Stanford has a policy that no medications are prescribed on the first visit.  It is written on the new patient pages.  I was not told that by intake coordinator.  My client said the doctor was very nice and agreed he needed the medication at the prescribed dose.  He verified the letter that Beth Israel Hospital in NY was well known as a reputable pain center.  He explained to my client in cases like his, where medication is stable and necessary, Stanford likes  to support the PCP in writing the prescription.  He stated the research validates it is better for the client.  He gave my client a form to give to the PCP and said he would fax a letter  explaining the validity of the dose.  It all sounds logical and medical but my client was still left without a prescription.

My client went to the PCP's office, a community health center.  The nurse  informed my client the PCP had written a prescription for two days only (this was before any information from Stanford) and he was gone for the holiday long weekend.  My client spoke to a supervisor who said there was nothing to be done.  AND BYE BYE.  As you can imagine, my client called me in a panic.  What was to happen?  Would withdrawal occur?  Would increased pain and suffering occur after more than five years on pain medication?  By the time I received the call it was late in the day.  I made some calls and only got voice mails or  asked to leave a message.  

The next morning, I knew  something had to happen.  It was the Wednesday before New Years Eve and medical facilities close down.  I decide it was time to climb up the administrative ladder.  I was able to find the medical director's email, phone and fax numbers.  I proceeded to write the story, asked him to intercede and emailed it.  To my delighted surprise within twenty minutes, I had a response.  He was going to look in to it.  I faxed him a release to speak with me and waited.  Three hours and I decided to try and reach the  pain doctor as a back up.  I spoke with the Stanford front desk and left a message even though I was told most everyone was gone.  Again, to my surprise and delight, the doctor called me.  I thought, Happy New Year, 2010 is going to be amazing.  I had a great conversation and asked him to call the medical director.  He said he would.  He called me back in about fifteen minutes to say the medical director had already decided to write the prescription.  I was elated and very thankful and so told the doctor.   We even spent a few minutes talking about the role of an advocate.  I called my client and was told the medical director had just called to come pick up the prescription.

And so I wish, this was the end of the story.  Today, I received an email from my client stating the insurance was not paying for the medication until a new medical necessity form was received and reviewed.  This could take up to seven days.  My client will have to pay for a few days.  Luckily, California has a rush review that has to occur within three days.  But still the earliest, the medicine will be available is three days past the original end date.  My client, having a terminal illness and chronic pain is loosing hope.  It was a very depressed email I received and have been doing my best to uplift the spirit.

What can I say about a system that reminds me of a Kafka novel or the life of Job?  Is this story an extreme example of our current system?  Unfortunately, it highlights, the absurdity of many policies and prejudices of our system and the harm done to many who in good faith follow what is asked of them, only to end up in the same place, bankrupt and still suffering.