Violated My Pain Management Agreement

[rentalguy1]

First, let me say I never do drugs (except what my doc prescribes) and I very rarely drink alcohol.

Last Friday I had a ortho appt for my knees. After that, I had labs scheduled for liver function, cholesterol levels, etc. Between the two appts I stopped by the restroom because I was about to bust. Then, when I show up at the lab, they tell me I have to give a urine sample for a drug screen. Well, I told them that I had just went, and couldn't give them a sample now. They told me to drink some water and hang out until I could. Normally that wouldn't be a problem, but my in-laws were visiting from Austin, TX last week and we had plans for the rest of the day with them. They were sitting at my house waiting on me get back from the VA. So, I told them I didn't have 2-3 hours to sit around because of the plans we had. I asked them if I could re-schedule and they told me to call the appt line and set it up. I tried that on the way home, but 30 minutes later when I arrived at my house I still hadn't got a human on the line so I hung up.

Fast forward to yesterday. I called the appt line again, and set up my labs for this morning. I show up at the check in desk this morning and I am told that no labs are scheduled and that I am flagged for violating my pain management agreement. Well, it's not a complete surprise. So I call to set up an appt with my new PCP to get this straightened out and I am told that it is rare that they reinstate a pain management agreement after it has been violated, but it is up to my PCP. The nurse on the phone also said that I was supposed to get a phone call the day before informing me that they were doing a random drug screen. I never got a call, and would not have used the restroom between the appointments if I had.

This is frustrating as hell, because I am not a freakin junkie or a alcoholic. I just had a busy schedule that one, single day (usually I am totally free to do whatever). Has anyone had any experience in this arena? I am about to blow a major gasket. :D

[carlie]

rental,

Can you scan and post a copy of the Pain Management Agreement?

Also, why did the idiots not tell you they only need about

20 drops of urine?

carlie

[Wings]

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Get a decision in writing --then APPEAL! You would be doing us all a service by addressing their blatant fascism. ~Wings

[john999]

Rental

You can appeal any medical decision the VA makes regarding your treatment. The first step is to call the patient advocate and explain the situation. I would also do as you were saying and talk to the PCP. I bet this happens all the time. I have a pain management contract also. If you drank a beer the day before the piss test that would be enought to violate your contract. I have had nothing but trouble with VA pain management. I got into a jam with them just for complaining about side effects of morphine they gave me. I do know there is a formal process to appeal any medical decisions the VA does, but they hide this, and the patient advocates try to never invoke it (causes paperwork and worries the boss). Sometimes you just cannot give water on demand. I have never been violated, but it is just a matter of time.

I have a civilian pain doctor as a backup. When I complained about the morphine Pain Management said I had to get off all my VA pain meds. I started with patient advocate and then called the medical director's office to complain, and start appeals process. You make a written appeal to the head of the medical director's office. It never got that far. It all got worked out in the end. Sometimes I believe the VA is just looking for an excuse to kick us off the program. The people running VA pain management seem to believe that every vet is getting drugs from VA and selling them on the street. The VA wants to know that you are taking the drug and not so much that you are taking other things. The assumption is not so much that you are a drug addict as a drug dealer.

[rentalguy1]

thanks all. i'm gonna wait and see what happens with the pcp appt next week. If it goes south, well, ...

[Notorious Kelly]

I unnahstand. They sent me a lab appointment with no info, so I called and asked "Do you need blood? urine? is this a fasting lab?"

Turns out it's urine for My Pain Management agreement- nice to know, cuz I wouldn't ordinarily hold my pee for a cross town drive :D

(I wonder if this is because I requested a medical marijuana letter from my doc? In Oregon I could get a MM card for $25 with a letter from my doc; it's $200+ without one).

[Stretch]

Thanks for the tip off.

I did exactly the same thing, but instead I went to the front desk and got a cafeteria voucher. I ate lunch drank a couple cups of coffee. I was ready for the dribble.

[rentalguy1]

Here's a quick update:

Had a appt with the PCP yesterday. I explained the situation, and she was receptive, but decided to berate me anyway. That pissed me off and I snapped. I told her that if the VA would have called me like they were supposed to this wouldn't have happened. She speaks up and says that she is the one who actually sneaked the random test in on top of my regular scheduled labs. She said she wasn't required to call me if I was coming in for a scheduled lab. I don't know how valid that statement is. She further told me that I should have EXPECTED a urine test because they always do it with labs. At that point I had her check my lab records to see how many times I've had a urine test since 2007. Of course, I already knew the answer was once. She was flabbergasted to find that out. Then she asked if I would mind taking a drug screen right then. I told her that would be fine, then we whipped all my pills out of my wife's purse and told her to count them in the name of full disclosure.

After all of that, she has the nerve to tell me that she has the ultimate, final decision on this. I snapped again and reminded her that she was just a PA and in actuality needed a MD to sign off on everything that she does, and that moreover, I know that there is a formal appeals process to this matter. That seemed to take the wind out of her sails a bit. So then I went and tinkled in a cup for them and left. She said that she was going to get the ball rolling that day, and that I should expect a phone call soon. Well, I haven't heard from her yet, and now it is the 4th of July holiday at the VAMC, so I won't hear anything until at least the first of the week, but that is expected.

gruntdaddy: I wasn't really thinking about the whole thing when I was there originally. I just needed to be done and get out of there at that moment. What is really throwing me off is that the lady that seems to be in charge of the vampire squad told me to call the hospital and reschedule it, like it wouldn't be a problem at all. This is the one and only time I will jump through their hoops, though. If the screw me around here, I will either drop what little narcotics I take for something non-narcotic, go outside of the VA for my pain management, or self medicate. I'm not the good little patient that complies with a bunch of BS. I try to live my life on the straight and narrow, and I refuse to be looked at like a drug seeker, drug user, or drug dealer.

[rentalguy1]

It's ON!!! <_<

[JR Reihs]

Raise the roof on these jokers..........I stopped going to the VA for these same reasons. These VA docs think they are god, but most could not hack it in the real world. What very few good docs they have get burnt on the BS.

F**k'm, raise hell......go to the top of the VAMC food chain.

[oldman273]

It's ON!!! <_<

Rental I can tell you that the problem you have is not unusual. What I need to know is how do we get some relief from these opressive Doctors? Me I suffer from Artheritis and IVDS and both knees. I had my Doctor out on vacation last week and since I am also under contract (Which I Hate) I go by their rules. My back has given me fits with spasm and a lot of extra pain. I had been in the bed for the most part of a week it was bad when my back goes out. I call in to speak to them on their phone lines and I am told since my Doctor was on vacation I should take some Tylenol. I was so mad. I have no recourse other than firing them for violation of the pain agreement? What should or who should I call? I am at the point of being a snowbird and taking off to another country this fall as the winter kicks my tail and the way valid SC bad back veterans are all under the evil eye. I hope it works out but to be honest it is just as bad on the outisde. I am serioulsy looking to move to the Phillippines this fall where my buddie lives he says that a lot of veterans are able to buy their meds a whole hell of a lot easier there in the Pharmacys there than it is to get proper treatment here. Any ideas or advice I look forward to hearing from anyone. Have a good day......

[allan]

Rental,

Since im intolerant to morphine & methadone the VA was prescribing Oxycontin 20mg CR & Oxycontin 5mg for breakthrough pain.

For somereason they stopped supply the 20mg CR & recomended I go to a private Dr & get a prescription. After locating a Dr I notified the VAMC that I was recieving the 20mg CR from him.

Not long after this I get assigned to a new outreach VAMC clinic near my home.

First thing this new Dr does is accuse me of violating pain management aggreement & getting pain meds from two different sources without notifying the VA.

He cut off "all" my prescriptions, removed all my diagnoses from the records & it took months of paying out of pocket to get it straightened out after filing a complaint against him with the VAMC.

Don't let them jack you around. Take it to the VAMC Director ASAP.

[MikeR]

I deal with the pain on my own and as long as I have health insurance I will stay away from the VA.

[Wings]

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Rental, call the Director of the VA Ethics Committee in D.C. I've spoken with her in the past, and she was friendly. The Ethics Committee can make a study case of your issue. ~Wings

[Notorious Kelly]

Carlie,

Here's a Pain Management Agreement I 'came across':

PMA Agreement

You can click on each page and enlarge it to read.

Edited July 8, 2009 by Notorious Kelly (see edit history)

[john999]

If you are going to use the VA then it is good idea to be really nice to your PCP even if they are a PA. If you have good insurance and you don't want to use the VA then tell them to go to hell. I use them because I get pills for free and I have gotten a hell of a lot of testing done that costs thousands of dollars on the outside. My PCP did all this for me. She got me SC'ed for CAD and a few other things. You have to swollow your pride and just act dumb and smile. You can trigger their helper response by pretending to be the pathetic vet who is earnestly dumb, but seriously ill. I told a pharmacist to go &&^% himself, but that was a mistake.

[airborne18]

The VA is a Pain in the butt when it comes to pain management. Without any pain management I live in a 8-9 level pain. I went to the VA with pain medicine already prescribe by my other doc. Violins here, was broke and just started the claims process, actually on medicaid at the time and we lost that. So I had to deal with the VA for Pain meds.. It took me 6 months for them to prescribe the meds I was already taking ( and they were not narcotics ).. And the Pain management nurse at my hospital is nice, but I just want to punch her in the face. She just tells you sorry, I cannot help you, it is VA policy.

Once I got service connection for my back.. The deal changed alot.. I no longer ask, I tell them what I want. And if they say no.. I just go over their heads.. I am nice about ( YES ALWAYS BE NICE ).. And I only do it with the Pain Management nurse, now I tell her it is my POLICY not to be in pain.

My point here is.. if you are service connected for the condition causing the pain., then you should be able to overturn the decision very easy.. If it is not service connected then you might have a fight.. Just make an appointment with your PCP, explain exactly what happened.. Your situtation acutally happened to me, except I did wait the 2 - 3 hours.. But you know where you failed to live up to your end, and you had a reason. If the PCP says no, then say I want to talk to your supervisor, or the doctor..

If this does not work, go to your neurologist or orthapetdic, ( i don't know what your medical problem is ).. and explain it to them.. they will probably be more sympathetic and will either prescribe it or help you get it overturned.. ( this has worked for me ).

[john999]

When I first went to the pain clinic I asked them for vicodin and for mobic. They said "NO" to both. They gave me morphine instead. Am I crazy or are they crazy? I could not stand the morphine or the methadone so I got percoset and they will probably take that awayf from me now. All the pain clinics both private and the VA are a pain in the ass. Either they are drug dealers who only take cash or they are so afraid of the DEA they won't prescribe what you need.

[rentalguy1]

Airborne: I wish it were that easy, but they are all on a power trip it seems. I have appealed to the chief of staff and director of the hospital, so we'll see. I am service connected for the condition that causes the pain, and have been so for the last 15 years.

[rentalguy1]

OH, I also looked at the VA's own pain management literature last night, and they have neither a medical or a legal leg to stand on here. They have completely mis-handled this situation. Failure to submit to a piss test is not reason for immediate cessation of opiod therapy, per their own written material.