Sunday, August 5, 2012

Sorry, That's Unacceptable

Actual conversation, the details have been slightly altered.

Me: Hi, I'm calling in an emergency narcotic prescription for my nursing home patient, Terminal Cancer.

Pharmacist: Which facility?

Me: The Local Nursing Home, Lake Forest.

Pharmacist: What do you need?

Me: Terminal is a hospice patient.  He's in alot of pain tonight.  I would like to increase his dilaudid PCA from his current continuous dose of 0.7mg to 0.9mg per hour.

Pharmacist: Have you called in an emergency prescription  for dilaudid before?

Me: Yes, the DEA number on the script the hospital sent a few days ago was wrong, so I had to phone in the original dose.

Pharmacist: Unfortunately government rules state that you can only call an emergency dose once for a  patient and a given medication.  You could fax us a hard copy though.

Me: But it's three in the morning, and I don't have a fax machine at home.  Where am I going to find one at this hour? Could I scan and email you a script?

Pharmacist: Sorry, that's unacceptable.  You could give an order for a different medication.  Would you like to change the PCA to morphine?  We would fill that.

Me: The patient didn't get enough relief with morphine in the past.  That's why he was put on dilaudid in the first place.

Pharmacist: I'm sorry doctor.  That's all I can do.  Unfortunately the new government rules on narcotics are making everybody's life more difficult, especially the patients.

I pause in shear frustration.

Pharmacist: Maybe you should just send him to the emergency room.  That's what everybody else does!

4 comments:

Lynda Halliger-Otvos said...

I'm beginning to. Think that the rules are what is unacceptable; especially the patients who need to be taken care of. My brother in law just died last night of lung cancer with inadequate pain relief for the majority of the last year. It is unconscionable and yet what's the solution?

Doc Nieder said...

Please check my blog, familypractice2.blogspot.com to see how burdensome the narcotic law is in KY. The only upside is that hospice patients are excluded.

Anonymous said...

I would think that hospice patients would be exempt! That is just ridiculous.

Shelley said...

Disgusting. That is all that comes to mind. If we won't provide appropriate pain relief to those in the final stages of a terminal condition then we could at least offer the ability to end the patients life if they so choose.

In 1990 my grandmother died at home in my arms of ovarian cancer. She was in aqelia hospice program. We could only get her Tylenol 3 that last week!