Closure of Vancouver Clinic Leaves Hundreds Desperate for Pain Meds

The Payette Pain Clinic in Vancouver, Washington, used to supply about 800 people with pain medication, including, in some cases, extremely high doses of opiate-type pain medication.

The clinic, owned by nurse practitioner Kelly M. Bell, has lost its credentials to prescribe controlled substances, which has left hundreds of opiate-dependent patients in search of a new way to get their medications. Area hospital officials say they can't keep up with patient demand, and area doctors say that they are unwilling, in many cases, to continue prescribing opiates to these patients for fear of malpractice lawsuits.

Many Payette Patients Now Enduring Opiate Withdrawal

According to a series of articles on the OregonLive website, the Washington Department of Health began investigating the Payette Clinic after receiving 41 separate complaints.

Many patients of the Payette Clinie were maintained on very high levels of opiates, and experienced severe withdrawal symptoms due to their inability to receive their medication at the clinic.

One hundred and twenty of these patients were sent to Southwest Washington Medical Center's Interventional Pain Clinic. Christine Gauf, the clinic's director told reporter Laura McVicker of The Columbian that the clinic has been inundated with patients.

Though her staff is trying to provide assistance, "Some [pain patients] will just have to wait," Gauf said in McVicker's April 20 article. "It's going to be months to get through 120 patients."

The dilemma facing doctors who are reviewing patient cases from the disbanded pain clinic is that although these patients are clearly dependent on opiate medications and in chronic pain, some were maintained on such high doses of medication that it would be a medical malpractice to continue treatment with narcotics. Dr. Michael Bernstein, director of Southwest Washington Medical Center’s Department of Behavioral Health, has formed a committee of doctors and specialists to discuss how best to handle the situation.

Kim Manning, whose sister was a patient of the pain clinic, spoke with McVicker about the difficulty of the situation.

Manning's sister suffered from chronic migraine headaches, and while she was a patient of the Payette Clinic, her dosage of morphine gradually increase to 750 mgs -- an amount that doctors say is 10 times the usual dose for a pain patient. Manning told The Columbian  that when her sister could no longer get morphine from the clinic, she went into a withdrawal so severe her organs started failing -- and that even after her sister was  admitted to the hospital and put on a respirator, doctors still would not prescribe opiates to relieve her suffering. "It's just inhumane what she's going through right now," Manning said.

A memo passing between area doctors recommends either suboxone (an addiction treatment medication for opiate dependency) or medical detox protocols for pain patients who meet the criteria for addiction.

Christine Gauf admitted to The Columbian that waiting lists for care are long and that many doctors are reluctant to take on these new patients. Pain treatment is "tricky," she explained. Pain is subjective and personal, but doctors also need to be aware of drug seeking behaviors and addiction.

In 2007, 454 Washington state residents died from overdoses of opiate medications.

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