In todays society there are various health care providers. They practice in all
types of settings and often can find themselves placed in a circumstance where
they must make accurate and caring decisions for patients and his/her
caregivers. Patients with a disabling disease may encounter many type providers throughout his/her disease process. A patient must be able to place their trust in them and rely on their clinical
judgment to improve their health care needs. Now more so than ever, a health care provider should carefully recognize the importance of his/her role and practice with integrity, compassion, and skill. We as a community at times overlook the importance of the role of the pharmacist, yet they are a primary gate keeper for the sick and disabled. The following is a formal complaint in regards to pharmacist, Lori Estridge, Walgreens Pharmacy at 5555 Edmondson Pike, Nashville, TN 37211 (Nippers Corner). [continued below]....
On May 29, 2011 at 2:18 pm my significant other (patient) and I drove up to Walgreen
pharmacy window to drop off a prescription (refill) which included Soma and Roxicet. The pharmacy representative immediately responded by saying she would have to check to see if they had
enough Roxicet to fill the prescription. Within five minutes she told us that it would be a 45 minute wait. We sat in the parking lot until 3:00pm and then drove back to pharmacy window. At this
time we were told by the representative that Tenn-Care would not pay for Soma until preauthorization was performed and would only pay for 80 tabs of Roxicetand not the complete prescribed quantity, 150 tablets ordered by the neuro surgeon. We offered to pay for the
remaining 70 tabs to ensure appropriate dosage was received for time period of 30 days and asked how much it would cost. The representative stated that they could not allow cash payment unless
the entire amount was paid for or we could just take the 80 tablets that wouldbe covered by Tenn-Care. When I questioned why, the representative stated that there was a new law that did not allow them to receive partial payment. Upon further questioning, the pharmacist supported the representatives statement, however, could not provide me with the DEA 2011 legislative title or
number. We decided to make full cash payment for both medications and then were told to wait another 20 minutes. While waiting, at 4:14pm I decided to call a TN Care representative (1-866-434-5520) and explain to her our dilemma. The representative stated that she did not know of any such law and the TN Care enrollee had every right to pay for remaining count until physician of record could send them clinical information to over-ride the 80 tablet limit. I asked if she would speak to the pharmacist and she agreed to. I parked the car, walked into the pharmacy with cellular phone in hand and the pharmacist refused to come to window to speak with the representative. I then proceeded to place the phone on counter with the speaker on however, the pharmacist ignored the conversation and placed a call to someone else. After
the pharmacist finished her conversation, she again told me that it did not matter what Tenn-Care stated, it had to do with a new DEA law and she could not fill entire prescription. She again gave
me only two choices: 1) pay for entire amount with cash, or 2) accept only partial quantity that TN Care would pay. Let me be very clear, she never walked up to window, made very little eye contact, and she spoke to me in a very abrupt and demeaning way. Before leaving, I again asked for information regarding the new law and she could or would not provide me with evidence. At
that point I determined to fill only 80 tablets and pay for complete order of Soma (it too needed preauthorization from TN Care).
As of this month, the patient, Traci is a new TN Care enrollee. She became legally medically disabled March 2011. Prior to this day, Traci nor I possessed complete knowledge of Tenn-Care prescription benefits, but we know now because after returning home I researched and read everything available on TN Care benefits. In brief, this is what I know:
1. Fact: Certain medication prescriptions
presented at pharmacy that have not been prior-authed cannot be filled until auth is obtained. It is the responsibility of the pharmacy to notify physician of record for authorization
either by telephone or by fax. If they are not able to reach a physician, the patient is to be provided an authorization form to have completed by physician.
When I called Lori later from home at 8:09 pm, I asked her if they had called or faxed the authorization to the physician of record. She stated she had not but would do so. I asked her what about the remaining 70 tablets that were ordered by the physician, she stated they are
gone. In fact, on the bottle it reads 80 tablets and no refills.thats not what was written on the prescription and ordered by the neuro surgeon! Since when does a pharmacist re-write a prescription quantity without consent by physician? Traci has been a Walgreen customer for several years which would provide the pharmacist with a history of her medications. It could be easily
noted what her prescribed dosage has been for months.
2. Fact: If the prescription is presented on a weekend or holiday, making it difficult to reach a physician, or there is a delay in reaching the physician, the pharmacist has the right to
perform a 72 hour over-ride to provide the patient with three day supply until auth can be obtained. We never were offered this option!
After learning of this rule, when I called the pharmacist later that evening to ask her why she did not provide us with the option of 72 hr over-ride, Lori stated she had offered that, when I disputed her, she then stated its my word against yours.
3. Fact: Over-rides should be considered if the medication is crucial for the patients
health and well-being.
Traci has been on this treatment regimen since both of her surgeries June
and August of 2010. To abruptly stop anarcotic that is being used for pain management could cause tremendous negative consequences. I, as a clinician of 28 years can clearly understand this.why does a pharmacist not know this? Are they not medically trained upon medications, especially schedule II drugs?
As I continued to speak with Lori on the telephone regarding her clinical judgment and the patient physical/emotional effects that may be caused by abruptly stopping medication, she stated I appreciate that, thank you and then hung up on me. Loris behavior was astonishing! I have been a clinician for 28 years and have been a patient advocate in numerous circumstances and I cannot comprehend such disregard of patient rights. Loris lack of interest and concern for her patient was very bold and will have adverse consequences that include her quality of life in two weeks if we do not seek out medical intervention. This was completely unnecessary and preventable.
4. Fact: Nowhere in the TN Care guidelines does it speak of a rule that prohibits enrollee to make partial payment for quantity. If there was such a rule, Traci as an enrollee should have been entitled to be provided information to support statement.
Please see guidelines as stated by Tenn-Care STANDARD CHAPTER 1200-13-14 Rule 1200-13-14-.11 March, 2011 (Revised) for supporting evidence. In addition to my Tenn-Care research, I called a colleague of mine, a pharmacist that works for the surgery center where I am a director of nursing, regarding a new 2011 DEA law. My colleague stated that he did not know of any new law that prohibited partial payment on quantity but he would do further research and get back with me. Since incident, further investigation showed no such law.
It is of great importance to me that Walgreens knows Traci is not Amerigroup member #XXXXXXXXX, she is a human being! I have known Traci for 14 years and have lived with her for 12 years. I am an RN of 28 years and have worked various arenas in the healthcare system. For these reasons, I feel compelled to speakin behalf of Traci and her health related issues. Ill never forget the day I met Traci in 1996 at our place of employment. She was a vibrant young woman with a contagious laugh! Her work exceeded any previous marketer that our health care facility had. She was energetic, forthright, honest, dependable, and to put it simple, a go getter! I watched Traci climb the ladder of success for years because of her strong work ethics. Traci will always be noted in our healthcare community as one of the best company representatives and marketers around. Her illness began in 2006 when she started having neck and back discomfort. At first, we put it off thinking it was the constant driving, carrying luggage, briefcase, and luncheons from office to office.
However, the aching was persistent and only relieved by rest and over-the-counter medications. By 2007, the pain became more intense and unrelieved by conservative measures and we began to seek out medical help. Her PCP initially tried to relieve Tracis symptoms by administering steroid injections at painful sites; back of neck and right shoulder (too numerous to count), prescribing
narcotics, anti-anxiety medication, and muscle relaxants, but to no avail, the pain continued to increase and began effecting her upper body strength and endurance. He finally referred her to a
neuro pain clinic for evaluation. After six months of various combinations of narcotics including cervical spinal injections and physical therapy, Traci was exhausted, depressed, and tired of
the effects that the medications were causing. At times, I witnessed her being so impaired that she could not communicate appropriately but it was the only way to relieve her pain. She was unable to work because of the pain and/or narcotics. It was at this time that we applied for medical disability, but were denied. Our financial status was in shambles because we went from two incomes to one and her medical bills were mounting. Traci, the women that she is, stopped all
medications, and went back to work. From 2008 to 2010, I personally witnessed her condition rapidly deteriorate. The first part of 2010 her condition caused severe pain (6-10 on a scale of 1-10) continuously. I had to help her get out of bed in the morning, wash her hair and help her get dressed to go to work. Traci pushed everyday to continue to perform her job. Her PCP finally referred her to a neuro surgeon which immediately ordered numerous tests that included; MRIs,
nerve conduction, labs, and a myelogram. The results were devastating! I then understood why her condition had deteriorated so quickly and what was causing her severe pain. The thing that amazed me was that she had been living day-to-day with this disease and going to work
in-spite of it! Like I said, Traci is an incredible person! Following her two major surgeries in June & August of 2010, her mobility and endurance further decreased. She became so physically limited that it was impossible for her to go back to work. Because of this, the neuro surgeon, based upon his knowledge and experience of her condition, determined that Traci could no longer follow her
professional path. He would not release her to work again and determined her medically disabled. Her medical information was submitted to the State disability department, and following a complete medical board review including a comprehensive medical exam, Traci was approved Medical Disability
in March of 2011, then approved Tenn-Care May of 2011. For Traci and I, it has been an extremely long and hard road to finally have a glimmer of hope!
In conclusion, Traci is not just another Tenn-Care member that some providers often frown upon, because of their inadequate knowledge or discriminatory behavior, but rather, she is a person..a person that raised 6 children, has 3 grandchildren that love and adore her.a person that I have chosen to live my life with.a person that has given her time to so many others in need.was an active member of charitable organizations and used her talents to raise enormous amounts of money and support for those in need and are less fortunatea person that worked from
the age of 14 years and paid into our broken health care system repeatedly! Too often health care providers become biased and unaware of their attitude toward patients experiencing pain, especially related to chronic illness, and it becomes exhibited in their behavior resulting in the patient feeling hopelessness, helplessness, and shame. Developing effective empathy skills can help patients feel safe and promote a level of quality of life. Roger and colleagues list three conditions that is necessary for the maintenance of mental health; 1) congruence, 2) unconditional positive regard, and 3) nonjudgmental understanding (as cited by Helms et al., 2006). Perhaps this is what Lori, your pharmacist, needs to work on! She was in violation of several code of ethics including Walgreen Mission Statement of Diversity.
Ronda, RN, BSN, MSN