Thursday, May 03, 2007

The Great Drug War of 2007

With as many years of experience I have with getting health care for my large assortment of rare conditions, I was pretty sure I'd seen it all when it comes to the bizarre policies and practices one finds throughout the medical industry. Little did I know that a recent week-long stay in the only hospital on St. Croix would put me at the center of what will go down in hospital history as "The Great Drug War of 2007."

One thing I'd learned from previous hospitalizations is that it's pretty much a crap shoot as to whether or not the docs and the hospital pharmacy will ever get their act together enough to deliver the right medications to you at the right time. Since I take a lot of pain medications and cannot miss a dose without paying a huge price, I make sure to bring my own supply of meds with me just in case this seemingly basic task becomes FUBAR fast.

FUBAR doesn't begin to describe what happened after I was finally taken up to my room. Right after I arrived, a very nice nurse went over my list of meds with me to make sure everything was listed at the proper dosage. When she had a complete listing, she headed off to the hospital's pharmacy to get the drug delivery system rolling. She returned in less than 15 minutes to deliver the bad news: The hospital pharmacy either didn't carry the medications I take or didn't carry them in the proper dosage, so they'd need me to bring in my own supply to ensure I got what I needed when I needed it. Being the good natured person that I am, I said, "Sure, no problem" and thought that would be that.

Foolish, naïve, little me.

The next morning, shortly after the day shift of nurses came on, I received a visit from the head nurse for the floor, a very nice lady with a bit of mischief dancing in her eyes. She had come to tell me that it was against hospital policy for a patient to keep medications in his/her possession, so I needed to hand over my personal supply of drugs to her so a nurse could give them back to me when the time came to take each one. I laughed and told her as politely as I could that there was no way that would be happening. That got a nice little eyebrow raise from her, which was quickly followed by a lengthy explanation about how this policy was for my own safety, to prevent double dosing and possible interactions, etc. I nodded, smiled, and told her that's all well and good, and that I'd be happy to send my medications home with my hubby if the hospital were able to provide these same medications to me in a timely manner. But since that wasn't the case, I'd be hanging onto my personal supply of medications but will gladly let the nursing staff know what meds I'm taking and what time each was taken to avoid any safety concerns. Exit the head nurse.

About half an hour later, a doctor came in (not my attending physician), and he proceeded to explain to me once again that there was a hospital policy against patients having any medications at bedside. For the next twenty minutes, we replayed the same conversation I'd had earlier with the head nurse over and over. Each time I refused to comply, he seemed to believe it was because I wasn't clear and would then explain the policy again. I finally told him that I wasn't doing what he wanted because I failed to understand why he thought it was necessary -- I was refusing to go along with this policy because it seemed an insane request to ask a 44 year old woman to hand over medications that she has safely self-administered for years so a nurse could hand the medications prescribed by my doctor and paid for with my money back to me.. I added that given the fact that the hospital staff couldn't seem to keep track of the written health history I provided them numerous times when I was admitted, that I'd be damned if I would trust them with keeping track of $1500 worth of medications that I had already paid for, some of which could not easily be replaced (due to FDA regulations on narcotics) should they "disappear." He stammered and stuttered for a bit, then turned and walked out. This was a man who was clearly unaccustomed to having a patient call the shots. (I do this to doctors a lot.)

Shortly after the doc left, my nurse for the day and the Vice President of Nursing. show up. It seems that I'm now the talk of the hospital, and they're sending in some of the big guns to put this uppity little crip in her place. At this point, I am totally amused and really starting to enjoy this whole little drama.. Both of these nice ladies spent a great deal of time going over the policy again and again, adding what they clearly considered their most compelling argument for me to comply: this isn't just a hospital policy. IT'S THE LAW. I nod, smile, and say yes, I understand their reasons very well, but the fact of the matter remains that my reasons for hanging onto my meds were far more compelling to me than the reasons for handing the drugs over, and therefore they'll get my medications when they pry them from my cold, dead, spastic, hands. When the VP of Nursing started to once again explain the policy to me, I had had enough. I finally had to say to her, "Look, my lack of cooperation isn't because I don't understand why you have this policy, so please do not try to explain it again. To do so would be completely condescending, and I don't deal well with people who are condescending to me." Well that got her where it hurts! She got all huffy and hostile, and demanded that I hear her out. So I let her ramble out the rationale one last time. At the end of her monologue, she said, "So now do you understand why this is the law?" Me: "I certainly do - it's a law to help you all cover your collective asses. All of the reasons you recited are still less valid than my reasons for not complying, and therefore you won't be taking my medications from me."

This scene was acted out with numerous other players for most of the next two days. Eventually, the patient advocate and the hospital's director of risk management got involved. As this was more fun than I'd had in a while, I turned it into a true sport: the more insistent they got, the less ground I would give. I knew I was wearing them down when their demands shifted from giving up control of my medications to just having someone carry my meds down to the hospital pharmacy for their pharmacist to "verify" them. I told them that wouldn't be necessary as I had received these prescriptions from a licensed pharmacist with whom I had a long-standing relationship, and that I had verified them myself using the online drug identifier. Their reply: "Well we don't know your pharmacist." And I shot back, "And I don't know yours, so why should I trust him or her to tell me about meds they don't even work with but I've been taking for years?" They then stepped their demands back even further, offering instead to bring the hospital pharmacist up to my room to perform this verification. This battle had been going on for three solid days now, and I decided this was it - game over. I finally put an end to it all (at least to my part in these repetitive and unproductive back and forth discussions) by stating firmly that no one would be verifying anything because I was done, and I would leave against medical advice should one more person come to talk to me about this insanity.

I could hear the rumblings and buzzing in the hallways as word of the Drug Battle of 2007 was debated and discussed among the hospital staff. during the rest of my stay. However, no one said another word to me on this topic except for the head nurse, who popped her smiling face in one afternoon and said with a devilish little grin, "You are sure something else."

That I am. I'm a fat, little tattooed woman with pink hair and her own wheelchair who doesn't take shit from anyone. And I'm also the winner of the Great Drug War of 2007 - there wasn't one moment during my hospitalization in which my prescription drugs were more than two feet away from me.

St. Croix doctors never knew what was heading their way when I moved here three years ago, but believe me, the news about me is spreading.

1 comment:

da lurker said...

hay thc this is da lurker from ccc. saw no comments so i thought id leave one.