Monday, February 23, 2009

You're a Good Man, Sean Penn

"…For those who saw the signs of hatred as our cars drove in tonight, I think that it is a good time for those who voted for the ban against gay marriage to sit and reflect, and anticipate their great shame, and the shame in their grandchildren’s eyes if they continue that way of support. We’ve got to have equal rights for everyone."

---excerpt from Sean Penn's Oscar acceptance speech.

Bravo, Mr. Penn. Harvey would have been so proud.

Sunday, February 22, 2009

That's It, I Quit: Oxycodone Shortage Update

I got a few emails about my Oxycodone Shortage post, wondering if I ever got meds, and what the hell was going on. So here's my update, hopefully with a little less emotion and cursing than the other post contained (though I make no promises on either):

I see my physician, Dr. Fetus (for those of you unfamiliar, I refer to him as Dr. Fetus because he looks way too young to be a's like having your disease managed by Doogie Howser), every three months. At that time, he gives me three seperate hard copies of my Oxycodone prescriptions for the next three months. He does so, because the previous method of getting the pills was, to say the least, ineffective.

Prior to this every-three-months plan, the idea was this: at least three days prior to the date I needed the refill (not counting weekends, during which I am by pain management contract unable to ask for pain meds refills), I was to call the Prescription Coordinator (hereafter referred to as "The Rx Dick") and request the refill. The Rx Dick then prints up the Rx on the computer and sends it to Dr. Fetus to be signed. When that's done, he calls me and I come to the office to pick it up.

Sounds simple, doesn't it? Sounds like it should be a cakewalk, huh? Not so.

The problem is, the Rx Dick doesn't just do prescriptions. He's also the clinic's full-time radiologist. If you're thinking, WTF? You're not alone. Because of this strange arrangement, the Rx Dick is never available to take phone calls. You have to leave a voicemail. Now, that in and of itself is not a problem. In fact, I can definately see the advantages: you don't have to actually talk to someone, you can leave all the info on the message and expect it to be handled forthrightly. Well, that would work....if the Rx Dick ever CHECKED his messages. Instead, nine times out of ten his voicemail would be full. And not just for a few hours...often, for a few DAYS.

The receptionists, although usually very helpful, are not of much help in this situation. Their protocol is to refer ALL Rx calls to the Rx Dick. They cannot take messages for him. Unless it is urgent, they won't page him or try to track him down for you. And even if they ARE willing to track him down, most of the time he's busy in his other position as X-Ray Dick and can't help you anyway. So, all they can do is send you to the voicemail, and hope for your sake that he'll check it sometime this week.

Even when he HAS checked his voicemail and sent the Rx to be signed (what they call "pending"), it often goes unsigned for several days....because Dr. Fetus is only in the office a few days a week, and no one seems to know in advance (or won't tell patients) when exactly those days and hours will be. And even when it's been several days, and a patient languishes, waiting for meds, no other doctor will sign a pain med refill for another clinic doc.

To make matters worse...the Rx Dick NEVER calls to let you know the status of your prescription. Even if you call several times and beg him to return your call, you will be ignored. A good 75% of the time, he won't call you to tell you your Rx is ready to be picked up, either. You have to call the front desk and ask the very helpful receptionists to check the drawer and see if an Rx is waiting for you. Often, you have to do this a number of times before anything with your name on it appears in that drawer.

As a result of all this, I have had numerous occassions when I've gone without meds for days, even a week or more. I've ended up in the hospital, for want of meds that I've duly called in, in advance, and still do not possess.

About a year ago, I brought this frustration up to Dr. Fetus, who was genuinely surprised. He had no idea I was having this amount of trouble. So we came up with the every-three-months solution.

And it was working quite well....until this week

On Sunday, my husband went to fill my prescriptions. The pharmacy told him they had no Oxycodone. At first, my husband was skeptical. We've had trouble in the past with pharmacists who are bitchy about filling these particular meds. So he went to another pharmacy. This one also had no meds. This pharmacist told Jonathan that the entire town was Oxycodone-free, due to a problem with "the precurser to the medication." His advice was for us to go back to our doctor's office and get an Rx for Percocet. Jonathan was confused, as the precurser for Percocet is the same for Oxycodone: they are both opiates, synthesized from the poppy flower. If the precursor for one is in trouble, neither would be available. So he tried yet another pharmacy. This one also had no pills, but told him the problem was much larger than the last pharmacist had led us to believe: the shortage was not local, but nationwide. Nowhere in America could Oxycodone be found.

He came home, empty-handed.

We immediately got on the 'net...and became even more confused. One article said that the shortage was due to the FDA's guidelines about how many pills could be made. Those guidelines, the article said, fell well short of demand. Another article quoted the FDA---and two doctors---as claiming there was no shortage. Finally, we went straight to the horse's mouth: the FDA's website. Lo and behold: there's an Oxycodone shortage, and they have little to no idea as to when it will end.

I refused to panic. Yes, I was out of meds...but with a nationwide crisis, surely it would be no big deal to switch out this prescription for another.

I am, apparently, quite naive.

On Monday morning, I began making phone calls. In the year since I stopped communicating with the Rx Dick, his ways haven't changed a bit. The voicemail was full. I call six times, each time speaking to a receptionist who sent me dutifully to the Rx Dick. The receptionists, trying ever so hard to be helpful, asked me to be patient; they were aware there was a shortage and "many patients" were in need of a new prescription. I understood that; but this one of the "many" had no hope of getting a new prescription if I couldn't leave a message! Finally, one suggests that I try after lunch. "Sometimes, the Rx Dick will check his messages after the lunch hour," she said. How helpful! I'll do just that.

So I did...and got the answering service. The office closed at 1PM that day for "the holiday." Not one of the six times that I called that morning did any of the oh-so-helpful receptionists tell me that the office was closing early...for President's Day.

I didn't sleep that night, struggling with pain and having nothing stronger than Ibuprofen and some extraordinarily nasty-tasting morphine cough syrup left over from my last bought with walking pneumonia. My mantra that night: I'll call them in the morning, I'll call them in the morning.

And so I did. This time, I was able to leave a message with the Rx Dick. Concerned that nothing would get done that day as I so desperately needed, I also asked to speak with my doctor's medical assistant. I got her voicemail as well, and left yet another message. I called and left messages several times that day.

No one ever called me back.

Another sleepless night. My mantra that night: I WILL speak to someone tomorrow, I WILL speak to someone tomorrow.

Wednesday came, and I began calling first thing in the morning. More voice mails, nothing in the drawer, call after call. Finally, just moments before the office closed, one of the oh-so-helpful receptionists had news for me: my prescription was "pending." Was my doctor in that day, to sign it? NO. I would have to call back tomorrow. Could I talk to the Rx Dick? No again...he left work early. There's a prescription crisis going on, affecting "many patients," and the guy responsible for helping those many skipped out early? Huh?

Another sleepless night for me. My mantra that night: This will be the LAST NIGHT I go through this, this will be the LAST NIGHT I go through this.

The office opened Thursday morning, and the phone calls began. At first, the Rx Dick's voicemail was full again. But I perservered. I was able to get through and leave messages, and again left messages with the medical assistant. I marked them all as "urgent." And still, no one called. Once, the no-longer-quite-so-helpful receptionist chided me. "You need to call three days before a prescription is due to be filled, you know." Yes, I am aware...are you aware I've been calling since Monday??? "You need to call back tomorrow," I was told, in a not-so-nice tone. I wondered what mantra I would be repeating that night...

Jonathan called as he got off work late that afternoon, to speak to a wife trying desperately to ward off panic. I was feeling ignored, invisible. I couldn't understand why this was so very difficult. In need of support, I had gone to the obvious place: my MS support group. They were all astonished. Several of them had a completely opposite experience: their doctors had called THEM to get them new meds, before they themselves were even aware there was a shortage. I was now not only frustrated and angry, I was resentful. Would it have been so hard, so unthinkable, for someone at the office to extend to me the same courtesy? Why was I having to beg for help?

I was feeling upset, at the end of my rope. Jonathan, on the other hand, was livid. He went straight from the office to the clinic, intent on getting some answers. He waited patiently in line, and then approached a might-be-helpful-who-knows-stranger-things-have-happened receptionist. At first, she was argumentative. She was put out, as she had "just talked" to me. She insisted the computer showed I had only started calling on Tuesday, not Monday. A straw man, as far as my dear husband was concerned. She then told him that the prescription was pending, and I should call tomorrow. He was not pleased. He asked to see my doctor, and told her he was quite willing to sit in the waiting room until the end of the business day in order to do so. That's when he found out that although Dr. Fetus had been there that day...he was already gone. And to make matters worse, even though both he and I had been told repeatedly to call tomorrow BY THIS SAME RECEPTIONIST, he would not be there that day, either!

Jonathan was flabbergasted. He knew that chances were, I'd spend all day tomorrow calling, too...but with my doctor gone, no one would do a thing. And then I'd be stuck for the entire weekend. This meant I'd be without meds, for a week. The chances I'd make it through that weekend without hospitalization were slim to none.

He related this to her, but she responded by repeating that this was really the job of the Rx Dick, and we should call tomorrow. He asked for her name, so he could know exactly who was bestowing upon him "the wisdom of the ages." She was not amused.

Jonathan then turned on the charm, asking who exactly was in charge. This is where things get...surreal. This is the moment when we find out exactly how this modern, high-traffic doctor's office is run.

Apparently, every day the office has a "preceptor," who acts as a sort of "boss" for the doctors for the day. This changes day by day, and the receptionists don't know who will be the preceptor until the day before. OK, fine, who is the preceptor right now? There isn't one; SHE LEFT EARLY (does ANYONE there actually work a full shift?). So who is in charge? The receptionist has no idea. There are a number of residents working with patients, and one attending. So if we call tomorrow, who is the preceptor? She checks her computer. Dr. Already, she says. My husband looks up at the board. You mean the same Dr. Already who is here right now? Yes, but she's not the preceptor today. She can't act as today's preceptor; she isn't preceptor until tomorrow. And although she is the only attending there at the moment, and therefore technically in charge, she has a "full patient load" and could not possibly deal with this now. And besides, doctors don't like to sign pain meds for another doctor's patient. Jonathan reminds her that I've been taking these pills for YEARS, and my pain management contract is on file in their computer. Again, the receptionist tells him that Dr. Already is not the person to deal with this.

Who SHOULD be dealing with it? My husband wants to know. "Well, I suppose that would be the Prescription Coordinator, but she's not here." She? We were under the impression that the Rx Dick was the Prescription Coordinator...and he is no she, as far as we know. "Oh, no, he's only the ASSISTANT Prescription Coordinator. 'Inga the Invisible' is the Prescription Coordinator." Now, I have been going to this office for years, and dealing with the Rx Dick for what feels like eons. Everyone has always referred to him as the Prescription Coordinator. I have never heard of, nor have I ever seen, Inga the Invisible. But what the hell, we'll talk to her. "She's not here." Let me guess...she left early? "Well, she only works sort of part-time." Great. When will she be in next? "I don't know." Helpful, very helpful.

My husband then says to the receptionist, "My wife has a chronic illness. She NEEDS these medications. She needs them NOW, not tomorrow. And it sounds to me like the chances of her getting through to anyone tomorrow are about the same as they were for her getting through TODAY, and that leaves her with an entire weekend to suffer without the medications that she, under the pain management contract she signed with this office, is entitled to. This situation is not something that is within her control. I understand that Dr. Already has a full patient load today...but there are only three people in this waiting room. I am more than willing to wait until everyone has been seen, and then can talk to her. But I absolutely need to talk to someone today, not tomorrow."

The receptionist again pleads the full patient load and tries to get us to come back tomorrow. My husband then asks her if she knows what it is like to watch someone you love be in pain.

She leaves. A few minutes later, she returns. She asks Jonathan to give her the prescription for Oxycodone, and in return gives him a prescription for Percocet, signed by Dr. Already.

I guess she does know what it's like to watch someone you love be in pain.

I, at the moment, am not in pain. But thanks to several days of battling pain, I have a terrific case of I am still not sleeping.

My mantra now? That's it, I quit, that's it, I quit.

I am actively looking for another doctor. I like Dr. Fetus well enough, but I can't take this prescription nonsense anymore. I cannot understand why this was such a debacle, why a simple piece of paper signed by a physician was so difficult to achieve. They clearly knew there was an Oxycodone shortage, but no plans were in place to cope with the "many patients" who would be affected by it. It was left to doctors and prescription coordinators who chose not to deal with the problem, but take off early to play golf or do whatever it is doctors and prescription coordinators do when they skip out on the people who need them.

This was a crisis...but instead of helping me, I was treated repeatedly as if it were my fault, and as if I were being bothersome or downright rude by expecting my doctor's office to be able to handle this in a timely manner. And the fact that so many other doctor's offices in town were not only able to handle it in a timely manner, but did so in a way that showed actual CONCERN AND CARING for their patients just proves to me that it can be done. And it SHOULD have been done.

But it just wasn't.

So I'm out of there. I'm considering a DO. My friends who have them seem so much more satisfied with their doctors than do the ones with MDs. So I got a list of doctors covered by my insurance, and I'm looking up websites and trying to create a short list of DOs to check out. Hopefully, by next week's end at the latest, I will be sitting in a new doctor's office...preferably one who has ACTUALLY helpful receptionists as well someone in charge and people who finish a shift, especially when there is a nationwide prescription crisis.

I don't think it's too much to ask.

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Monday, February 16, 2009

Venting: Oxycodone Shortage!

There is a nationwide oxycodone shortage. NO ONE has any. To make matters worse, everyone is telling a different story. One pharmacy blamed the FDA and their "guidelines" as to how much of the med can be made. Another blamed a recall. One told my dh that there was a "problem with a precursor" to the drug. News articles are also confusing. Most blame the FDA, but some seem to doubt there's even a shortage at all. The FDA itself denied it until a few days ago. Their website now acknowledges the shortage, but no one seems to know when it will end.

I knew none of this, until this weekend. I tried to get my RX filled. No dice. One pharmacist told me point blank to get an RX for something one knows when this will end.

Hey, great idea! At least it's something. So I start calling my doctor this morning. He isn't in. I am told to speak to the prescription coordinator (a useless person, as I know from long experience with him). His voice mail is full. I call again and again. The voice mail remains full, and the receptionists are at a loss as to how to help me.

I decide to try again after lunch, as sometimes the Prescription Dick will clear his messages then.

Not once of the half-dozen times that I spoke to a receptionist, did any of them tell me that THE MOTHER FUCKING OFFICE WAS CLOSING AT 1PM FOR THE HOLIDAY!!!!!!!!!!!!!

WTF? It's President's Day, people. Since when did doctor's offices close for THAT? These assholes were open all day New Year's, but President's Day? Nope, gotta take off for THAT!

I'm going down there in the morning and I am not leaving without a prescription for SOMETHING. If they give me a hassle about my pain management contract and no substitutions and whatnot, I will kindly point out that I would take the meds IF ANYONE HAD THE FUCKING THINGS.

It's either that, or admit me, because I can't do this another night. The later it gets, the worse it gets. I am scared shitless right about now, and all I have is some nasty morphine cough syrup left over from the last time I had pneumonia.

I hate the FDA today. How hard could it be to unclench and let them make some more pills??????

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Friday, February 13, 2009

NDN Newz: Killer Back to Work

Former Capitol Hill staffer Carlos Fierro is back at work in D.C., just months after killing a Pueblo man.

Fierro is charged in the drunk driving death of William Tenorio, 46, a member of the San Felipe Pueblo. Police say he was driving drunk when he hit and killed Tenorio in New Mexico on November 26, 2008. Fierro, who has at least one previous DUI conviction, fled the scene after the accident.

Tenorio's family was shocked to learn that not only was Fierro released from electronic monitoring, but had been permitted to leave the state and continue his work in Washington, D.C.

"They're shocked and concerned ... that they weren't aware of it," Stephanie Poston, a family spokesperson, told the paper. "They want to be engaged in the whole process."

Apparently, you can get drunk, kill a Native, and go right back to work. And the family? Who needs to inform them? That's what newspapers are for, right?

For shame.


Nutbag Judges: Jailing Kids For $$$

In Wilkes-Barre, Pennsylvania, the juvenile court system was once a model of efficency: efficent corruption, that is. An accused minor would be brought in, often without a lawyer (violating the 1967 Supreme Court ruling gaurenteeing minors the right to counsel), and given a "speedy trial" lasting only minutes. Following the McTrial, these youths were sentenced to detention centers for even the most minor of offenses and often against the recommendations of probation officers assigned to the cases. Many had never been arrested before.

It was fast. It was uniform. And it was making the judges stinking rich.

Two of those nutbag judges, Luzerne County Judges Mark Ciavarella and Michael Conahan, were charged on Januuary 26 with taking $2.6 million dollars in payoffs between 2003 and 2006 to send teens to one of two privately run youth detention centers run by PA Child Care LLC and its sister company, Western PA Child Care LLC. Shortly after charges were brought to bear, both men were removed from the bench by the Pennsylvania Supreme Court. They pleaded guilty to fraud today in federal court, earning them sentences of more than seven years in jail.

Although Ciavarella, age 58, denies he recieved kickbacks for sentencing minors to the two detention centers in question, he penned a letter in which he admitted he "disgraced his judgeship." The judge, who presided over Luzerne County’s juvenile court for 12 years, also wrote: “My actions have destroyed everything I worked to accomplish and I have only myself to blame.”

Conahan, age 56, has thus far refused to comment on the case.

As of yet, no one associated with the youth detention centers have been charged. The investigation is on-going. Mark Sheppard, attorney for Robert J. Powell (who co-owned PA Child Care and Western PA Child Care until June), insists his client was a victim of extortion. “Bob Powell never solicited a nickel from these judges and really was a victim of their demands,” he said. “These judges made it very plain to Mr. Powell that he was going to be required to pay certain monies.”

In addition to removing the robes of the judges, the high court has launched an investigation to determine whether any of the cases involve warrant the action. Hundreds or perhaps even thousands of juvenile offenders' records could potentially be expunged.

“I’ve never encountered, and I don’t think that we will in our lifetimes, a case where literally thousands of kids’ lives were just tossed aside in order for a couple of judges to make some money,” said Marsha Levick, an attorney with the Philadelphia-based Juvenile Law Center, which is representing hundreds of youths sentenced in Wilkes-Barre.

Detention centers are not uncommon in Pennsylvania. Counties contract with the privately-run centers, alloting them either a fixed overall fee or a certain amount per youth, per day. In Luzerne County, Conahan is accused of shutting down the county-run juvenile prison in 2002. He then assisted the two private companies in securing tens of millions of dollars in contracts, a percentage of which was dependent on the number of juvenile offenders residing in the centers. PA Child Care, for example, was awared a 20-year contract worth an estimated $58 million (this contract was later canceled by the county as exorbitant).

Ciaverella has been under fire from area youth advocacy groups for several years. The groups accused Ciavarella of violating the constitutional rights of children. The judge sent a quarter of his juvenile defendants to detention centers from 2002 to 2006, compared with a statewide rate of one in 10.

They thought he was cruel. They thought he was harsh.

Now, they know why.


Thursday, February 12, 2009

I'm Up...I'm Up...I'm Up Again

Yep...insomnia. Hello old friend. Back again so soon? You sure know how to overstay your welcome!