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My mother has been in pain management for chronic back

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Addiction Medicine Specialist
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My mother has been in pain management for chronic back pain and lumbar surgeries for many years. She is bed ridden even with pain management medications. Her prescription is for oxycontin. For the past week the doctors office has refused to submit the required pre authorization, and as a result she has been withdrawing cold turkey. Multiple emails and phone calls have failed to get a response. Would this potentially be grounds for loss of a medical license? Thank you for your time.
Sun, 4 Feb 2018 in Pain Management
 
 
Answered by Dr. Matt Wachsman 2 hours later
Brief Answer:
and this would help her how?

Detailed Answer:
Hello and thanks for asking,

First, if she is bed-ridden, then how is she even getting evaluated for the treatment?

Obviously, the doctor did not make the drug not authorized. Mostly, the lack of authorization means that the drug will not be covered by the insurance but that does not mean it cannot be gotten just that you would have to pay for it. You might want to discuss that with the pharmacy. which could also do the same authorizations but they won't. Generic versions of oxycontin are expensive but less than the non-generic. Alternative medications could be tried such as long-acting morphine that is not expensive. Is the pain management office even still open? A lot of them have closed.

Have you paid the doctor to do the authorization? Or is the doctor supposed to spend (in general, these authorizations require at least 4 hrs of work to get through) hours of non-compensated work?

Did the doctor recommend the surgeries? Because certainly, that did not go well. Did the doctor do the surgeries? Shouldn't the primary care physician be involved in this?

So, my understanding is:
1) There was an initial evaluation that recommended back surgery(s) that were probably not indicated
2) some previous doctors pocketed thousands for doing surgeries that failed.
3) the patient is referred out to pain management instead of being set up for physical therapy or other modalities by the primary care physician who no longer cares for the patient in any meaningful way.
4) this did not go well. Evaluations for drug problems haven't' been done by the doctor sending the pain management referral. Evaluation by primary care or contact with primary care seems to have not been done
5) likely at the state or federal level there have been restrictions on the availability of narcotics without any regard for the people on them
6) all of this comes down to the pain management doctor who has no alternatives, probably has made hours of calls to get the drugs and been turned down.

Ok,
Then, a re-evaluation of the entire set up is obviously in order. There is so very much wrong here that even relatively bad management will likely improve things. Going to the emergency room for something that should have been otherwise handled will likely get a replacement prescription if there is not already one that is active. This is bad but fixes the immediate situation. The emergency room might admit for narcotic withdrawal. Which is generally not the right thing to do. But this would fix the immediate problem and likely also set the patient up with physical therapy and have her overall medical issues addressed adequately. The hospital might decide the patient is a drug addict and put them into methadone or suboxone treatment. This is a bit of a stretch of the imagination and, it would get the patient's pain issues well treated and more than likely also get them into rehabilitation of physical issues, get them counseling, get support services going.

Certainly one can send a grievance for literally any reason or for no reason. Doesn't fix the patients problems.

Feel free to ask further.
Regards

Above answer was peer-reviewed by
 
Follow-up: My mother has been in pain management for chronic back 1 hour later
she has had five back surgeries with the last being 10 years ago and follow up visits with surgeons have stated they don't want to operate. she is bed ridden to the point of exclusively seeing doctors.

she has an active prescription awaiting pre auth which will be denied and she must then start the appeal process with insurance; the cost is approximately $2k without insurance, which she can't afford due to being on permanent XXXXXXX disability.

it took until March of last year for them to perform her pre auth and as a result she reminded the doctor at every visit since October that she will require a pre auth in January 2018. my aunt is also a patient and had her pre auth done during her visit on Monday, and was not required to pay any additional fees.

physical therapy isn't possible due to her need for knee surgery, the condition of her back, obesity, and a weak heart with a pacemaker.

my question isn't to help her, as she's already doing everything she can to resolve this within her power.

I feel a doctor ignoring a patient for five days despite multiple phone calls and emails is unethical, unprofessional, and has resulted in tremendous pain and suffering. no other patient should have to go through this. she has been unable to find an alternate pain management doctor who will maintain the prescriptions that work for her.
 
 
Answered by Dr. Matt Wachsman 7 minutes later
Brief Answer:
Two thousand for one script is highly unusual

Detailed Answer:
Could be, it just seems high for non-chemotherapy for ... 60 pills? Well, which is one of the most profitable drugs ever.

Five days seems small. My wife waited more like 5 months.
Calling daily is helpful to get it done. But wow, it's likely they have more than 10 ahead of you. They really do take more than 1 hr to do, so it would be a significant fraction of the entire work week. They literally wouldn't be able to keep the lights on.

And then Humana does not have a way to get drugs authorized. And then Pennsylvania doesn't authorize drug/narcotic recovery. And vaccination is not paid for by insurances who expect them to be given. It's a bit random to blame an entirely dysfunctional health system on one particular doctor.

And, again, an appointment (which is paid for) to discuss other medications and treatments is an option. Declaring her hospice?

Above answer was peer-reviewed by
 
Follow-up: My mother has been in pain management for chronic back 1 hour later
I understand our healthcare system is a mess. for further detail, my mother doesn't have cancer and isn't terminally ill. we're in NJ and her insurance is blue Cross blue shield and Medicare.

I'm an auditor; if I ignored one of my clients for five days and missed a filing deadline for their financial statements (equivalent to a prescription fill date in this analogy), I would not only be fired, but my firm would be sued, even if it's just a small business requiring an audit due to having a bank loan.

given this man is a doctor and responsible for the well being of his patients, I find it unacceptable that he's held to a lower standard when it comes to pain and suffering of humans versus a piece of paper asserting the general reasonableness of numbers on a financial statement. opiod withdrawal is dangerous, yet he continues to ignore his patient. how is that acceptable?

thank you.
 
 
Answered by Dr. Matt Wachsman 2 hours later
Brief Answer:
I don't really see that you are asking for my input.

Detailed Answer:
https://en.wikipedia.org/wiki/Aetna_Health_Inc._v._Davila
this is for context and tone not specific to this. BUT I will mention that the doctor is held to SOME standard and insurances are NOT held to ANY standard. except to give paperwork.

5 days is not a long time in this context. Moving faster would impair the care of other patients. You have no idea how many are in line ahead of you. A lot. Pain management is busy and everyone right now has a prior authorization needing completion.

Is this no narcotics? Because there are an awful lot of cases in which the physician is trying to get the narcotic dose to be not into the toxic range.
Could the person have spaced the narcotics at a somewhat lower dose?
Above answer was peer-reviewed by
 
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