I just need to reach out and see if anyone has had an experience like the one I had today. I've said before that I'm a former clinician so I think I'm familiar with the health care system - and I know that we all sign contracts with our PM docs - I signed mine and read it very carefully and thought I understood it. Well, I guess I didn't. You see, last week in the middle of the night - you know that time when the rest of the house is sleeping and we are creeping around trying to be quiet and pretend to sleep - I managed to kick a chair with my bad leg/foot. Well, I did everything I could to keep the flare down and quiet my leg down but by the next evening when my entire leg was purple and my pain level was still a 10 I decided (with the "help" of my significant other telling me he was carrying me screaming if I didn't play nicely) to go to the ER. We get there and the local doctor actually knew quite a bit about RSD/CRPS and gave me a cocktail of medications that took my pain down to a 5 - given that I'm hardly ever less than a 7 I promptly asked him if he'd marry me and he said that he was happily married but he gave me his business card with his personal cell phone number and said that if/when I had similar problems that he would be happy to help me in the future. As I was literally praying and thanking God for such a wonderful doctor and my significant other was telling me that he was being thankful that he hadn't been thrown to the curb - we took all of the paperwork from the visit and made sure to ask that it be faxed to my PM so that she would have a copy when I saw her on my visit today. Well, fast forward to today. It was my 3rd visit to her (new doctor obviously and I thought she was going to be soooo wonderful) She basically stormed into the exam room with a new copy of the pain contract and told me that I had violated the contract, that there were other PM docs in the area and that we had a trust relationship that I had violated. She had me reread the entire contract again - all of it - right in front of her - out loud - and initial/sign it - to make sure that I understood all of it - and then she made me sign a letter of warning. It seems that I'm not allowed to go to the ER for pain. That even with breakthrough pain I am not allowed to go to the ER - she is to control all of my pain and if I allow the ER to give me ANY opioid medications that I am breaking the contract (it does not say that in the contract anywhere). She said that the only acceptable reason for me to have gone to the ER would have been if I had suspected I had broken my toe/foot/leg - and then they could have given me medication. Well, we all know that they would not have given me opioid medications for that and a broken toe does not warrant a trip to the ER. I did not argue with her as I was afraid that she would not fill my scripts for the month if I did. I just don't know what to do. I'm work comp - I fought for MONTHS to be allowed to switch to this doctor - I was told how wonderful she is - I have no idea what happened today. I've never violated my contract to my knowledge - and I wouldn't think that being at a 10+ out of 10 for over 24 hours and going to the ER is a violation. I have no way to reach her for emergency care - and she has no plan in place to allow her patients to reach her. I've had an excellent physician who did allow for emergency on-call access - I have never abused such a thing as I've been an on call clinician before. I just don't know what to do. Have any of you been through anything like this? She made me break down and feel violated in her office today and she seemed proud of it and not to care at all that I was as upset as I was - I'm usually a very strong person - but today I just lost it. She was totally unwilling to discuss any of my concerns or anything about my reason for my visit today other than the contract and than to refill just my primary medications. She told me that the rest of my medications I will just have to go and see my PCP for - knowing that I don't have health insurance and that this will cost me a lot of money. I also had gotten a verbal OK from my work comp people to go ahead and start the process of getting the SCS removal started - but she won't even discuss that until they give it to her on official letterhead as well as to continue my group pain therapy sessions which had stopped - they had given it to me verbally and I had taken the precaution of getting it via email which I had printed out - so now there's at least another month delay that is being caused because she wouldn't discuss something with me that could have been validated with a simple phone call. I just don't know what to do. Does anyone have any advice? Has anyone else gone through anything like this? Has anyone else had a contract like this that limits even ER visits? I've just never heard of anything like this. Any advice or support would really be appreciated - I just don't know what to do and that doesn't happen very often. Thank you for listening to me babble and whine for so long - and I'm sorry for venting - it's been a tough summer and today just made the rest of it look like a cake walk. I sure hope that all of the rest of you are doing well and that you are having good days. Take Care,
All the pain clinics in this area tell you to go to the ER for flares like that as they don't do emergent care, otherwise they'd never get any sleep. I've gone at least 7-8 times since mine can't put the stimulator he wants to in me because I'm too anxious (and I won't let him). I had to have the ER call his office during business hours and verify they sent me there. He told the ER guy I needed a stimulator. The day after he told me he wouldn't do it. I've never had a problem with the contract and going to the ER. I just call and let them know where I went, what they gave me and if it helped and I have the worst pain mismanagement doctor in the world.
They have an on call service, but only if you go to the right ER and the doctor calls.
As for ER horror stories, consider yourself lucky you got anything...long rant follows....
I've been to the ER that will call his service, they are the ones that caused this, had one doctor keep smacking my leg and telling me there was no way that hurt and I needed to see my primary care doctor. (I was having problems with the medication from the primary care, it was giving me sickening headaches and the only thing you can take with it is Tylenol which I am oh so conveniently allergic to) I tried to tell him I couldn't get in to see him and got tossed out and told I was drug seeking, went another time, got a shot and sent home, went a third time and was basically given prescription benadryl for the pain, and called a drug addict, another time they gave me dilaudid, which was fine until it wore off and the pain was worse than before, I called the ER and they gave me the number of the service, the lady told me to take an extra morphine or two and call in an hour, I took one and didn't help much and called back to be sure about the 5th one since I wasn't sure if this was breaking my contract. I went a couple other times and had no problem.
I went to their sister hospital's ER and other than the wait times which I can no longer endure had no problem ever.
Went to the other hospital on my plan and really want to find a lawyer to sue them for discrimination. The first two visits were fine other than no armband and I had to ask what they were giving me.
The last time I went was because I had fallen 20-30 times in 2 days and couldn't take more than 5 steps without falling. I was asked how come my insurance had changed (one company bought another) and how I had insurance without a job (COBRA) then tossed in a bed, allowed to use a bedpan once, a doctor poked at my back and asked me what my doctor's plan was. I told her I don't know, he canceled yesterday. Then she tried to get me to their pain clinic. I'd already been there and their doctor yelled atme saying I couldn't possibly have this from the Levaquin causing tendinitis, that doesn't happen (watch tv dumb @$$, class actions suits everywhere) and said he "might" take me on if I saw his psychiatrist who turned out to be a psychologist which I already have. (Basically another you're crazy verdict) I wasn't giving the psycholotist I had up for a guy that "might" treat me. So I couldn't be seen by their PM since the doctor she'd refer me to was the original guy's partner and they'd just compare notes. She left (refused to take x-rays or anything, I thought I might have cracked a vertebra and had something pinching the spinal cord or something to explain the rise in amount of falls) and the nurses were looking into putting me into a nursing home for the weekend. The person with me had to ask if I could take medications since they wouldn't answer a call button, they said sure, never came in to see what I took or bring water, this happened twice. I had to crawl to the bathroom since they wouldn't answer the call button another nurse as well as mine saw this and I was told to go back and someone would be with me, I told the other nurse apparently not since they couldn't answer a call button and then went into a 4 day flare and I'm still trying to get back to normal. I started hyperventilating and still no answer from the call button or my friend telling them I was having problems breathing. I then started screaming and they magically appeared. Their "social worker" came in and I got told to drive myself to the Mayo clinic since they weren't going to treat me there, started with the whole do you believe in God speech, got told to stop the pity party, she'd had back pain and pulled herself up because she had kids to raise. The doctor never came to check, after screaming to be released and waiting another hour while they decided no nursing home because I'd just get sent back to them, I was told by the nurse that I was a drug addict and needed a better plan than driving around to all the hospitals since she'd heard I'd been at the other hospital (the one with the long waiting lines) last week looking for drugs, which I hadn't. I'd told the doctor I didn't go there that night because of the wait and my pain and this nurse took it upon herself to "manage" my care. I'm now fighting with my insurance company for $400 of charges for their "care" since I should have seen my primary care guy, to top it off, their "social worker" was their head nurse.
Sorry for the long rant, but I want a bill of ER rights, I carry a note from my PM doctor saying I'm not abusing, a cut out of a magazine explaining what RSD is, and bring all bottles with me to the ER every time, not the actions of a drug seeker. I'm sick of nasty nurses in a foul mood deciding I'm an addict. Just because I have a prescription for morphine does not make me a drug addict or seeker, I already have the drugs, they aren't working!!!
I'm scared to return to the last hospital and don't think I'll be treated anywhere else as I'm sure I've been put on the "list" so basically if I break anything I'm going to have to call the primary care guy, explain to his nurse what is going on and wait 2-3 weeks for attention.
Sorry for the long rant about the ER here but I really wish someone would do something about their attitudes. I've complained and nothing is getting done.
I have never in all my life heard something as batty as that!!! For her to scream about violation of the pm contract, for you to have actually violated said contract, it HAS to say in the contract something like, "In the event of breakthrough or uncontrollable pain, you will not go to the emergency room for medications. You must call the pain management doctor's office and leave a message detailing your problem and someone will get back with you during the next business day. The emergency room will not be used by you for any reason except in an emergency, eg heart attack, stroke, broken bone, stitches, etc. If you go for anything not considered an emergency you will be in violation."
:-D Aren't I good at legal sounding mumbo-jumbo? ROFL
Anywho, I know pain contracts state that you cannot go doctor shopping, you can't get any pain meds from another doctor. The latter does not extend to the emergency room! Of course you should notify the pm of a trip to said er and all, but she totally lost it. She was in the wrong and can't possibly uphold a justified violation of the contract. You can't uphold something that it does not say and does not exist.
With all that said, I'm not sure what you should do about it. It doesn't sound as if talking to her and saying, "Nowhere in this contract does it state that I am in violation of my contract if I go to the ER for (reason) and if it does say that, please point out where."
Actually, you need to contact your lawyer and inform him/her of what happened immediately. Your lawyer is the one who might be able to do something. Other than that, I can't think of anything you could do.
See Karen agrees with me (happy dance) LOL. I have "doctor shopped" I've seen everyone on my plan and that wasn't even a violation as long as I didn't get drugs or prescriptions from them. (Which I haven't) I have hated my guy since the third visit and have been desperate to find someone else. But he's the "big dog" around here is all I ever get told and to stay with him.
First of all, her behavior was completely unprofessional and heartless..If she had an issue to discuss with you she should have done it in a rational, calm manner, not like a bear with PMS....
Since she makes herself unavailabe, and you were in terrible pain I would have like to know what HER strategy would have been!!!!
I hope you have an attorney to help you out with this WC challenge!!!
The relationship you have with her is now tainted and the trust level you have in her as a healer is probably gone.....I know how disappointing it is when you hear great things about a doc, and it turns out to be no so.....
She had no reason to flip out like that..where is her compassion!!
Please get help from an advocate to figure out a plan and to find out your rights!
Take care of yourself....hoping you are feeling better!
hugs from Tigerlily
The following user gives a hug of support to tigerlily11: Ginamjp (10-19-2011)
hi i have been in pm for a few years and they have always told me to call them first if my pain increases...i have gone to the er before and they will ask me why isn't my pm doctor helping me...and basically there is nothing they can do..basically what the issue is your not allowed to get pain meds from any doctor including the er cause your pm doctor can get in trouble thats why they have to take all the precautions like having you sign the pain contract...i found this out cause one time i had knee surgery while i was seeing a pm doc and the surgeon gave me a script cause i needed to be on more pain medicine then i was well my pm doctor knew that the surgeon gave it to me and i was discharged...he told me that he could get in trouble if i was recieving meds from another doctor that i was to strictly get the meds from him and no one else...so your doc may be freaking out cause of that cause the government has really started watching docs who write pain meds