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#733248 - 07/22/08 07:01 PM
I've been cut off
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dpalmento
Newbie
Registered: 02/07/08
Posts: 29
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I guess I made a mistake asking for a one month supply of Norco from my oncologist. The nurse called today and said that you get 40 tablets and you have to get that refilled every 2 weeks? I said, yes. She said that we are sending you to a pain management doctor and won't refill your norco anymore.
I don't want to go to pain management. I don't want injections in my back. I have had enough procedures and surgeries for my lifetime. I'm only 44 and have had 10 surgeries including double mastectomies with reconstruction and total abdominal hyst, not to mention being in several car accidents. I have L5S1 disc bulging and nerve compression. I got sent to an orthopedic dr and he only tried NSAIDs which made me sick at my stomach and did not help with pain at all. Another side effect of a cancer drug I am taking is bone and muscle pain. I'm really tired of all this.
I'm thinking of an OCS. Any advice for me? I know you all have more experience with treatment than I do.
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#733458 - 07/23/08 05:51 AM
Re: I've been cut off
[Re: dpalmento]
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Felisdia
Stranger
Registered: 07/20/08
Posts: 15
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 the more post you read the more you see how people with pain are mistreated in this country.. If you choose to go to a pain doctor you dont have to get shots i go and i dont get shots just my meds.. If i may ask what state do you live in and what state could you go to a pain doctor maybe i can tell you a few
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#733480 - 07/23/08 06:41 AM
Re: I've been cut off
[Re: genethebean1]
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woodgirl
Veteran
Registered: 08/23/07
Posts: 598
Loc: Boondocks, Oregon
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Oh, that is just awful. To require a person to literally suffer, is just cruel. I have a pain management contract with a regular ole family doc. Same contract as through pain management, just my own Dr. I see for every ailment. I don't know what you should do, but I agree, you should talk to your oncologist again, and try to work out an agreement. Most Drs. don't think about the fact that if you get scripts twice a month on insurance co-pay, you end up paying double. I also get three Hydros a day. I have tried celebrex, mobic, and other n-saids. They make me sick to my stomache also, can't sleep. And they greatly complicate my asthma. Sometimes the best medicine isn't the newest, most expensive, it's the one that adds quality to your day. That's what I told my dotor. And he actually got the point.
I've never dealt with an OCS, but from what I've read here and at other forums, it sounds very expensive, not to mention unreliable. So I would try to find another Dr., if yours refuses to treat you right, one with some compassion. I hope you have some luck in finding a Dr. more willing to help you cope with your pain.
Edited by woodgirl (07/23/08 06:43 AM)
_________________________
Its 3:00 a.m. McCain took an Ambien, and Palin has gone moose hunting. Who do we call now?
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#737363 - 07/28/08 07:14 PM
Re: I've been cut off
[Re: chemsynth]
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TheMoodyBlue
Pooh-Bah
Registered: 11/17/04
Posts: 1265
Loc: LET'S ALL KEEP AUSTIN WEIRD !
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How in the world can a MD say they specialize in pain management and say the NEVER prescribe opioids? That's ridiculous.
This is incredible, but it is the reason the NIH survey is still being conducted. Chemsynth
Ed, wouldn't this be considered to be malpractice? Patient abandonment is reaching epidemic proportions. Do you think she has any recourse with the State Medical authority in her state?
For everyone's benefit, here is a good explanation of patient abandonment and the issues surrounding it.
___________________________________________________
Patient Abandonment
A health care provider may decide or be forced to terminate services to a patient for any one of a variety of reasons. Although terminating services to a patient is certainly a significant and undesirable event, it is legally permissible if the provider carefully follows certain steps before discontinuing services. If the provider fails to follow these steps, it may find itself liable to the patient based on the theory "abandonment" if the patient alleges he or she suffered injury because the provider terminated services without sufficient notice.
This article will discuss the steps a health care provider should take to terminate services to a patient without committing patient abandonment.
PATIENT ABANDONMENT
A provider may want to quit providing services to a patient for many reasons, including:
* The patient refuses to cooperate with the provider and its staff.
* The patient will not pay his or her bills.
* The patient is unruly and obnoxious to the point where it is in the best interests of all concerned for the provider to quit providing services.
* Reimbursement for services has been denied or the provider has ceased to be a Medicare or Medicaid provider.
* Environmental factors exist which endanger the provider's staff (e.g., physical threats, a dangerous dog, sexual harassment).
What a provider must not do, however, is "abandon" a patient. Abandonment generally means a unilateral severance of the professional relationship between a health care provider and a patient without reasonable notice at a time when there is still a need for continuing health care.
Court decisions involving patient abandonment generally deal with abandonment by physicians. Still, the legal principles established by those cases are instructive for other providers. For example, in interpreting Ohio law in 1965, the United States District Court for the Northern District of Ohio quoted an earlier Ohio decision which stated:
"....although a patient may, in the absence of an agreement to the contrary, discharge a physician at any time, before a physician or surgeon can withdraw from the case, it is necessary for him to give reasonable notice to the patient in order that another physician may be procured, the character of the services of the physician and his relation to the patient being such that he is not permitted under the law to arbitrarily quit the services at any time without any cause, and leave his patient without medical attendants."
Three elements must exist for patient abandonment to occur:
1. The termination of services must be unilateral, i.e., not by mutual agreement.
2. The termination must occur without reasonable notice, meaning notice adequate to give the patient a sufficient opportunity to secure alternative care; and,
3. The termination must occur when there is still the necessity of continuing care.
WHAT TO DO
Because the issue of patient abandonment arises in a situation in which the health care provider, itself, desires to unilaterally terminate services at a time when there is a need for continuing care, the key to avoiding patient abandonment is to give reasonable notice of the termination of services. The underlying rationale is that reasonable notice affords the patient time to secure alternate care and the patient therefore is not "abandoned." If reasonable notice is given, that critical second element for patient abandonment does not exist.
Given this background, the following steps are generally expedient when a health care provider feels compelled to discontinue services to a patient:
(1) Examine the Patient's Records
First, the patient's records should be carefully examined to determine the degree of need, if any, for continuing care and the availability of other sources of care, i.e., other providers. If a patient is in the midst of ongoing care by the provider and is unable to find comparable care or has not been given adequate notice of the provider's intention to discontinue services, then the provider should not discontinue services without pursuing the remainder of these steps.
(2) Notify Attending Physician
Second, assuming the provider is not the patient's physician, the patient's attending physician should be notified in writing of the problems the provider is experiencing with the patient and that it is the provider's intention to stop providing services. The physician may be able to intervene to correct the problem or to assist the patient in finding another provider that will provide services comparable to those provided by the provider terminating services.
(3) Give Reasonable Notice to the Patient
Third, the patient, or those responsible for the patient's care, should be notified in writing as to the date the services will end, the reason or reasons for the action and the ways in which the provider will assist the patient in securing appropriate services elsewhere.
The letter should advise the patient that the provider will make available to the patient, and other providers retained by the patient, copies of all medical records and other information relating to the patient. This helps in maintaining continuity of care for the patient.
It also could be useful for the letter to give the names, addresses and telephone numbers of other providers in the area which would be available to provide services to the patient.
Generally, the letter should be sent by certified mail, return receipt requested, so the provider can prove the letter was received by the patient or the responsible party. A copy of the letter should be sent to the patient's physician as well. A copy of the letter and the return receipt should be kept in the patient's records.
This notice must be received by the patient far enough in advance of the date services will terminate to give the patient sufficient time to secure alternate care, i.e. it must be "reasonable". How far in advance will be held to be reasonable will depend upon the facts of each case including the patient's condition, the availability of other providers, the ramifications if alternate care is not secured, and the reason for termination of services.
Exact Steps Depend Upon the Situation
The foregoing steps are a basic approach concerning discontinuing services to a patient. Remember, however, the key step is the third one -- giving reasonable notice to the patient.
Because each situation can be unique, it can be very helpful for a provider to have a written policy stating the steps to be followed prior to unilaterally terminating services to a patient. By setting forth the steps to be followed and who within the provider makes the final decision as to whether or not services will be terminated, the policy can assist in avoiding inadvertent liability through patient abandonment.
It must be emphasized, however, that the appropriate resolution of a specific case depends upon the particular facts surrounding it. Before choosing a specific course of action, therefore, a provider should consult with its attorney to discuss the situation and to obtain advice based upon the specific facts involved.
©1987, 1997 John C. Gilliland II
The content of this article was last reviewed and updated as necessary on 4/19/05.
Patient Abandonment Post
_________________________
Ego sum in poena, proinde Ego emo
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#737391 - 07/28/08 08:11 PM
Re: I've been cut off
[Re: musician7]
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mistyblue
Member
Registered: 05/28/08
Posts: 133
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And this is why people are taking things like using OP's into their own hands. The original poster's situation is sad and callous on the doctor's part. My brother has cancer, before that was diagnosed he had permanent nerve damage in the legs and back. Pretty much has been in pain for a long time.
Since losing private insurance and relying on the VA, he gets 3 hydrocodones a day alloted to him every 30 days. He went through three rounds of chemotherapy, it did not do any good or put him in remission and damaged his heart. He has decided to forego chemo, at least for now. When he was on chemo, he was prescribed some heavy duty pain meds, now that he chooses not to have it, he gets barely anything.
He goes for his "warehousing" checkups and new prescriptions, and never once does this doctor ever suggest going on something else more suitable for long term pain managment or up his dosage or anything. It is totally ridiculous to me. Once when she went on a vacation and did not leave a note for this med to be filled, after he called and complained, the covering doctor finally called back. He is the chief or whatever his title is. He was totally non compassionate and even said to my brother that "he really did not want to hear about that now" when he (my brother) was saying what kind of pain he deals with. !!!!
What did he think they would talk about - the weather or something? I have made a complaint about this doctor and some other issues. Not finished with this yet.
Misty
Edited by mistyblue (07/28/08 08:12 PM)
_________________________
Just the thought of you
turns my whole world
a misty blue
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#737481 - 07/29/08 05:18 AM
Re: I've been cut off
[Re: uluvme]
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chemsynth
Threadhead
Registered: 11/07/05
Posts: 978
Loc: MA
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Hey Moody
i don't know what constitutes "abandonment" in a realistic sense. as an emergency physician, it is Very Tough to abandon a patient with whom i have little if any ongoing relationship. clinic docs, inpatient docs, primary care physicians, and subspecialists are a little different. they are supposed, at the termination of their doctor-patient relationship, to set up ongoing medical care for the patient with another clinician. now, in a pain clinic setting i can imagine a number of things going on:
1. the doc refused to prescribe more opioids, but offered additional, non-pharmacologic therapy. we all know the procedure-happy approach of some clinicians, but everyone should be aware that there is growing concern among physicians that the "treat pain" approach to medicine imposed by JCAHO. the emerging thinking is that return to function--albeit with pain--is preferable to prescribing pharmaceuticals. So there could have been more than one therapeutic option offered in lieu of opioids. that is not abandonment.
2. i don't know if "abandonment" occurs if a clinician does not believe a patient to have a medical condition that mandates ongoing treatment. for example, my wife is a pediatric transplant pulmonologist. if she has someone under evaluation for transplant, she can't refer that patient to another facility because 1) they have the medical condition and 2) the closest followup is nearly 5 hours drive away. BUT if she has a patient who says she has asthma--but in reality does not--is she under any obligation to refer that patient to another pediatric pulmonologist if that patient clearly does not have asthma? i don't know.
'course, the pain doc in question could just be a jerk and not care what the law is. REgardless, if people don't like what is happening in pain care in the US--well, take matters into your own hands a different way--Consider taking the NIH survey.
hope this helps,
chemsynth
Edited by chemsynth (07/29/08 05:19 AM)
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