Doctor will be disciplined for pain treatment
08/13/02
WENDY Y. LAWTON

For the second time, the state's doctor watchdog group plans to discipline a Roseburg doctor for failing to give sick or dying patients enough pain medication.

The original accusations against Dr. Paul A. Bilder caused a national stir in 1999, when the Oregon Board of Medical Examiners became the first in the nation to sanction a doctor for undertreating pain. The case cast a spotlight on a shift in medical practice, scientific research and state policy: Giving too few painkillers is as harmful to patients as giving out too many.

"In Oregon, with Death with Dignity and chronic pain laws, we're pretty tuned into this," said board chairwoman Dr. Marcia Darm. "And I think the medical community in general is more tuned into treating end-of-life pain."

According to a order signed and sent Monday, the board charged Bilder with unprofessional conduct, gross or repeated acts of negligence, and inappropriately prescribing controlled substances.

Bilder, a 57-year-old pulmonary disease specialist, declined comment Monday. His Portland attorney could not be reached.

The board order alleges that Bilder didn't properly treat two dying patients in 1999 and 2000. The investigation was launched after the board sanctioned Bilder the first time.

According to the new charges, one patient had prostate cancer, which put pressure on his spinal cord, making a wheelchair necessary. After surgery, the order states, Bilder treated the man with Tylenol with codeine. Two months later, after the patient complained, Bilder prescribed a morphinelike narcotic.

Later, the order states, Bilder refused to give the patient a urinary catheter and had a confrontation with a hospice nurse about pain medication.

The other patient had chronic pulmonary disease and breast cancer. Doses of narcotic given to the woman weren't sufficient, board records show, and reveal a lack of knowledge about proper prescribing.

Before the board votes on a new round of discipline, Bilder can request a hearing. Options range from a letter of reprimand to a license revocation.

Three years ago, board members disciplined Bilder for similar complaints from six patients treated between 1993 and 1998. Back then, Bilder signed an agreement aimed at improving his practice. Kathleen Haley, the board's executive director, said Bilder met all the requirements, including enrolling in an intensive program in which doctors assess his work and suggest better strategies.

Wendy Lawton: 503-294-5019; wendylawton@news.oregonian.com