Social Impact of Pain group announces that WHO will now classify chronic pain as a disease entity under the new edition of The ICD 11.

https://www.linkedin.com/pulse/social-impact-pain-group-announces-who-now-classify-chronic-mangino

SOCIETAL IMPACT OF PAIN:

The conviction of Doctor Mangino was obtained by convincing jurors that prescribing opioids for chronic pain was to be done only according to The World Health Organization [ and the “Opioid Prescribing Guidelines of The Pennsylvania State Board of Medicine ] “Ladder” of analgesia…which suggested a gradual increase in the dosing of opioids after patients had failed to improve from other medications.

These “Guidelines” of The Pennsylvania State Board of Medicine and WHO, are not “laws” under how Pennsylvania defines the crime of “unlawful prescription.” They are suggestions, with no force in the law. ( in most jurisdictions across the USA ).

There was no evidence presented at trial that Mangino violated any criminal standard for prescribing; which depended on his having specific knowledge that his patients were misusing or selling their opioid pain pills.

The Commonwealth prosecutors spent a lot of time and effort to get their expert witnesses to testify that Mangino could not prove his patients had “chronic” pain…because Mangino relied only on “his” expertise as a pain specialist without ordering all kinds of tests and outside consultations with other specialists.

Comonwealth kept referring to the guidelines and WHO “Ladder.,” to drive home the incorrect message to jurors that Mangino’s patients did not “need” the opioid medications…quoting Mangino’s interview statement claiming he said patients did not “need” medications…but after destroying Mangino’s complete sentence which was hand recorded in the destroyed interview notes–where Mangino stated that once he realized a patient did not need opioids…he “stopped prescribing.”

The point being that it was the WHO “Ladder” which was used to convince jurors that Mangino did not follow a gradual ascendency to his prescibed dosages of narcotics; but that he rather kept the patients on the same dosages they had been getting for over several years prior to coming under Mangino’s care.

In other words…Mangino refused to arbitrarily decrease the patient’s dose of opioids if it was working for them.

Pennsylvania told jurors that was a drug crime !

Even though the European pain societies had been considering classifying chronic pain as its own disease in 2001…long before Mangino was arrested: that information never reached the jury.

Mangino sent his lawyers plenty of medical articles which could have been incorporated into his medical expert’s ( Doctor Forrest Tennant ) report for trial testimony…Tom Leslie, Mangino’s lawyer, never sent the exculpatory-type articles…nor did he bother to insure that Doctor Tennant would forward an Expert Report to support Mangino.

While these articles themselves would have been inadmissible…Mangino’s expert could have made passing reference to them…and they could have been used to impeach the testimony of the Commonwealth experts. But I guess Mister Leslie’s law school failed to teach him that.

Maybe this new classification of pain as a separate disease will help to make trials more fair in the future. It’s a little too late for Doctor Mangino.

Filed under: General Problems