blitzz1000
02-29-2008, 04:47 PM
This is my first time here, and I am suffering sorry..please bear with me.
I have an L1-L2 spinal fusion...L5-S1 collapsed disc DDD permanant nerve damage, blah..blah..etc..etc..had to resign in Jan 2008 and am in the process of going thru Cobra...
Have (or had..not sure) Pain Management Doc who was prescribing Norco and finally had some glipse of function and real life..fabulous!! After my last Ortho Doc visit, I explained my MRI had not been approved due to insurance lapse due to Cobra...without any warning, I received a VM from Pain Management Doc's Office-Manager explaining no more meds for me until MRI...(4 days ago) I have a physical dependenence (NOT ADDICTION..y'know the diff) and have left at least 4 messages requesting the Doc call me to explain and help me thru this horrible time since I cannot function since my mind is completely confused, body is shutting down, and pain is unreal..any advice?? Is this legal/ethical? And what can I do to get thru pain?? Thank you in advance...
Painful in NJ...
I have an L1-L2 spinal fusion...L5-S1 collapsed disc DDD permanant nerve damage, blah..blah..etc..etc..had to resign in Jan 2008 and am in the process of going thru Cobra...
Have (or had..not sure) Pain Management Doc who was prescribing Norco and finally had some glipse of function and real life..fabulous!! After my last Ortho Doc visit, I explained my MRI had not been approved due to insurance lapse due to Cobra...without any warning, I received a VM from Pain Management Doc's Office-Manager explaining no more meds for me until MRI...(4 days ago) I have a physical dependenence (NOT ADDICTION..y'know the diff) and have left at least 4 messages requesting the Doc call me to explain and help me thru this horrible time since I cannot function since my mind is completely confused, body is shutting down, and pain is unreal..any advice?? Is this legal/ethical? And what can I do to get thru pain?? Thank you in advance...
Painful in NJ...
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brianpain33
02-29-2008, 05:26 PM
blitz:
Welcome to the pain management board and sorry that you have had to come to us for support. I really think this is unreal what this PM doc has done to you. He really owes it to you to call you and explain why you are not able to go on receiving the medication that is helping your pain. I would be thoroughly angry and mad at the situtation and the doctor too. I think that it is definitely negligence although I don't know what the laws are in NJ. He should at least give you enough medication so that you are able to titrate down and not go through horrendous withdrawal which I know all too well because I have been through it. If he does not call you back, then you might have to go back to your PCP if you have one. You would have to explain the situation and ask if he would manage your meds. My PCP is the one that handles and manages my meds. How long have you been with this PM doctor? I can't understand why he would just up and cut you off since your insurance won't pay for an MRI? How uncaring and selfish is that. I am sure others will offer more advice and feedback so keep looking back and know that we are here to offer support whatever happens. I have some things you can do for withdrawal if you need it.
Brian
Welcome to the pain management board and sorry that you have had to come to us for support. I really think this is unreal what this PM doc has done to you. He really owes it to you to call you and explain why you are not able to go on receiving the medication that is helping your pain. I would be thoroughly angry and mad at the situtation and the doctor too. I think that it is definitely negligence although I don't know what the laws are in NJ. He should at least give you enough medication so that you are able to titrate down and not go through horrendous withdrawal which I know all too well because I have been through it. If he does not call you back, then you might have to go back to your PCP if you have one. You would have to explain the situation and ask if he would manage your meds. My PCP is the one that handles and manages my meds. How long have you been with this PM doctor? I can't understand why he would just up and cut you off since your insurance won't pay for an MRI? How uncaring and selfish is that. I am sure others will offer more advice and feedback so keep looking back and know that we are here to offer support whatever happens. I have some things you can do for withdrawal if you need it.
Brian
ozzybug
02-29-2008, 05:43 PM
Blitz-
I join in welcoming you to the community. I am also so sorry you are going through this. I hate to do it, but have to ask some questions so we can get a better idea what your situation is.
I understand your pain issues, but I also have to ask how long you have been with this PM doctor? You mentioned you explained the delay with the MRI, but didn't specify if you explained it to the PM doctor or not. If you did explain it, did you do it in person at an appointment, or via voicemail or leaving a message with the office personnel? If you left a voicemail or a message with the office staff, it could be that your message was thoroughly misunderstood or miscommunicated to the doctor.
Are you on other medications besides the Norco? Also, how long have you been taking the Norco and other meds? Either way, it's horrid if he just dropped you that way because of something you have NO control over.
This is a really bad place to be in, because if you call too many times, it could appear that you are harrassing, BUT your body is dependant on those meds, so we all understand the urgency to get this straightened out ASAP. Not only did they simply drop the script without notice or help, but they are not returning your phone calls. I know you want to speak with the doctor, and because you have no control over the MRI being approved, you shouldn't be punished. I know some doctors actually have rules about how many times you can call about any kind of medication issue. I know of one doctor that will only allow you to call once even if you get the voicemail (which is the case 99.999% of the time). BUT, if the call isn't returned, what is a patient supposed to do? Suffer until their next appointment. This kind of rule only works when you have a human being answering the phone and following up, or at the very least have a human being RETURN a phone call!!
I just kind of get the feeling there is some sort of HUGE misunderstanding here because most doctors won't simply do something like this unless they think you have done something that breaks their rules. I certainly hope that they will return your call so this can be straightened out.
We are all here for you. Please keep us posted.
I join in welcoming you to the community. I am also so sorry you are going through this. I hate to do it, but have to ask some questions so we can get a better idea what your situation is.
I understand your pain issues, but I also have to ask how long you have been with this PM doctor? You mentioned you explained the delay with the MRI, but didn't specify if you explained it to the PM doctor or not. If you did explain it, did you do it in person at an appointment, or via voicemail or leaving a message with the office personnel? If you left a voicemail or a message with the office staff, it could be that your message was thoroughly misunderstood or miscommunicated to the doctor.
Are you on other medications besides the Norco? Also, how long have you been taking the Norco and other meds? Either way, it's horrid if he just dropped you that way because of something you have NO control over.
This is a really bad place to be in, because if you call too many times, it could appear that you are harrassing, BUT your body is dependant on those meds, so we all understand the urgency to get this straightened out ASAP. Not only did they simply drop the script without notice or help, but they are not returning your phone calls. I know you want to speak with the doctor, and because you have no control over the MRI being approved, you shouldn't be punished. I know some doctors actually have rules about how many times you can call about any kind of medication issue. I know of one doctor that will only allow you to call once even if you get the voicemail (which is the case 99.999% of the time). BUT, if the call isn't returned, what is a patient supposed to do? Suffer until their next appointment. This kind of rule only works when you have a human being answering the phone and following up, or at the very least have a human being RETURN a phone call!!
I just kind of get the feeling there is some sort of HUGE misunderstanding here because most doctors won't simply do something like this unless they think you have done something that breaks their rules. I certainly hope that they will return your call so this can be straightened out.
We are all here for you. Please keep us posted.
Executor
02-29-2008, 10:46 PM
What's happening here is that the PM Doc is very, very cautious and unfortunately, you are caught in the middle. I'm not defending the Doc by any means, but he's probably had all kinds of patients who have put off or canceled testing to avoid being busted. So, the Doc has put in a stringent policy, and again, you're caught in the middle of a no tolerance policy. Unfortunately, you've got to bite the bullet and get the MRI and then make a follow up appt and explain the situation.
Again, not defending the Doc, but he's got patients by the dozens who scam and defraud him almost every day, especially if he's a PM Doc.
Good luck.
X
Again, not defending the Doc, but he's got patients by the dozens who scam and defraud him almost every day, especially if he's a PM Doc.
Good luck.
X
sandollar
03-02-2008, 06:59 PM
I hope I am understanding this correctly.
I had a PM and when his office decided not to take my insurance anymore, He had me on the Fentanyl Patch and something else (I forget), anyway, He knew by law, if he saw me he wouldn't get paid, But if he left me high and dry with withdrawals, he could go to jail; So he told me how to wean myself off until I found another PM and then made appts JUST for me to pick up scripts (not to see him) of lower and lower doses until I was off of it.
It seems, until you can get the MRI, the Humane thing to do is help you with lower doses, there HAS to be somekind of law he has to follow. I agree, don't call too much, it makes YOU look bad and you want to make HIM look bad. Can you ask your Pharmacist? Believe it or not, they have LOADS of info, and if he can't do that by law, they will know where to send you to get help with your meds and with your PM.
Good Luck,
Sandollar
I had a PM and when his office decided not to take my insurance anymore, He had me on the Fentanyl Patch and something else (I forget), anyway, He knew by law, if he saw me he wouldn't get paid, But if he left me high and dry with withdrawals, he could go to jail; So he told me how to wean myself off until I found another PM and then made appts JUST for me to pick up scripts (not to see him) of lower and lower doses until I was off of it.
It seems, until you can get the MRI, the Humane thing to do is help you with lower doses, there HAS to be somekind of law he has to follow. I agree, don't call too much, it makes YOU look bad and you want to make HIM look bad. Can you ask your Pharmacist? Believe it or not, they have LOADS of info, and if he can't do that by law, they will know where to send you to get help with your meds and with your PM.
Good Luck,
Sandollar
Shoreline
03-03-2008, 01:51 AM
Although this does seem very cruel and unusual, To think a doc would go to jail for not refilling your medication or dropping anyone as a patient is completely rediclous Sand Dollar. In fact he didn't have to refill your medication at all if your not able to pay for an office visit. You won't die from opiate withdrawal so there is no riskof law suite where you have compensable damages. Simply giving you taper instructions covers his backside against any slap on the wrist he might recieve if you had a legitamate case of patient abondonment for a medical review board to consider, not the police.
Spreading the idea that patients are somehow entitled to a lifelong supply of opiates or continued treatment and the doc has no has no choice about this without fear of breaking a non existant law couldn't be farther from reality. There is no law, regulation or standard of care to suppoort the idea your doc would go to jail if you weren't given the meds you want or feel you need. This sense of entitlement is more than likely going to get you labeled in a negative way than offer anyone any workabale solution to a similar situation. A doc cuts you off and you're going to call the police and say what? I'm sick and my doc won't give me more narcotics unless I pay for an office visist?
Telling you the truth is not an insult or an attack SD, it's just the way it is. Your doc did what he did out of a sense of compasion, not a legal obligation or fear of being arrested.
Blitz, rather than waiting for a phone call that isn't likely going to come, you would be better off making an apt, offering to pay cash and explaining the situation. Cobra will reimburse you for money you spend out of pocket if you make the payment and decide to continue your insurance under Cobra.
Good luck, Dave
Spreading the idea that patients are somehow entitled to a lifelong supply of opiates or continued treatment and the doc has no has no choice about this without fear of breaking a non existant law couldn't be farther from reality. There is no law, regulation or standard of care to suppoort the idea your doc would go to jail if you weren't given the meds you want or feel you need. This sense of entitlement is more than likely going to get you labeled in a negative way than offer anyone any workabale solution to a similar situation. A doc cuts you off and you're going to call the police and say what? I'm sick and my doc won't give me more narcotics unless I pay for an office visist?
Telling you the truth is not an insult or an attack SD, it's just the way it is. Your doc did what he did out of a sense of compasion, not a legal obligation or fear of being arrested.
Blitz, rather than waiting for a phone call that isn't likely going to come, you would be better off making an apt, offering to pay cash and explaining the situation. Cobra will reimburse you for money you spend out of pocket if you make the payment and decide to continue your insurance under Cobra.
Good luck, Dave
sandollar
03-04-2008, 01:34 AM
Dave,
Soooo, Being I was on extemely high doses of Fentanyl and several other Opiates and I go into seizures and something bad happens, there not liable? They can put us on all this and increase our doses and one day just drop us and have no responsability?
He was very nice about it, I agree. And it was scary, I came off very fast and went into seizures with every dose reduction (not fun).
I could of paid for my visits with no problem, it never occured to me, He never offered, he was dropping all Medicare patients. Period.
I never meant I would call the police, I just assumed there was a law or something. That people could have Heart attacks coming off some of this stuff cold turkey. That's pretty scary.
Sandollar
Soooo, Being I was on extemely high doses of Fentanyl and several other Opiates and I go into seizures and something bad happens, there not liable? They can put us on all this and increase our doses and one day just drop us and have no responsability?
He was very nice about it, I agree. And it was scary, I came off very fast and went into seizures with every dose reduction (not fun).
I could of paid for my visits with no problem, it never occured to me, He never offered, he was dropping all Medicare patients. Period.
I never meant I would call the police, I just assumed there was a law or something. That people could have Heart attacks coming off some of this stuff cold turkey. That's pretty scary.
Sandollar
cmpgirl
03-04-2008, 02:29 AM
Hey all: I'm not at all familiar with the legal aspect of this whole situation, but Dave, would you not say that when a physician takes the hypocratic oath, which includes "first do no harm", that there has to be at the very least a question of ethics here?
Is the hypocratic oath something that is considered legal and binding? I guess, as CP patients, we should all try to find this out. I know I'm going to do some research.
It just seems that it happens an awful lot to people who don't deserve to be left hanging by a thread, with the almost certain result being painful and unnecessary withdrawl. It just seems cruel.
Anyway, keeping everyone in my thoughts and prayers..... cmpgirl
Is the hypocratic oath something that is considered legal and binding? I guess, as CP patients, we should all try to find this out. I know I'm going to do some research.
It just seems that it happens an awful lot to people who don't deserve to be left hanging by a thread, with the almost certain result being painful and unnecessary withdrawl. It just seems cruel.
Anyway, keeping everyone in my thoughts and prayers..... cmpgirl
Shoreline
03-04-2008, 11:21 AM
I Totally agree that it's unethical to discontinue someones medication without notice or cause and force them into withdrawal or a detox facility. However, ethical and legal are two entirely different things.
The hypocratic oath does say do no harm, but harm is subject to interpretation by the doc. Most docs would never prescribe these meds or at this dose because they believe the meds themself do harm and making a patient dependnent on these meds is doing harm in their minds. LIke comp girl said, docs do it all the time and there isn't a single doc sitting in jail because he discontinued someones meds. However there are plenty sitting in jail or having their licence revoked for prescribing them wrecklessly.
As far as the risk, we all have a choice to sit at home and ride it out, go to the ER where meds like clonidone can be prescribed, or check into a rehab if someone is actually afraid for their life or wants to be medicaly monitored through the detox phase. But as a rule, discontinuing opiates isn't life threatening and doesn't put one at risk of seizure.
There are other meds that can be life threating, cause seizure or require medical attn if discontinued abruptly. Anti depressants can cause serritonin syndrome, benzo's can cause seizure, but the actual risk of being permanently damaged in some way from opiate withdrawal is minimal to none. My point was to clarify the legal aspect of what has been done. If patients could extort or blackmail a doc once they have become dependent, no doc would risk prescribing these meds.
I don't see any good coming from a debate about the ethics or using opiates or a docs respopnsability when discontinuing them, but people should understand the difference between ethical/moral and legal. That's all. ;)
Take care, Dave
The hypocratic oath does say do no harm, but harm is subject to interpretation by the doc. Most docs would never prescribe these meds or at this dose because they believe the meds themself do harm and making a patient dependnent on these meds is doing harm in their minds. LIke comp girl said, docs do it all the time and there isn't a single doc sitting in jail because he discontinued someones meds. However there are plenty sitting in jail or having their licence revoked for prescribing them wrecklessly.
As far as the risk, we all have a choice to sit at home and ride it out, go to the ER where meds like clonidone can be prescribed, or check into a rehab if someone is actually afraid for their life or wants to be medicaly monitored through the detox phase. But as a rule, discontinuing opiates isn't life threatening and doesn't put one at risk of seizure.
There are other meds that can be life threating, cause seizure or require medical attn if discontinued abruptly. Anti depressants can cause serritonin syndrome, benzo's can cause seizure, but the actual risk of being permanently damaged in some way from opiate withdrawal is minimal to none. My point was to clarify the legal aspect of what has been done. If patients could extort or blackmail a doc once they have become dependent, no doc would risk prescribing these meds.
I don't see any good coming from a debate about the ethics or using opiates or a docs respopnsability when discontinuing them, but people should understand the difference between ethical/moral and legal. That's all. ;)
Take care, Dave
Executor
03-04-2008, 12:05 PM
Shoreline- I think you make some excellent points. It's a very complex issue and in the Docs eyes, they don't see anything wrong with cutting off addicts or diverters, and I have to say that I agree with them.
However, honest, innocent people invariably get caught in the middle of these no tolerance, no exceptions policies. In most cases, I think PM Docs should take it one step further and call the patient in to dismiss them and explain why. This crap of sending a letter or having a nurse call and then refusing to hear from the patient is unethical, I think. Maybe some of the extreme cases would warrant this type of action, but for the others, some type of due process must be realized. I realize that Docs don't want confrontations & etc., but at the same time, if just one person gets to explain what may appear like a different situation, it's worth the time. What's ironic about all of this is that a vast majority of PM patients have very complex and bad problems....Many are also elderly. Just the shear combination of everything makes me believe that at least some people may not think quite clearly or understand everything. Not trying to make excuses, but rather be practical. I don't like a one size fits all policy.
Just my.02.
However, honest, innocent people invariably get caught in the middle of these no tolerance, no exceptions policies. In most cases, I think PM Docs should take it one step further and call the patient in to dismiss them and explain why. This crap of sending a letter or having a nurse call and then refusing to hear from the patient is unethical, I think. Maybe some of the extreme cases would warrant this type of action, but for the others, some type of due process must be realized. I realize that Docs don't want confrontations & etc., but at the same time, if just one person gets to explain what may appear like a different situation, it's worth the time. What's ironic about all of this is that a vast majority of PM patients have very complex and bad problems....Many are also elderly. Just the shear combination of everything makes me believe that at least some people may not think quite clearly or understand everything. Not trying to make excuses, but rather be practical. I don't like a one size fits all policy.
Just my.02.
Fabrashamx
03-04-2008, 10:14 PM
Hi,
Dave is right. opiate withdrawal is not recognized as fatal, and most doctors will cut you off cold if they think you did something shady, I certainly agree that it is cruel to cut some one off with no warning or taper for something like this, or for and reason other than blatant noncomplaince, but they certainly can do it, it happened to me last month, theres a thread on it if you are interested.
Your doctor was a total jerk for not meeting with you and going over your options and at least designing a taper for you, but no law says they must.
This is why I push in so many of my posts for pain patients to try and support a standard of behavior in pain management on both sides, where all of us have rules we know, and dont have to fear quite as much diversity in methods from doctor to doctor.
It will certainly never be a law that pain must be treated with narcotics, but if all doctors who were willing to prescribe had standardized contracts and care plans, and we were organized to know what to expect and what our part in our treatment is, it would help all of us enormously imho.
I am so sorry this happened to you, you didnt deserve it, and hopefully you can find another doctor to help.
Your Friend, Fabby
Dave is right. opiate withdrawal is not recognized as fatal, and most doctors will cut you off cold if they think you did something shady, I certainly agree that it is cruel to cut some one off with no warning or taper for something like this, or for and reason other than blatant noncomplaince, but they certainly can do it, it happened to me last month, theres a thread on it if you are interested.
Your doctor was a total jerk for not meeting with you and going over your options and at least designing a taper for you, but no law says they must.
This is why I push in so many of my posts for pain patients to try and support a standard of behavior in pain management on both sides, where all of us have rules we know, and dont have to fear quite as much diversity in methods from doctor to doctor.
It will certainly never be a law that pain must be treated with narcotics, but if all doctors who were willing to prescribe had standardized contracts and care plans, and we were organized to know what to expect and what our part in our treatment is, it would help all of us enormously imho.
I am so sorry this happened to you, you didnt deserve it, and hopefully you can find another doctor to help.
Your Friend, Fabby
brianpain33
03-04-2008, 10:43 PM
I have had to endure a very fast taper of 40mg/day Oxycontin and 4(5mg) Percocets per day down to 4 Ultracet per day in one week. You talk about going through withdrawal. I thought that I was going to die. I also had to go off of Klonopin in the the same time very quickly and nearly suffered seizures from it. I thought that I was developing parkinson's the way I was twitchin, shaking, and jerking. I couldn't eat, barely drink, vomiting, blah blah blah. I do know that people can die from stopping the benzodiazepines anxiety/pain medications (ie. Klonopin, Xanax, Valium, Ativan, etc.) and go through horrendous withdrawal symptoms from stopping anti-depressant cold turkey which I have also endured. There is nothing like the vertigo and every other step you take it feels like you just fell 3 feet and also the dizziness, lightheadedness, severe depression, suicidal thoughts. It makes you not want to walk. So to go through all 3 at the same time, I honestly don't know how I made it, God willing I guess. The toll that it took on me mentally will last for a long time though. I still have a lot of anger towards the doctors that did it but I know that I was partly to blame as well. Ok thanks for letting me vent.
Brian
Brian
Executor
03-04-2008, 11:44 PM
Brian-
Do you mind sharing why you were forced into such a fast taper? You're right thought.....Those on heavy meds can die!! Heart attack...You name it. It goes waaaaay beyond suffering in my bood.....It's almost like being poisoned.
BTW, I enjoy your posts. You add lots of value to the site.
Ex
Do you mind sharing why you were forced into such a fast taper? You're right thought.....Those on heavy meds can die!! Heart attack...You name it. It goes waaaaay beyond suffering in my bood.....It's almost like being poisoned.
BTW, I enjoy your posts. You add lots of value to the site.
Ex
alcat
03-05-2008, 12:36 PM
Hello-
I too think that your doctor is unethical. Is there any resources in your medical community such as a patient advocate? A lot of times there is also lawyers that can help at little or no cost to you. My husband and I had to seek legal help but "made too much money" for legal aid. We did, however, find someone that cost much less than a typical attorney. If you cannot find someone in your area, try going to legal aid website or call they should be able to give you a list of attorneys that can help at lower cost.
I wonder how your doctor would feel if the rug was yanked out from beneath him??
I too think that your doctor is unethical. Is there any resources in your medical community such as a patient advocate? A lot of times there is also lawyers that can help at little or no cost to you. My husband and I had to seek legal help but "made too much money" for legal aid. We did, however, find someone that cost much less than a typical attorney. If you cannot find someone in your area, try going to legal aid website or call they should be able to give you a list of attorneys that can help at lower cost.
I wonder how your doctor would feel if the rug was yanked out from beneath him??
alcat
03-05-2008, 12:44 PM
Me again,
Yes, I know I'm new, but along with the reply I wrote about legal assistance. I am not trying to imply that you will have a legal leg to stand on, but that it might ease your mind what you can do within legal or patient's rights. Thank you-
Alcat
Yes, I know I'm new, but along with the reply I wrote about legal assistance. I am not trying to imply that you will have a legal leg to stand on, but that it might ease your mind what you can do within legal or patient's rights. Thank you-
Alcat