California Workers’ Comp – Fueling the Prescription Drug Epidemic?
On September 29, 2008 Krissie Bergo was admitted to treatment at the Malibu Beach Recovery Center. She had not abused street drugs or alcohol; she was admitted because she was hopelessly addicted to narcotics and benzodiazepines. Her pusher was “Dr. X,” her Workers Comp Pain Management doctor.
There is a doctor-caused addiction epidemic in California, but Krissie’s case, like tens of thousands of others, happened under the watch of Workers’ Comp.
When Krissie came to Malibu Beach she was taking daily large quantities of methadone, morphine, oxycodone, flurazapam and clonazepam. She was also using fentanyl patches. By far the most powerful and expensive of her medications was Actiq, which comes in the form of a lollipop, and has been approved by the FDA for terminal cancer patients. Krissie did not have cancer; she had carpel tunnel syndrome, which she developed while she working as a legal librarian for the Motion Picture Association of America (“MPAA”). As a result of a botched (and probably unnecessary) operation on her elbow by a workers’ comp surgeon, she had also developed Reflex Sympathetic Dystrophy, a chronic, painful, and progressive neurological condition that affects the skin, muscles, joints and bones.
An independent pharmacy estimated the cost to the MPAA and its insurers was a staggering $51,250 per month. Krissie reports that she was taking most of the medications for at least 3 years.
A workers’ comp defense attorney representing the MPAA, called the Center after attending an expedited hearing about Krissie’s condition. Krissie’s MPAA health insurance had expired. The MPAA workers’ comp carriers were refusing to pay for the expensive medical regimen prescribed by Dr. “X.” She was going into withdrawal.
Here are some excerpts from the hearing transcript, called by Krissie’s attorney George Savin and two Defense Attorneys.
DEFENSE LAWYER: The primary issue we have here is that Dr. “X” who has seen [Kristen] for the last four years has basically come up with additional recommendations, which I believe are contrary to your previous recommendations. In other words, he is suggesting she remain on some medication, including the Actiq, methadone, flurazapam, provogil, and clonopin. He’s also suggesting a trial – adding a [narcotic] pump on her. Would that be contrary to the way you thought she should be treated?
MEDICAL EXPERT: My objection here is that the patient is taking more and more medications, each of which I might add, has their own set of complications, especially the gastrointestinal tract. She’s building up a resistance to them and she has to be detoxified. Now if this lady had terminal cancer, I would have no qualms about giving her all the narcotics she wanted. [But what] we have is a 33-year-old woman that was otherwise healthy and now, over the last five years of her life, basically she has been incapacitated and literally addicted to drugs. She needs to be gradually weaned off her medications to the point what she is able to have her brain control her level of pain. The goal of pain management is to help people manage their pain. It’s literally not to turn them into drug addicts.
There was a huge article from the New York Times about the pain management people just ordering drugs helter skelter. That’s also been a lot to do with the pain management people receiving kickbacks from the some of these drug companies. These are very expensive drugs. This is not like taking aspirin.
I would get her into detox as quickly as possible. I think we’re all concerned that we have a young adult woman here with longevity of at least another 50 years and she won’t live another 50 years if she’s on all these medications.
At Malibu Beach it took a record 62 days to detox Krissie off the drugs prescribed by Dr. “X”. (Heroin and alcohol detox generally take only 5-7 days.) She stayed in residential treatment an additional 11 days to stabilize, and then spent six weeks at Oceanside Transitional Living.
When she left treatment a new pain management doctor put her on “maintenance” Suboxone for her pain. Suboxone is a Schedule III narcotic originally developed to quickly and efficiently wean addicts of opioids like heroin. It is now being used to control pain. This new application is somewhat controversial among treatment providers, but for the MPAA workers comp carriers, it must have felt like a windfall. Krissie’s post treatment pharmaceutical bill dropped to less than $1,500 per month.
Recently Krissie came back to Malibu Beach, not because she relapsed but because she wanted to get off the suboxone. It was a very long and painful seven week detox. Suboxone has a long half life. It gets in your bones.
Today Krissie is free from all narcotics, hoping to settle her Workers’ Comp claim within the month. She proudly donated blood for the first time in many years.
After Krissie we admitted another workers comp client. We’ll call him Sam. Sam was also represented by George Savin. Mr. Savin insisted Sam come to Malibu Beach for treatment after he tried to kill himself. Also suffering from carpel tunnel syndrome, several botched operations by workers’ comp surgeons left Sam depressed, unemployable, and about to be divorced. Dr. “Y” placed him on 45 mg/day of suboxone to treat his pain, which cost his insurance carrier $1,130 every month. Sam spent 30 days at Malibu Beach and left treatment able to lift his hands above his head for the first time in 5 years. He now takes only motrin for pain and has returned to the workforce.
There are reportedly tens of thousands of Sams and Krissies in California living a diminished quality of life after suffering a job related injury because workmans’ comp doctors have turned them into prescription drug addicts. (A recent study found that 3% of the workers’ comp physicians write 55% of the Schedule II narcotics prescriptions). Defense and plaintiff lawyers alike have told us that some of these claimants cost the workers’ comp system $5,000-$30,000/month in pharmaceutical bills. Attorneys repeatedly tell us that they represent claimants they would want to immediately send to treatment, if only the carriers would approve the one-time cost.
Investing in treatment could significantly reduce the financial burden of the insurance carriers.