The Toxic Balloon
(Page 2 of 4)
From what Nancy Strolich, a claims professional for the Kankakee, Ill.-based Birchwood Underwriters was seeing, on paper anyway, Rick Cornell’s workers’ compensation case was no different from many others.
Among the 220 cases she reviewed each month, Rick’s was one of those that she flagged because he was on an opioid analgesic. But there wasn’t much else there to worry about, at least not yet.
Still, Rick was in Florida and although she was licensed in Florida and her firm had an office there, she didn’t have face to face contact with him.
What Nancy couldn’t see was the inside of Rick’s body, which was beginning to resemble a chemical lab on tilt.
Five months after his work-related injury, Rick’s back injury was acutely painful and he was struggling to control the pain.
Rather than use the medications that he was given in the prescribed way, Rick was doubling up on his dosages.
Nancy could see that Rick was beginning to use more and more pain killers. But she couldn’t see evidence that he was taking Ambien and Prozac because those prescriptions were filled through his group health plan.
Rick worked in the medical field, but he was no student of pharmacy. So he wasn’t aware that taking all those drugs, the hydrocodone, the tramadol, the ibuprofen, the metaxalone, the Prozac and the Ambien was in some cases limiting the properties of individual drugs and amplifying the impacts of some of the other drugs in concert.
Nor would he acknowledge the fact that because he, his father and brother were all smokers, that meant that he had traits that predisposed him to becoming addicted to opioids.
All Rick knew was that less pills meant more pain. His dependency and use had gotten so strong and voluminous that he was beginning to feel withdrawal effects like sweating and nausea if he went without ingesting an opioid for more than five hours.
He knew he should cool it with the pills, but with his brother Petey gone, Rick just wasn’t in a mind frame to be self-preserving, despite the fact that he was married with two young children. Rick had always told himself that he would never be a heavy drinker like his father or take drugs, like he knew Petey did on occasion.
But the combination of ongoing pain and increased physical dependency on drugs was mastering Rick. So back Rick went to another doctor, recommended by Petey’s friend Buddy. “Dr. Limon’s the man. He gives you the pills right there,” Buddy said.
“Cash and carry, baby,” Buddy said.
“I like it. You got his number?” Rick said.
Rick told Dr. Limon a different story. He told him he was agitated, he couldn’t sleep from the pain and quite frankly, was now suffering from constipation.
More tales, more pills, and Rick was out the door with some Xanax, an anti-anxiety medication, the narcotic pain reliever Oxycontin IR and a laxative.
Rick wasn’t about to ask what the doctor was charging for the dispensing out of his office.
It was several weeks until Nancy got the bill for those prescriptions on paper and her eyes nearly jumped out of her head. Dr. Limon was charging for the Xanax and the Oxycontin IR at a 200 percent premium compared to what is usually charged at the retail pharmacy. He had even billed a 100 percent premium on the laxative.
In addition to using physical therapy, Rick was also seeing a chiropractor. He had been off work now for nine months and indications were that his back was still weak and he was still experiencing significant pain levels.
Just a few days after seeing Dr. Limon, Rick still wasn’t feeling right, so back he went to the doctor he used in his group health plan.
“Don’t you have anything that will help me sleep at night?” he said, using his voice to be a little accusative. After all, it was the doctor’s job to help him feel better.
“The Ambien’s not cutting it for you, eh?” the doctor said.
“No. Not really,” Rick said.
“Okay, try Lunesta.”
Nancy was now starting to see the volume of medications Rick was taking under his workers’ comp claim increase. But she had no indication of whether he was getting any better, or how his combined prescription regimen was affecting him.
Rick was now taking Xanax from one source and Prozac from another. Nancy was able to see that Rick was increasing his prescription frequency of hydrocodone, tramadol and metaxalone. She decided to place a call to the workers’ comp network physician to open up a dialogue.
This is what she got in her first attempt.
“Hello, you have reached Fountainebleu Medical Associates, where your health is our No. 1 priority. Due to high call volume, we are not available to answer your call at this time. Para Espanol, oprima el dos. If you are experiencing a medical emergency, dial 911. To fill a prescription, press one, to get lab results, press two, to speak to a medical associate, press three.”
Nancy dutifully pressed three.
“There is no one available to receive your call at this time. Please leave a message with your name, date of birth, social security number…”
Nancy’s other line buzzed. She had to answer it. She’d have to try that doctor in Florida again sometime. “Social security number? My social security number?”
(The Scenario continues on page 3)