Appealing Pain Management Agreement, Etc.

[rentalguy1]

Some of you all know that I violated my pain management agreement because I couldn't pee on demand. The chief of PC has seen fit to pull me off of darvocet due to this, even though I cannot tolerate the stronger narcotics due to suicidal behavior caused by them in the recent past. This person also put some lies in my medical records. I just found all of this out today, and I have contacted the patient advocate and been instructed to write a letter of appeal. Here it is for your comments:

Ms. X and Ms. Y,

First I would like to extend my appreciation to the staff of the James H. Quillen VAMC. The care that I have received from this hospital has been outstanding, and I look forward to continuing my care here for many years to come.

On June 22, 2009 I had a appointment with the orthopedic clinic at the hospital, followed by labwork which had been previously scheduled. Between the two appointments, I had a urgent need to stop by the restroom. This has apparently wreaked havoc on my medical care within the primary care clinic. When I arrived at the lab, I was told that I had been scheduled for a urine drug screen, and that I would need to provide a sample. I told them that I had just used the restroom on the way to the lab, and that I would not be able to provide a specimen for quite some time. They told me to drink water and wait.

Ordinarily, this would not have been a problem, but on this particular day my in-laws were visiting from Austin, TX, and my entire family was waiting on me to come home and resume our plans. They were only able to visit for a few days, and I did not want to let everyone down because I was stuck at the VA hospital waiting to pee. I explained my situation to the lady in the lab, and asked if I could reschedule. She told me to call the hospital and reschedule the lab. There was never any discussion of a violation of a pain agreement. Furthermore, I was never given any warning regarding the uds. Had I known I needed to give a urine sample at the lab, I would not have stopped at the restroom on the way over.

This incident has led to a violation of my pain management agreement, cessation of my Darvocet prescription, and questionable language in my medical records. These are the three issues that I wish to appeal.

I. Violation of Pain Management Agreement

A. I understand the need for a pain management agreement, and for the need of pill counts and drug screens.

B. As I understand it, I am to be called in for a drug screen, and I am to be given 24 hours to respond to that call. This is per my copy of the pain management agreement.

1. I never received a call telling me that I was to submit to a drug screen.

2. If I had cancelled/rescheduled my ortho and lab appointments for that morning, because of my in-laws visit, would that have constituted a violation of my pain management agreement?

3. If I had been unable to keep that morning's lab appointment for any reason whatsoever, would that have violated my pain management agreement, even though I had no idea I was to be given a drug screen?

C. When I called in to reschedule the labs, I was given a date and time to be at the lab. There was no mention of a violation of my pain management agreement.

D. When I came to the lab at the rescheduled time is when I was notified that I could not have the lab work done and that I was in violation of the agreement.

E. I immediately called and scheduled a appointment with Mrs. Z, my new primary care provider, in order to rectify this dilemma. At my appointment she told me that she does not have to give me any warning of the drug screen, and that is what makes this random. I question the validity of that statement on the grounds that it is too easy to cause a violation if one does not even know there is to be a drug screen. She also said that I should have known to expect a urine sample because they are required at all labs.

1. I am not a medical professional, so I am not sure how I am supposed to know that a urine sample is required at all labs.

2. This particular lab appointment was for a lipid panel and liver function. All blood tests, as I am told.

3. The only other time I have been given a urine test is when I initially signed the pain management agreement in 2007. I was never required to give a urine sample at any other time until this most recent lab. This negates Mrs. Z's assertion that I should have known to expect a urine sample, because they are required at each lab.

4. Also at this appointment, I voluntarily brought all of my Darvocet pills in for a pill count, without being asked, and I submitted to a drug screen at the request of Mrs. Coeburn, without hesitation. The drug screen came back negative for anything except my prescribed medications, of course.

I seek to have my pain management agreement reinstated. I am not a illicit drug user. I am not a drug dealer, for if I was I would still have a prescription for methadone or morphine. I do not abuse the drugs that I am prescribed. I am a veteran who takes these prescriptions very seriously, and I try to live my life with integrity. I have been made to feel like a criminal in this case, and that is not how the VA is supposed to treat veterans.

II. Cessation of Darvocet Prescription

A. Due to the violation of my pain management agreement, my prescription of Darvocet was cancelled. When I appealed this through my primary care provider, the Primary Care Director, Dr. Complete Dumbass, stated that Darvocet is not the recommended narcotic therapy for long term pain management.

1. I have never been seen or treated by Dr. Dumbass.

2. It is very obvious that neither Mrs. Z nor Dr. Dumbass have reviewed my medical records thoroughly. If they had, they would have noticed that I tried the more appropriate narcotic Methadone, and failed it. I became suicidal on the stronger narcotic. That is the reason that Dr. Wishhehadntretired and I made the decision to keep me on Darvocet as long as I could manage my pain with it. I DO NOT WANT a stronger narcotic, as I am able to manage my pain level with Darvocet and my other medications.

B. I have been taking Darvocet continuously since late 2007, minus a very short time in early 2008 when I tried Methadone. That is nearly two years. To take me off of it now, would mean either withdrawals, or a severe increase in my pain level, or both. I do not want to suffer with either of these, nor do I want to take the risk of becoming constantly suicidal again with a stronger narcotic.

I seek to have my prescription for Darvocet renewed, as it best fits my situation. I understand that different practitioners have different thought processes concerning pain management, but is it really worth putting the patient through physical and/or mental hell just to show that you are smart? If it ain't broke, don't fix it.

III. Removal of Language From My Medical Records.

A. From 1994 until 2007 I was told by various VA doctors that my back problems were due to a back strain. They even had the X-RAYS to prove it. Since I am not a doctor, I put my full faith in them, even though I had debilitating symptoms that put me completely out of commission frequently. I had shooting pains down my legs. I had saddle area, leg and foot numbness. I also had urinary incontinence.

B. In 2007 my wife insisted that I go to a civilian doctor, and he sent me for a MRI. Turns out that I had worse problems with my back than I had been told. This MRI shows a disc bulge at L4-5, and a disc bulge, bilateral degenerative facet disease, and moderate central canal stenosis at L5-S1.

C. In December 2008 I had another MRI of my spine which showed the same conditions as the 2007 MRI.

D. On June 22, 2009 Dr. Complete Dumbass, Primary Care Director, made the following comment in my medical records, "Repeat MRI in 12/08 reviewed. No significant disc pathology to cause spinal stenosis."

E. I am not sure of Dr. Dumbass's qualifications in radiology, neurosurgery, or orthopedics, but I do know that his comment does not agree with the comments made by the qualified radiologists that read my MRI's. Furthermore, I am not even sure why a doctor would have made this statement to begin with. I want to stop short of a accusation of malicious intent, because I do not want to believe this to be true, but I feel as if I am being made out to be a liar and a drug seeker. The medical evidence in my records PROVES otherwise, though.

I seek to have this inaccurate language removed from my medical records. I do not need a explanation why it was put in there, I simply want it removed because it serves absolutely no meaningful purpose to be there.

Sincerely,

rentalguy

[Rockhound]

I don't understand why you have to even be a part of a pain management program. I receive Oxycodone for my pain, which is a class of narcotics controlled by federal regulation for opiates

The only thing I have to do is call ahead to have a new perscription written each month and if mailed out, I have to sign in person to get them, they usually come by fedX when mailed out. Which reminds me that I need to call, so I can get them renewed on my next visit.

Again, I hope the best for an acceptable conclusion to this problem.

Rockhound Rider <_<

Carlie..thanks so much

Rock...I understand you comments, and I agree with the VA's initial actions, however where our mutual agreement deviates is that according to my pain management agreement, I am supposed to be given 24 hours notice when I am selected for a "random" drug screen. Had I been notified, even the morning of the labwaor, this would not be a issue. The manner in which this transpired was not "random" at all, but was in fact "secret." Now that I know this provider intends to give secret drug screens, rather than random ones, I don't even have a problem with that. I'll simply hold my water any time that I have labs scheduled. And let's not even get me started on the illegality of this pain management agreement. "Sign this agreement, and submit to us or you won't get any pain medication." Anybody ever heard the term coercsion?

I do not intend to roll over on this one. I would prefer to suffer in pain and take motrin bought at Wal-Mart, rather than let them win. This is me beyond pissed off and ready for a fight.

[rentalguy1]

Oxycodone and Darvocet are in the same class of opiates. Some VAMC's are lax, and some are strict. It all stems from a VHA directive that came out in 2003. Mine can't make up it's mind which it wants to be. I think I just caught some docs on a power trip that week.

[john999]

If you are ejected from pain management program you can still get your meds from your PCP. You don't lose benefits. I remain in the program because otherwise I have to go out to the VAMC every month to get a refill of the percoset. The program is very inadequate. They tried me on four drugs. I had a bad reaction to methadone and the morphine. The percoset is not adequate to my needs anymore. Tramadol is just too weak. So that's it for me. They will not even discuss oxycontin as it is a "bad drug". What we all have to realize is that the VA is not concerned with vets becoming addicted. Their concern is with vets selling their medications on the street. Since oxycontin is a highly in demand by street addicts they won't prescribe it in their belief that I will turn into a drug dealer instead of using it for my chronic and long standing pain.

[rentalguy1]

Well, the patient advocate was a effin joke! The way I see it, I have two option here:

1. Get VA PCP to give me instructions to wean off the darvocet and then prescribe a non-narcotic that is comparable.

2. Go back to my civilian PCP and see if he won't prescribe the darvocet for me. After he hears about the violation, though, I doubt he would give me the meds.

I am honestly leaning towards option 1. I don't want to be on any narcotics anyway. I am deeply concerned about my pain level in the winter, though.

any opinions?

[john999]

Rental

Go to your civilian doctor to get the pain meds. In the meantime, go with the written appeal to the head of the medical department. Skip over the patient advocate. There is always a way to get back into these programs if you create a big enough fuss. Don't tell you civilian doctor about any "violation". Just tell him it is easier to get meds from him that deal with the VA. If you get back on the VA program don't tell him. Use him as your backup in case they do this stuff again for some reason. That is what I do. I have a private pain doctor in case the VA gives me a problem.