Recently the new effort by the General
Assembly to address the epidemic of deaths due to overdose of
prescription medication was signed into law. It did not contain the
provision that would have transferred enforcement to the Department
of Justice and left it in Health, Education and Welfare. I'm OK with
that. The proclivity of government attorneys to grab any case they
consider a slam dunk and to convert it into a conviction for the stat
sheet is reason enough for me.
The KMA opposed parts of this bill
ostensibly due to the doctor/patient confidentiality rule. I'm not
so sure about that. I think that doctors just don't like being
questioned about the practice of their art. However, requiring them
to consult KASPAR, our drug reporting system, seems to me to be a
practical move. Pharmacists already do it and it seems requiring
doctors to do it will not be too burdensome if the concerns about
providing timely relief can be adequately addressed.
But, I want to tell you a story. It is
a story about the flip side of that coin. It is a story about a
woman who has been plagued with back pain for over 20 years and has
undergone surgery after surgery in an effort to relieve the pain,
which is debilitating and unending. She is disabled due to this
condition and receives SSI, Medicaid and Food Stamps. Sounds like a
pretty flush deal until the last week of the month when the money and
food have run out but that is fodder for another story.
You may not be aware but recently
Kentucky, in an effort to save money, outsourced Medicaid to private
enterprise in a concession that the state just could not manage its
business or was that the rationale at all? Any business person knows
that to make money one must receive more than one pays out and
administering Medicaid is no different. The question is how do these
managed care companies save money? Are they more efficient or do
they just deny care? I am going to tell you that I believe it is the
latter and, if so, it is a despicable abdication of the
responsibility of the state. Already the managed care companies are
in lawsuits all over the state due to lack of payment or denial of
services and payments to providers. The governor and his
administration say we just need to give them more time to iron out
the kinks. I doubt that is the problem at all.
But, back to the story. This woman,
after complying with all the demands of the Medicaid regulators,
finally found a pain clinic that would prescribe the narcotics
necessary to control her pain. Not remove it but control it. The
clinic prescribed her fetanyl patches which delivered the medication
in a measured way so as to not deliver too much or too little. The
problem is that when she would get hot the patch delivered too much
which would then cause the effective period to be shortened. When
this woman would go to check in at the clinic, which was required
each month in order to refill the prescription, she would be tested
to see if an acceptable amount was present in her system. So, one
day it turned out that there was not so the doctor accused her of
selling her drugs and discontinued seeing her as a patient.
No problem, right? Just go to see one
of the myriad of pill pushers willing to prescribe anything to
anybody. Well, not so. It is amazingly difficult for a person who
is genuinely in need of help to gain access to those drugs. One
reason is that medical professionals are scared to death of running
afoul of the enforcement police and are loathe to prescribe the
necessary medications. In addition, the Medicaid administrators
require that a person endure each and every step all over again just
to prove they really need it. Try one step, even if it has
previously been proven ineffective, and if it doesn't work then try
the next step. What controls the steps? Is it medical knowledge, is
it concern for the patient's health? No, it is cost. Money, pure
and simple. Even this would not be too onerous except that weeks
expire between steps. Not just weeks but pain filled,
non-productive, writhing in the bed weeks of pain for something we
know how to treat but are unwilling to pay for. The reason for this?
It is fear of having to defend oneself from people who know nothing
about it and to avoid paying for medical care. It is the profit
motive plain and simple.
You might say, well, it is unfortunate
but some must suffer so that we can bring the larger problem under
control to avoid all the deaths of the prescription pill abusers.
Now, ask yourself if you would be so sanguine about this if the woman
were your daughter. I can answer that for you. You would not. You
would do what the woman's Mother and I have done which is insist that
she receive adequate care and you would be disappointed and dejected
just as we have been. You would be irate at managed care companies
and the inappropriate pressure brought on physicians who treat acute
and chronic pain and furious at the physicians who succumb to it.
I sincerely hope that the new law works
better that hoped and that our General Assembly adequately funds the
enactment of it. Perhaps if doctors can gain rapid access to
prescribing history then those who suffer may receive relief from the
torturous life they live. Perhaps that will mean that we will not
need those intrusive enforcement actions. Perhaps doctors can go
back to doing what they are sworn to do. Then all we will have to do
is deal with the heartless actuaries who refuse to pay for the
necessary care.
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