The Age of Advocacy

Ukranian Art, by Ana Plusk

The medical providers who work at opioid treatment programs in North Carolina have a weekly teleconference to discuss various things: difficult cases, best practices, and advances in treatment for opioid use disorder. We learn from each other.

Lately we’ve been talking more about advocacy efforts.

Especially with the opioid settlement money getting ready to flow out of the state’s financial faucet, we need to remind people that MOUD is the gold- standard, first line treatment for opioid use disorder. We also need to advocate for our patients when they encounter discrimination and are denied their legitimate medication.

Leading this effort is the person who chairs our weekly online meetings: Eric Morse, M.D.

Dr. Morse, owner of a number of opioid treatment programs across the middle of North Carolina,  started sending complaint reports to the Department of Justice when patients are denied their medication while incarcerated or admitted to other facilities.

He told us he sent a complaint about one patient seeking admission to a well-known abstinence-based inpatient rehabilitation facility. This patient was on MOUD but was told he couldn’t take the medication while at the facility. He made another complaint about a patient who was denied the ability to continue MOUD while incarcerated.

The DOJ let him know they decided not to pursue further investigation. That’s disappointing, but not surprising.

Another provider reminded our group that it’s much better to try to educate these facilities and their medical providers rather than make reports to authorities. However, in both above situations, Dr. Morse had exhausted all efforts to contact and educate the medical directors of both facilities prior to sending any complaints.

We now have a website to submit complaints about violations of patients’ rights directly to the Department of Justice: https://civilrights.justice.gov/report/

Anyone can report a violation of a person’s rights experienced at healthcare facilities, jails or prisons, places of employment, schools or educational programs, voting rights, or public facilities. You can print the form, fill it out and mail it in, or you can submit online. The patient can submit the complaint, and so can anyone who witnessed the violation. It can be submitted anonymously, but no reply about outcome could be sent in that case.

This month I’ve been more vocal to our patients who were denied their civil rights. I printed a stack of the complaint forms and have them on my desk. I’ve handed out several to patients who were denied their usual dose of methadone or buprenorphine when incarcerated at our county jail. Maybe one or two complaints won’t matter, but I’m hoping that after fifty or a hundred are submitted, the DOJ may look closer.

I’ve also kept in mind the advice to try to work with other physicians before complaining about them.

In this following example, I changed details to protect the identity of my patient.

A few weeks ago, one of our patients was involuntarily committed to a psychiatric facility in a nearby town. He called his counselor at the opioid treatment program and said the admitting psychiatrist told him that the facility “wasn’t a methadone clinic” and that he would not be getting his usual daily dose of methadone while he was at this facility. My patient was understandably worried he would go into opioid withdrawal. He gave the counselor his psychiatric doctor’s name and asked that I call to advocate for him.

I was happy to do this.

I didn’t have a signed release of information giving me permission to talk to this doctor, but I felt this was an exception to this rule. Medical professionals can communicate without a signed release if there’s a medical emergency. I would call involuntary commitment to a psychiatric hospital an emergency, of course.

When I finally got her psychiatrist of the phone, he was not pleasant.

I introduced myself and thanked him for returning my call, trying to be as polite and friendly and collegial as possible, but my efforts didn’t work. He kept saying, “I can’t talk to you about this patient because I don’t have a release.” I pointed out that under emergency circumstances I felt we could talk even without a release, but he disagreed.

I told him that I appreciated how he felt about this situation, and that he felt he couldn’t talk to me, but perhaps I could give him useful information. I told him the patient’s usual dose of methadone, and said best practice was to continue this dose for the duration of hospitalization. He said that while he couldn’t talk about this patient, in general he didn’t dose patients if he felt they didn’t need it. I then said that the only circumstance I could think of where it would be appropriate to hold the dose would be if the patient was sedated and he was worried about overdose. He then said, “You’ve hit the nail on the head,” over and over.

I can’t say he was lying because I couldn’t see this patient for myself. But I did know he had called his counselor within the hour and sounded very alert and very angry.

This physician was short with me and talked over me to some degree. For a man who said he couldn’t talk to me he interrupted a lot. And, as I pointed out, he could have gotten permission from the patient to talk to me, but he wouldn’t.

What I gleaned from our interaction – and I may be wrong, and prone to overreacting – was that he didn’t think much of me or of our opioid treatment program who were putting people on methadone when they didn’t need it. I felt undertones of hostility and distain from his manner.

After the patient was allowed to leave, 72 hours later, he signed a release so we could get his hospital records. It was thin and short on information. It contained only his discharge diagnoses and not much else. The patient wasn’t on any new medications and there was no admission history and physical, no doctor’s note, and no mention of methadone anywhere in this record. There was no documentation of the conversation with me, and no reason why he allowed this patient to go into opioid withdrawal for three days.

I gave my patient a form to report this to the Department of Justice, as I feel my patient was treated inappropriately and was discriminated against by this doctor who refused to dose my patient as usual while he was being held in a psychiatric hospital against his will.

I will send a complaint report this as well, and I’ll let you know if I get any follow up.

This needs to end.