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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At 6:21 AM, Blogger bizQuirk said...

I would urge you to do two things about your so called doctors and that medical practice.

1. Hire a lawyer and at least threaten to sue for pain and suffering that was totally avoidable in the normal course of standard treatment.

2. Report practice to the state medical board.

At 10:51 AM, Anonymous orodemniades said...

Holy crap what a bunch of nonces. I'm glad you're getting another dr.

At 4:39 PM, Anonymous Anonymous said...

Fucking assholes!

At 6:01 PM, Anonymous Howard said...

A time I buy in since throughout this time they have demonstrated theirs confidence and seriousness, they are not swindlers as many(many people) and deliver a qualit product, for it already I am assiduous and believe that they must be reliable as them.

At 2:16 AM, Blogger Angel said...

I had to revisit this post, in light of the "talks" about vicodin & percocet lately.

My neurologist prescribed Dilaudid for me as a rescue medication for Migraines so I don't have to go to the ER if it's THAT bad (and my abortive isn't working).

We were told at the pharmacy that there is now a Dilaudid shortage because of the oxycodone shortage (docs switched patients to dilaudid). I did get my meds, but who knows about next time?

Hope you are hanging in there with all this heat (((ZA)))) XO

At 4:18 PM, Blogger Kelly said...

I'm finding the same dilaudid shortage here... I had back surgery recently, and while I try not to take it unless really necessary, it makes a difference to have it on hand. I can't imagine what it must be like to be in pain constantly and not be able to take care of it.

At 9:40 AM, Anonymous Anonymous said...

i was just watching the news & my doc. office was shut down & the doc. arrested,now mind you i was told to go to this office due to the fact that the 1 i was going to was going to be shut down & the DEA was telling my pharmacy that this doc. office was clean & not just a pill mill.well,according to the news it,what do i do? just suffer i guess,i can not believe that i have been doing everything by the book,following instructions from my pharmacy as to be steered in the right direction so i dont get stuck in this situation im in now,wow! its not bad enough that medicaid wont pay for our pain meds. if the doc. doesn't except medicaid now the office is shut down.i quit too!! i guess my next move is to wait for that grandmal seizure & pray i dont die.


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