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Patients with devastating chronic pain caused by motor vehicle accidents, work related injuries, cancer and chronic diseases are living in dread. Pain control specialist, Dr Frank Adams has been sentenced by the College of Physicians and Surgeons of Ontario (CPSO) in July because of "incompetence."

Dr Adams is a pain management expert, neuropsychia-trist and pain researcher. He has achieved outstanding results with complex and difficult cases and is highly respected by his peers.

The outcome of this "test case' is expected to intimidate other physicians from using or considering a number of scientifically-sound and internationally-recognized pain control techniques that have enabled thousands of chronic pain victims to reclaim their lives.

The CPSO's disciplinary panel has stated that "patient outcome [of the sentence] is not relevant." In the College's processes, physicians are judged not on positive patient outcome, but on maintaining the (unwritten) standard of practice of the profession as arbitrarily interpreted by peers of the college's choosing. Thus the machinery of the discipline process against one physician can be used to choke off safe and effective emerging approaches that should be given even-handed consideration in ongoing professional discussions and research.

The lack of adequate pain control and the scarcity of physicians knowledgeable in this area are major failings in health care in Canada, as discussed in the June 2000 report of the Senate Committee chaired by Senator Sharon Carstairs.

Dr Adams played a central role in influencing pain control guidelines adopted by the US National Institute of Health, the American Federation of State Board Examiners (counterpart of Colleges of Physicians in Canada), Mount Sinai School of Medicine (New York City), Texas State Board of Medical Examiners and the World Health Organization. These guidelines specify that patient outcome is a crucial criterion. The case against Dr Adams isn't based on a patient being harmed or on patient complaints. In fact, he was convicted on the basis of case histories that related excellent medical outcomes.

The College's own actions show a number of shocking improprieties and misuses of power. Although it chose to investigate on the basis of "reasonable and probable" grounds, the College has not given Dr Adams legally mandatory disclosure of what those grounds were. Neither Dr Adams, nor the patients whose files were reviewed, were interviewed during the investigation. Even the College's only expert witness did not recommend a conviction of "incompetence," nevertheless the discipline panel found Dr Adams guilty. The penalty may be loss of licence or a severe limitation on his licence, which could prevent him from using techniques his patients desperately need.

Since the College has already imposed some limitations on Dr Adams during the disciplinary process, a number of patients have already endured hardship. The College's action in a number of other discipline cases has aroused public concern about a pattern of serious procedural improprieties, misuse or abuse of power and the future implications for health care in Ontario.

Medicine is a self-governing profession. The Regulated Health Professions Act specifies that it is the duty of the Minister of Health to ensure that the profession is regulated and coordinated in the public interest, that appropriate standards are developed and maintained and that the intent of the Act is carried out.

Source: alive #216, October 2000