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Wednesday, August 3, 2011

Combating the Drug Seekers in Health Care

No joke.
He came to our Emergency Room complaining of chest pain.  He is only 25 years old which is a little young but not unimaginable.  At the Admitting desk he stated he was not taking any pain medication.  He provided identification and was ushered into the Emergency Room.

The typical exam began with an EKG to establish his heart rythm along with bloodwork for routine laboratory tests.  Armed with a careful review of these results, our competent ER Physician entered the patient's room.

The young patient quickly began asking for pain medication stating that he had an abnormal heart valve which caused tremendous pain.  The Physician physically examined the patient and returned to his desk all too familiar with this scenario.

Too many years in medicine...
A relatively young patient complaining of a pain which is difficult to pinpoint.  Usually it is abdominal pain with no specific point of origin or a headache that comes and goes for days.  That's the first red flag.  Secondly, the patient asked for pain medication as soon as the Physician walked in the room.  Red flag number two.  The biggest of the signs for drug seekers is what our patient did next.  He asked for a specific pain medicine by name and he didn't just ask for Percocet or Valium or a low level pain med.  He went straight for the grand-daddy of them all: Dilaudid. 

I won't mention the type of clothing he was wearing nor the absurd amount of tatoos.  I wouldn't want to appear judgemental and sterotype this young man who clearly just needed a little pain management from his reported congenital heart defect.  But we knew something he didn't.

You see, most drug seekers think they've got it all planned out.  They travel from clinic to clinic, hospital to hospital, acquiring drugs on-the-spot AND a prescription "to go".  They complain of a generalized pain that can't be disproved and they drain our healthcare system with unnecessary tests and supplies and thousands of man-hours working up these false healthcare scenarios.

But what we know is exactly where he's been AND what drugs he has been prescribed...including dose strength and quantity.  There is a nationwide database accessible by healthcare providers which lists all narcotic drugs.  All our Physician had to do was enter the patient's name and date of birth.  Up on our screen popped the history of all the places Mr Chestpain had been in the last six months.  We also learned that he was not only on Dilaudid but that it was a LARGE dose AND he took it TWICE each day.  On top of THAT, he also took Oxycodone DAILY.

The name says it all.  I guess they don't read either.
This kid was loaded with several 30 day supply prescriptions of both drugs.  He had hit multiple facilities in the same WEEK.  It was a wonder he was even able to walk.  On the list we can see the names of doctors that prescribed the drugs so we can see who he continues to return to for meds.  Why would they continue to prescribe them, you ask?

Some doctors simply don't care.  Other doctors don't want to risk being taken to court for failing to address pain control, and believe me...it happens.  It happened to the doctor we have on tonight in our ER.  Physicians are obligated to offer pain control when a patient requests it.  The only buffer they have is how they offer to control the pain.

Our trusty Physician tonight, after reading Mr Chestpain's history, walked back into the patient's room.  Mr. Chestpain refused to let me perform a cardiac ultrasound until he received his pain medication.  So our Physician asked him how Mr Chestpain would like him to treat the pain when he is already on Dilaudid and Oxycodone?  Mr Chestpain's eyes widened.  Obviously caught off guard by the fact that our Physician was aware of the scam.

Our Physician explained calmly that there is nothing he could give the patient that was any stronger than what he was already taking...and taking a lot of it... daily.  The patient began to curse the doctor.  He unhooked his blood pressure cuff, EKG lines, etc and stood up.  He declared that he will not be treated in such a manner and that he will simply revisit the hospital down the street because "they gave me pain medicine without any problems".

Unfortunately, Mr Chestpain began to verbally threaten our doctor as he walked out of our ER, including punching him if he wanted to step outside. So, to do his part to help society, our Physician called the police.  It is against the law to threaten a healthcare worker.  By getting the police involved, he might be able to get this young man off the street and in some counseling.

The police arrived and we all had to fill out statements about what we saw.  The police recognized Mr Chestpain's name and said he was a constant annoyance for the PD.  Unfortunately we see this all too often in the Emergency Room.  You wouldn't believe the stupid stories we hear from some of these people.  In fact, I once had a young man bring his elderly grandma to the ER for a similar situation.  He had worked out a scam where he could get his demented (documented) grandma some pain meds (and keep them for himself) while he checked himself into the room next to hers for the same thing (pain meds).  When he was unsuccessful in getting meds for himself, he threatened to take granny to another facility.  Turns out, she had an unfavorable EKG and needed to be admitted.  Long story, won't go there but I was shocked at the level to which this young man had stooped for drugs. Poor granny didn't have a clue what was going on.

Between the drug seekers and illegal aliens abusing our medical system, it's a wonder the system has stayed afloat this long.  Meanwhile, I pay $300+ per month for health insurance that I've never used.  Go figure.

BTW, if you ARE a drug seeker, here's a Best of CraigsList post from an ER Physician spelling out exactly how you can obtain your drugs without pissing off the entire ER staff. Some vulgar language but VERY funny (and true).

~OJD

8 comments:

Lamb said...

I am one of those weird people that is allergic to a crap load of drugs AND I abhor taking painkillers. They always make me queasy and I don't like the *fuzziness* they cause in my head. Surprisingly, this has annoyed some doctors in the past. They tell me they are going to write a prescription for pain and I tell them not to bother. Worst ever was when I ripped a hole in my foot (and I do mean a hole all the way through) while doing some farm work. I ended up with a few stitches. What was bad, I also ended up with 3 doctors in the ER standing there telling me I NEEDED a shot for pain and/or a prescription for painkillers despite my assurances that it wasn't that painful! I finally accepted a couple of pills from one doctor, telling him I would take them when I got home, just to shut him up. Yeah, I ended up flushing the pills, lol. Why don't doctors believe a patient when they say they aren't in pain?

Sharon said...

I love the Dr letter to Druggies on Craigslist.That is so true & typical of how they act. Also in the medical field (billing) we see people that have page after page of accounts & they are usually for pain issues. The cartoon is TRUE at least thats what it feels like at our hospital. I am one of those who do not want Codine. Thank goodness I still have some Darvocet left from 2 yrs ago if I need them.

russell1200 said...

With 300 million people in a country you expect some losers. But we seem to do a bangup job getting more than our quota.

Our news paper posts the pictures of those arrested in the surrounding counties and what they are arrested for. Attempting to get drugs under false pretenses is not an everyday one (B&E unfortunately is), but it still comes up frequently.

Lila said...

In my neck of the woods the issue seems to be an overabundance of drugseekers and then lawsuits when they die of an overdose. So now everyone is treated like a drug seeker. Hubby is pretty much missing 2 lower disks they have been so destroyed. So he is on a pain management system. However he hates pain meds and feeling loopy so he takes as few pills as possible and aims to dull it rather than completely remove it. He recently broke a couple toes but being him taped them and went to work. Wearing his steel toed boots felt fine but by the end of the day he had swollen up from the heat and pulling it off was agony. He went to our PCP doc and she refused to give him anything, even tylenol, because he was already on a pain pill and he shouldn't need anything else. She no longer prescribes anxiety meds, pain meds, depression meds. She send you to a specialist. That is the norm here due to malpractice suits. It is insane.

Arsenius the Hermit said...

My son told me when he lived in Florida a lot of the people in his apartment complex did this.

The Orange Jeep Dad said...

@Lamb Good question! I will ask my Er doc tonight to see what he says. That just doesn't make sense to me. If you say you don't want them, I get that..they should too.

@Sharon I hear you. My mom has been in medical billing for over 20 years. I usually am the one that catches when they've given a false name. They register under John Smith and when I plug their date of birth or medical record number in my system in Radiology, it pulls up their previous records under a different name. Then I call Admitting and try to sort it out.

@Russell Nice that the paper posts the pics to identify the losers. Too bad they can't carry a sign like Bill Engval says: "Here's Your Sign".

@Lila First, I would ditch that PCP. If she won't prescribe that much stuff, what's the point of going to her. There most certainly is a purpose for pain meds. I've had them for broken wisdom teeth while waiting for the dental appointment. Also had Valium the day of my vasectomy to help calm my nerves (according to the doctor, that's what it was supposed to do) but let me warn all you guys...ain't NOTHIN' strong enought to fade that kinda pain. Beg her for a tubal, or hysterectomy, or oblation..anything that gets you out of the V. But enough on that ;-)

I also think it's a good idea to try to save up meds for crisis situations. I stock pile antibiotics whenever I can. Lost my last bottle of pain meds to my brother-in-law when he had multiple kidney stones but plan on getting some more. The viscous lidocaine comes in real handy when the kids have cuts in their mouths or toothaches too.

Pharmaspider.com said...

I took pain pills to get to sleep because I didn't want to go to work the next day exhausted.

Gary said...

I was a patient with vague abdominal pains, that seemed to vary in intensity. I was dismissed readily for years, no pain meds of any kinds, just sent home. Then one day the pain really got bad in the same area and we all found out by then I had chronic pancreatitis. Now, I don't even ask for the drugs, they are coming. Not to mention unlike a drug seeker, the triage department can tell by my vitals, I'm in a lot of trouble. 10 days on life support once. They respect the fact I waste no ones time and if I am there, it's needed. Now had they taken my complaints seriously and not treated me as a drug seeker, maybe we could have got this before I was chronic and doomed, somewhat???

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