Day 4 of our medical nightmare: Observations and FAQ

by Stephen Cobb on June 11, 2012

We spent Sunday, June 10, at home in our new apartment surrounded by boxes that have not been unpacked. Spending 3 days in any kind of medical facility will blow a hole in the best laid moving plans. Coming out of the facility in a heap of pain will only make the hole bigger.

Nurse Layla keeps vigilChey is in a lot of pain and spent most of the day in bed asleep with, as you can see on the right, the ever faithful Nurse Layla in attendance. (A few years ago Chey got a type of memory foam mattress that has air pockets to keep it cool.) Chey tried to sit up and read but it was too painful to sit up for long and the Ativan makes it hard for her to concentrate enough to read.

In between unpacking boxes I wanted to get a few more observations down on paper, as it were, and answer some questions that I can hear forming out there. My apologies in advance for any typos.

Q. Was Chey arrested?
A. No.

Q. In what kind of locked facility was Chey held?
A. The Sharp Grossmont facility called Behavioral Health.

Q. Was Chey held on a Section 5150?
A. No. Section 5150 is part of the California Welfare and Institutions Code. Quoting from Wikipedia, 5150 is a section of the Lanterman–Petris–Short Act or “LPS” which “allows a qualified officer or clinician to involuntarily confine a person deemed to have a mental disorder that makes them a danger to him or her self, and/or others and/or gravely disabled.”

Q. Why do you say Chey was detained against her will?
A. When Chey was inside the secure medical facility she and I were told that she would be detained for 72 hours under Section 5150 if she did not agree to stay on a “voluntary” basis.

Q. What are some implications of being held on a Section 5150?
A. The federal government is informed of all 5150 holds and you can probably forget your right to own or possess a firearm if you have been 5150’d. You also lose the ability to obtain or retain the  Top Secret (TS/SCI) clearance that Chey needed to work for the NRO.

Q. What was the detaining facility like?
A. It was a clean and modern building located on a beautifully landscaped hospital campus, but with high walls so you couldn’t see much of the campus, and the doors were locked and alarmed, meaning the doors could not be opened by anyone but staff and attempts to open them set off a loud alarm. All personal possessions have to be handed over to staff. Prayer beads are not allowed. You would expect many of the people staying at such a facility to have serious behavioral problems.

Q. You say Chey has suffered for years from under-treated chronic pain, how unusual is that?
A. Chronic, under-treated pain afflicts over 100 million Americans.

Q. What is a drug seeker?
A. This is medical code for someone who is judged, at the sole discretion of a nurse or doctor, to be seeking drugs to get high and/or feed an addiction.

Q. Is it drug seeking to ask my doctor to give me something for my pain?
A. That depends on your doctor’s opinion. He or she can call it drug seeking if they like.

Q. What about seeking relief for pain while you are in hospital, surely that is okay?
A. When Chey was in the psych ward she was handed a document that said: “When having pain, it is important that you promptly communicate the type of pain you are feeling, its location and the level (zero to 10) so that we can create a plan to treat your pain.” Another document stated her right to prompt medical treatment. Chey’s attempts to communicate as instructed in this documented were not only ignored, but she was told “We’ve called your husband so he can tell you to stop bothering us.” Chey entered with level 8/9 pain and her pain remained at that level through her departure.

Q. Is Chey a drug seeker?
A. No. She is a pain relief seeker. Chey has no desire to get high. She just wants to control her pain to the point where she can do more than like in bed wincing in agony every time she adjusts her position. Getting enough pain relief to where she could work again would make her very happy, but not high.

Q. What are the implications of being branded a drug seeker?
A. Very few doctors will treat you. You may also lose the ability to obtain or retain the  Top Secret (TS/SCI) clearance that Chey had to have to work in data security for the NRO.

Q. What is a pain contract?
A. Some doctors refuse to prescribe strong pain medicine, regardless of the patient’s condition, and without any evidence of drug abuse, unless the patient first signs a “contract” in which the doctor asserts the right to deny further treatment if the patient violates certain clauses.

Q. What is an example of a pain contract clause that a doctor might cite as a reason for denying treatment?
A. “I will not ask for more pain medication than I am currently allowed.”

Q. Are you serious, I mean are these pain contracts for real?
A. Very much so. Here’s an AMA article: “what is becoming common practice in many pain specialty clinics is using a preprinted, standardized form that says, ‘If we’re going to treat or prescribe controlled substances to you, these are the conditions under which we’ll do so–and sign this document, and if you fail to do so, then we’ll fire you from our practice.’ ”

Q. Did Chey sign a pain contract with a pain specialist?
A. No, she was forced to sign a pain contract by her primary care doctor in San Diego in order to continue the treatment plan she was on in New York.

Q. What is an example of a pain contract?
A. Here’s a sample pain contract. Note that there is nothing in the contract for the patient. There is no provision to get more medication if the patient experiences additional pain.

Q. What are some more sample pain contract clauses.
A. These contracts tend to have clauses like: “I agree that I will use my medicine at a rate no greater that the prescribed rate and that use of my medicine at a greater rate will result in my being without medication for a period of time.”

Q. Why do you say Chey was forced into an unsupervised “cold turkey” detox?
A. Note that the sample pain contract includes a provision to end the treatment over time. Chey was already out of medication where her doctor refused to provide any more, and no supervised detox was offered.

Q. What other information can I find about pain contracts?
Here’s more info from an article on the topic in a medical newsletter: “may require patients to submit to blood or urine drug tests, fill their prescriptions at a single pharmacy or refuse to accept pain medication from any other doctor. If patients don’t follow the rules, the agreements often state that doctors may drop them from their practice.”

Q. Do all doctors think pain contracts are a good idea?
A. Thankfully no. Here is a good explanation of why pain contracts are bad for patients and doctors.

Q. Are pain contracts legal?
A. I’m not a lawyer but a pain contract hardly fits the normal definition of a contract since there is no choice in the matter. The patient agrees or suffers the consequences, like disabling levels of pain.

Q. The apporach taken by Chey’s doctor sounds pretty uncaring, what are some examples of other uncaring things that Sharp Rees-Stealy doctors have said to Chey since she became a Sharp HealthCare patient?
A. 1. Hematologist, consulted for hemochromatosis: “You’re wasting my time, I have patients with real diseases to see….have you ever seen a picture of child with leukemia, that’s a real disease.”
A. 2. Rheumatologist, after cursory examination of patient’s hands: You obviously have osteoarthritis, what do you want me to do about it? (Delivered with a tone and attitude that clearly implied “Get out of here you are wasting my time”.)
A. 3. Endoscopy doctor, after an endoscopy, speaking to me and Chey: “Don’t ever tell your doctor you are bleeding from the rectum again, it’s a complete waste of my time.”

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