drs say they have different caculations each different,i didnt no you had to ask that when you made apt really makes you sound bad.ah whats your limit?before i come all the way there&wait for apt& then its no good,strike out start over with referals primary care?they had a limit or they refer it back to you that dont work,so drs&everyone shud no the exsact law&proseadure so your not stuck in lymbo the dr&nurse would no law&no how to get you to write place,but they dont no so they cant tell you makes alot of people stuck not even noing whar to do&they arnt sure what to do either,shudnt put all this on the patient to figure out the laws for the doctors,they dnt no what to tell us i can just go threw more names,

    ive always passed&was good with my meds i never did anything for years weres the credit for that,:-)fed up since january

  5. Ya i have never violated anything all ten years&have had good urine test&i still get that with new pain doctors cus of there caculation.its not fair,can they legaly just not get your regement to you cus of new law!it sure is never a problom to get other meds filled&i havent had a problom in years,how can someone in pain b using it to get high when it just helps pain for people with pain it dnt get us high just barly helps with pain,&just makes us normal day to day,not high,just cus drug addicts are addicted they dnt have pain it helps so it gets them high,pain patients dont get high cus they have legit pain,&we do get a tolorence after years,so i hate just cus u are trying to get your regement they draw to there own conclustion b4 they even see you or no anything about the last ten years that ive had to live&how its been,most dont even ask about pain or whats wrong they just say this is our dose we do,so you do have to dr shop for one like the one i had&understood me&my pain&that i havent raised it in years,they dnt examine or even go over your records,they dont even care they just say what there caculation is dnt it depend on the patient?we dont all have the same pain,&i never did anything wrong to be treated like this new laws treating people,and the longer your on pain medicine the more your tolerance is but i thot threw it all staying at the same dose i was doing good,then u here how someone broke a arm&get what they need but people that really need it cant,i never took meds for a broken arm,shud show my pain tolerance too,:-) no one cares about people in real true pain!i feal bad that everyones having to suffer.theres not a doc ive found to listen&examine you&care,nope they just say what caculation they can do,this is alot of waisted time&money going to dr&pee test pass&then find out they set there own caculation,ive seen pain dr b4 why cant they go off that?alot of waisted insurance money.looking for one that can care for me,ive never did anything not to get my meds,they make it so hard i just want to give up but i no i cudnt live my life w this amount of pain i wudnt b able to do the things i have been,there sending people with no choice but help from hospital that has my history,i have drs names ive been threw them all i cud help people from waisting time cus the dr dnt do pain meds or some refer it to your primary care who cant write over a amount,

  6. You are competly right,ive been able to do things,still in pain,but i dont get a high either its just my regular meds,&having to lower my dose to a caculation,during surgical perceedures they are still doing&refered me back to pain doctor,when a dr says your going to be in pain &not much to do but medicine cus i wasnt a canidate for a stimulator for risk of infection,now when you are crying when a dr says this its not something you like to here&then to make it so difficult for help when theres a caculation&im over that,why dont they take in consideration its helped for ten years,coming down to a caculation certainly wudnt help,why dont they look at your record&history of being on meds and take in account how many years it they think we want to live this was&when you goto a pain dr with a referal they can say they dnt want to see you your to complex,or each pain dr has a different caculation.i read in new law that if medicine was helping&improving your life&its working they cant take you off your normal that case i have old pain dr that says my regements good&i was good for six years so they refered it back to primary care to write&in notes refered back says regement is working,till jan 1st when drs stoped working for patients! If they cud take your pain away without medication&it wud be gone anyone in pain would trade there medication for no pain&a addict wouldnt,they did this to me my health condition was all caused by doctors,they shud help us,found some pain places in washington ive been threw hole list with my doctors that want me to go,there is only 3ive came accross but my research mayb can help someone else.they all still have there own set caculation,you dont even no that tell referal goes,your records&you get apt at the apt they tell you there caculation&im over that&you dont no that tell you get there,they dont like dr shopping&im starting to feal like i am some wont take you cus your a coplicated case,some you dnt no caculation when you get there,some wont take you if you smoke,one didnt want disabled people well arnt disabled people,if you really are,in some kind of pain?how can you not dr shop if they all have different caculations&you dont no tell you finally after waiting get there,y not put how many years its helped on there caculator someone thats took it for 20yrs is different than someone just starting to take it,i sarted on a 100 mcg patch 15yrs ago,9hospitalizations with surgery for breast, masectomy,5lynph nodes removed2x,then a tram flap taking out rectus mussle to breast,20infections&hernias tell finnally harrison sent me to uw,125patch every2days for the last6yrs then uw did a 12hr surgery wriping out infected mesh stuck to bowel&bladder6drs helped with surgery they took it out infected mesh,cut my stomach mussles&slide them like elevator doors,i have5more surgerys to go&havent went up since masectomy with lynph nodes left pain in arm&one with a plate,ive took nothing extra for stomach but i have a 2nd cronic pain i cant stand very long or it feals like my groined/stomach is riping so now i have more pain i have to sit after just brushing hair or shower cant stand that long,now its went into my leg,so i have referal for regular medication i havent found yet&a second pain referal for my stomach,so not only do i need my regular meds pain dr perscribed6yrs ago but help with new pain,a pain dr perscribed it in first place,as of jan first i cant even get regular meds&forget trying to tell them about a second pain,all tho i think ive done great at not increasing my dose for 10yrs ive had125patch hospital said take30mg every2to3hrs after major surgery a uw pain dr inpatient.i need a doctor that will listen not just say i have a limit &not talk to you or examine you just say you take more than our limit&not help with drs verifying i have pain,i cant even get regular regement from a pain dr6yrs ago how do i get my regular meds&talk to a dr about my new pain?how does decreasing my meds going to help?i have to suffer cus theres a dose caculation??? Angie harden1@facebook,or

  7. I understand the concern over opiode usage however, there are people like myself who are in Chronic pain and Tylenol or acupuncture just doesn’t work. I was diagnosed with Rheumatoid Arthritis and have an extremely high blood count & factor. When I have a flair up nothing works except percocette 7.5. I do not abuse drugs. My general practitioner recently left the practice and a new Dr. Took her place, she treated me like I was a drug addict and was drilling me asking if I’d ever had addiction problems, no I have not. She then proceeded to tell me that she was going to start weaning me off them. I told her there is no weaning me off I can stop cold turkey. However, I cannot perform my job duties at work as I’m a waitress & to please give me something else . Sometimes I can barely move my hands & it is very painful to walk all day. I also see a Rheumatologist who has put me on Enbrel, in hopes of remission. My new Dr said well who knows how long it will be before remission occurs. Ok? So I’m supposed to suffer in the meantime? I have no problem with being urine screened etc but to be treated like I am a liar is totally unfair because the drs are afraid to help because of the new law!!! There are people suffering who would never think of abusing drugs. Please find a solution so that people like myself can be helped!! Tena

  8. 9yrs i have been threw alot i had a pain dr for 4yrs my regement for daily living ive been on the same 9yrs ive had a second major surgery that caused cronic pain dr refered my pain meds for my primary care to write of january1st he retiered gave me one mth of meds&said for office to do a pain referal&they told me they were done i wait 2wks no call i goto uw&they never got any referals no pain dr referal after they saidthey were done.we thot pain dr was reviewing a new primary care dr took his place i signed pain contract w him.he said my body is used to more than caculated dose so he cudnt bring me down to caculated dose so he said he cud do my meds.but to cover his but he said to cover his listens he had to write addiction clinic&meanwhile for me to get pain dr he wrote that he said to b able to do my same old scripts tell i cud get into pain dr who perscribes cus hes old&said he wudnt be around forever,as things cudnt get worse i have a heal time of a year&im having surgery march20th,so i go to dr to see why no referals were done to a pain dr&to get my refill they told me he quit&i didnt do anything wrong,no letter,no notice,no 30days of scripts i went from125fentenal patch&breakthrew pain med oxycodone, but not only did he give me no notice,or my med refil that was due i signed a pain contract id b introuble if i did something but i didnt,kitsap medical clinic has left 200people w no dr no meds &no notice&i cant even get a referal done to b able to get my meds.lady said my medical issues are to complex&there bussy,i cant even get referal or 30days of meds im on medicare who can i call to turn them in i cant go w out meds ive had to live w for9years, i trade the pills anyday if they cud fix me but ill have probloms forever i havent even gone up on my dose after9 surgerys&cant move stuck in wheel chair tradethen anyday,but no notice or referal just we cant take everyone on they already did new dr gave a month,i signed pain contract i go in for refil they said he qiuit no referal,no meds,no notice just come get records&names of new primary care numbers so i have to find one get pain referal&go to pain dr apt&hope to get meds.left me with nothing,new laws i guess were can i turn dr inn at?i was abandond with papers from pain specalist w me on same meds it was just refered back to primary care,they no its ok new dr said hed do it tillhe gets me to someone who will&he quits without notice or meds,were can i get help,cost more id think to keep people in hospital&alot of people are going to b left w that as only option&it cost more im calling medicare&you can have referal done to pain dr doesnt mean theyll do it,the uw says there overwelmed every dr is sending people there&they say theycant take on all of washingtons pain people, im abandond any help were to complain about how ive been treated or anyhelp w locating a pain dr&getting my reg meds or help to get referal would b great,or name of lawyer that can help im disabled&need my meds to help me with living no weaning either from dr, wow hu, (360)895-2128 angie frank is caregiver,

  9. Thank God someone is taking a stand for those of us who suffer with chronic pain, something that is grossly misunderstood by anyone who has not lived with the endless, life-altering, debilitating, suffering of day in, day out pain. Medication for us is not a matter of "getting high" or "feeling good", because used correctly, we don't experience that, it is a matter of being able to necessary perform daily functions such as showering, making dinner, going to church, seeing family. Without proper medication, we would be housebound, waiting to die, wishing to die, to end the unbearable pain. This is not a life anyone would choose and has bears no resemblance to the life of a drug addict, unless one has a predisposition for addiction and you abuse the medication, not taking your medication as prescribed, and that can happen, but you can't punish the many for the few. Doctors need to be in control of making appropriate decisions as they were trained to do and as they are the ones seeing the patients first hand, not legislators who have neither training nor access to those who are suffering. The more we strip doctors of their ability to make informed decisions, the further our health care system strays from being a sensible, balanced, working system.

    • grossly misunderstood by anyone who has not lived with the endless, life-altering, debilitating, suffering of day in, day out pain. Medication for us is not a matter of "getting high" or "feeling good", because used correctly, we don't experience that, it is a matter of being able to necessary perform daily functions such as showering, making dinner, going to church, seeing family. Without proper medication, we would be housebound, waiting to die, wishing to die, to end the unbearable pain

      I've said this very thing for a long time now! No one will understand until they themselves suffer this kind of endless pain!