Close this search box.

Oregon Doctor Disciplined For Inadequate Treatment Of Pain

Print Article


Adequate control of pain, especially at the end of life, is a key issue in modern medical care. Increasingly doctors, nurses, patients, family members and advocates realize that death need not be physically painful. The most recent demonstration of that consensus among medical care providers comes from the Oregon Board of Medical Examiners.

Dr. Paul A. Bilder was disciplined last month by the state Board for failing to provide adequate pain control for six of his patients. This may be the first time an American doctor has ever been disciplined for providing too little medication, rather than too much; disciplinary proceedings for overuse of medication are relatively commonplace in medicine.

Dr. Bilder, a pulmonary disease specialist, agreed to the imposition of disciplinary measures rather than undergo a contested proceeding. He acknowledged that his undertreatment of pain “showed unprofessional or dishonorable conduct and gross or repeated acts of negligence. He will be required to complete a one-year peer-review program, visit a psychiatrist regularly and take a course on physician-patient communication.

According to the Board of Medical Examiners, Dr. Bilder failed to provide adequate pain control for at least six of his patients. Specifically, he:

Treated an elderly man who was dying of cancer and in pain with “substantially inadequate amounts of pain medication,” contrary to a hospice nurse’s request for stronger pain drugs and anti-anxiety medication. He also refused a hospice nurse’s request to give the man a urinary catheter. Dr. Bilder told the board he thought the catheter would cause infection. The patient died of his cancer three weeks later.
Ordered removal of a urinary catheter from a dying and incontinent cancer patient, against the wishes of the patient and family. Dr. Bilder told the hospice nurse to use diapers instead. Dr. Bilder ordered a small fraction of the pain medication the hospice nurse suggested, and Tylenol for high fever. He believed the nurse’s request for additional pain drugs was excessive. The patient died that evening.
Stopped giving sedatives and pain medication to a 35-year-old woman with pulmonary disease while she was on a mechanical ventilator at Mercy Medical Center in Roseburg. He ordered a paralytic agent, which relaxes the breathing muscles to accommodate the breathing tube, without the use of sedatives. (Sedatives are often used to combat panic from having the breathing tube in the throat.)
Refused a nurse’s request to give morphine to treat anxiety in a 63-year-old woman with pulmonary disease and diabetes who was put on a ventilator at Mercy Medical Center because of acute respiratory failure.
Refused morphine or other pain medication for a hospitalized 82-year-old patient with congestive heart failure. The patient told a nurse, “I just can’t breathe, and I’m getting tired.” The patient became increasingly agitated, and his breathing and heart rates increased.
Failed to give a 33-year-old pneumonia patient narcotic painkillers or anxiety medication while installing a breathing tube through the patient’s nose. The medical staff made multiple attempts to get the tube in, causing the patient’s nose to bleed. The staff had to restrain the patient to complete the procedure.

The issue of adequate pain control was raised by a national study, published in 1989, showing that more than half of seriously ill and hospitalized patients die in pain. Recently the debate over physician-assisted suicide has pushed doctors to provide better pain control in hopes that patients will be dissuaded from wanting to end their lives.

Stay up to date

Subscribe to our Newsletter to get our takes on some of the situations families, seniors, and individuals with disabilities find themselves in. These posts help guide you in the decision making process and point out helpful tips and nuances to take advantage of. Enter your email below to have our entries sent directly to your inbox!

Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

Famous people's wills

Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.