I clearly remember in my nursing career when we all took on the task of adding the “5th vital sign”, the Pain Level of the patient, because Joint Commission required us to do so. Joint Commission is a non-profit agency, which made nearly $13 million in 2015, leaving it with total assets of $147 million, that both inspects hospitals’ performance and sets practice standards for their physicians. Essentially hospitals bend over backwards to follow their standards and meet a good rating during their surveys in order to get reimbursed for care provided to Medicaid and Medicare patients.
In other words, if you don’t do exactly what Joint Commission says in order to pass their surveys and testing, the hospital will go bankrupt from lack of adequate reimbursement for Medicaid and Medicare patients. That’s pretty powerful isn’t it?
In the hospital, the basics of nursing care entail vital signs. The original core vital signs were temperature, heart rate, blood pressure, and respiratory rate. Adding the pain level as a vital sign was first introduced as an idea in the early 90’s. In the early 2000’s, Joint Commission added it as a requirement. This point is when you can mark the turn towards a country now gripped in the throes of an opioid epidemic.
Now being a nurse practitioner with 15 years of NICU experience, I didn’t think anything of it at the time. There were moments in my career where pain control was one of my “hills to die on”. You see, not long ago, it was assumed that infants didn’t feel pain because of their immature nervous systems. Literally, neonates (preterm infants) underwent surgical procedures WITHOUT ANY PAIN CONTROL! Can you believe that?! Eventually it was discovered that neonates actually feel MORE PAIN because of their immature nervous systems, not less! However, at the end of my graduate degree while completing hundreds of hours of clinical hours at the local Children’s Hospital, I remember thinking- Damn! These people sure can addict these babies to drugs in this place. It seemed like half of the babies discharged were on methadone. The other units I had worked in for years, visited, or completed clinical rotations in certainly didn’t discharge babies in the same kind of state.
Fast forward to the summer of 2016 when the American Medical Association (AMA) makes a public statement to remove pain as the 5th vital sign stating that the Joint Commission has set standards for pain management too high, which is leading to the over-prescription of opioids. This, of course, was met with very divided responses. Many applauded the move, however there were many crying out that patients wouldn’t be receiving appropriate pain control without these measures in place. You can read a full synopsis of this statement here.
Moving to November to 2017, it seems as if Joint Commission didn’t have pure motives for their insistence of making pain the 5th vital sign. It has now come to light that Joint Commission has been nothing but financially cozy with pharmaceutical companies regarding this subject the entire time. From providing misinformation to physicians and hospitals downplaying the risks of opioid addiction using published materials by opioid manufacturers themselves, using paid researched backed by pharmaceutical companies to back their claims of low risk, to even allowing the maker of OxyContin to underwrite educational Joint Commission programing, paying for its own events to train hospital physicians about the accreditation standards. Joint Commission continued using Big Pharma’s materials, publications, and marketing to continually push hospitals and providers to treat patients until they were “free from pain”, despite research showing obvious risks to this practice.
While states all over the country have filed lawsuits with various companies in an attempt at holding manufacturers and distributers financially responsible for the financial fall out from a booming opioid addiction crisis, now West Virginia, the state with the highest opioid drug addiction in the entire country, has turned it’s sites on Joint Commission as well. While Attorney Generals of somewhere around 36 states have filed lawsuits against manufacturers and distributors, multiple cities in the state of West Virginia have filed class action lawsuits against Joint Commission. It is likely that many other states will follow suit in this arena as well.
These types of lawsuits are not common, however this kind of move is not unprecedented. States turning on Joint Commission is essentially the equivalent to very successful tobacco litigation. Although these lawsuits are financially driven, and are criticized to not be successful toward a non-profit group in a court of law, most likely these states are aiming for the ability of the hospitals to be able to function without the stringent and seemingly dangerous regulations provided by Joint Commission.
So let’s just take a step back and recap this simply shall we??
- Big Pharma throws money at Joint Commission.
- Joint Commission ensures that pain control is front and center in the hospital system and a main focus on passing surveys.
- Hospitals bend over backwards to abide by the new rules so that they can keep their good ratings and therefore keep their Medicaid/ Medicare Reimbursements.
- Big Pharma then keeps the ball rolling by providing the education Joint Commission uses to spur on the continued opioid use.
- Pain clinics opened up on practically every corner to deal with this new addiction crisis… and to prescribe MORE opioids.
- Millions of people now addicted to opioids causing very poor physical and mental health as never seen before in this country.
- Hospitals, States, Medicaid, and Medicare monies are now tapped dry dealing with this opioid epidemic.
- Big Pharma laughs all the way to the bank.
That about covers it, right?? Now, let’s play the game:
Name the other medical arenas where Big Pharma has been able to pull this off! And, go!!
(There are many mainstream news articles written on this subject. An example can be found here.