Discrimination As A Standard Practice

doctors walking away

Medical Discrimination

Many people believe that Opioid Sparing is becoming the standard practice in medicine. They are sadly mistaken. Instead, the standard practice is now to discriminate against patients with disabilities with severe pain as a component. Many facilities have instituted No-Opioid Policies. If patients have an allergy to NSAIDS or a comorbidity like Chron’s disease, or Kidney Disease they may be provided no alternative options. 

I have treatment resistant Complex Regional Pain Syndrome (CRPS) and tried and failed a multitude of treatment modalities. During these trials I developed allergies to several Opiates, NSAIDS and endured a bout of Serotonin Syndrome. So, my treatment options are now extremely limited.

When I present at the ER, I pull up my EHR from my PCP’s office and hand it to the Triage Nurse so they can transfer my allergy list. Unfortunately, I’ve learned from experience that a handwritten list gets me labeled as a “Drug Seeker” because my pain management regimen is unusual.

I was recently admitted to the hospital for kidney stones. I was too ill to attempt to take any medication prior to going to the Emergency Room and didn’t anticipate being admitted, so I didn’t take my medication with me. I was transferred to a different facility because the hospital where I initially sought treatment didn’t have the specialist I needed on staff.

It took over four hours after I arrived for the hospitalist to visit me in my room. When we discussed my pain management regimen I suggested that she contact my Pain Management Physician for recommendation since my treatment options are extremely limited, and my maintenance medication is a compound that I knew they wouldn’t have access to. She refused. 

I use Ketamine troches (sublingual lozenges).  They could have substituted IV injections. Which would have been a non-opioid alternative.  But, the doctor stated “Ketamine is dangerous”.

I explained to her that I my pain condition was not responsive to Opiates. Two hours later the nurse came in with some pain medication. A Norco tablet, which is a weak opiate. Their justification was that my blood pressure was elevated. The Hospitalist had ordered Norco for mild to moderate pain and IV Dilaudid for Severe Pain. Apparently, they believed that I am ignorant of the fact that Opiates lower blood pressure, they don’t raise it.

An hour later they finally provided the Dilaudid and my pain reduced from a 9 to an 8. The orders were that it was to be administered every 4 hours if requested. Instead, when requested, it was often delayed 2-3 hours. The pain would be so intense that I would develop tremors & vomiting.  

Knowing that I’m difficult to treat, I gave them credit for making some attempt to control my pain. Until the day I was being discharged. My last dose of IV Dilaudid was at 4 am. When the nurse came in at 8 he brought me a Norco and I was extremely confused. I told him they don’t work and the orders for severe pain are for Dilaudid. That’s when he informed me that they don’t administer IV meds to patients that are being discharged.

I requested an ADA accommodation. Due to my medical condition, the medication they were offering was not sufficient to treat my condition. He claimed that if he administered Dilaudid he would lose his license. Apparently, he thought I was stupid. Hospital policy is not the law. Then he claimed that the ADA doesn’t require he dispense Opiates. I informed him that I wasn’t requesting Opiates. I was requesting that they effectively manage my pain. I didn’t care what treatment modality they utilized, as long as I wasn’t allergic to it and it effectively managed my pain.

I spoke to a Patient Advocate, who afterwards sent up their Risk Management Coordinator.  When I explained the situation to the RMC, she stated “You know the law” and agreed that they were in violation of the ADA. She went and spoke to the doctor who knowing they were in violation of the ADA refused to accommodate my disability. So, it appears that Baptist Hospital Downtown’s  policy is to NOT effectively treat patients with Severe Pain conditions by offering non-opioid alternatives or to comply with the ADA.

Unfortunately, this was not an isolated incident. It’s not reserved to Baptist Hospital Network. During an ER visit to Methodist Hospital I fell on my CRPS affected limb and my pain was at a 9. Since I can’t take NSAIDs for pain relief I was provided 2 Tylenol. At Christus Santa Rosa they administered one of the Opiates that I’m allergic to with Benadryl. Patients reporting pain are disbelieved and/or stigmatized for seeking treatment or due to the medications they take. This isn’t a problem exclusive to my city, region or state. It’s a national crisis.

In a nationally representative cross-sectional survey study, 21% of 2137 US adult survey respondents indicated that they had experienced discrimination in the health care system, and 72% of those who had experienced discrimination reported experiencing it more than once.

Patient-Reported Experiences of Discrimination in the US Health Care System

We’re in the midst of an underacknowledged crisis in care. A raging PAINdemic and Discrimination in Medicine. Opioid Phobia is so prevalent that patient abandonment is common and patients are stigmatized due to their medical conditions or pain management regimens.  If you’re a patient with a complex medical history with multiple comorbidities you’re essentially a pariah. You’re automatically disbelieved, either labeled a Drug Seeker, accused of Catastrophizing or of having a Somatoform Disorder because “no one” could possibly have the symptoms or combination of health conditions you’re describing.