# Drug seekers



## Epi-do (Dec 31, 2007)

Sorry, but I just need to vent about a run from the other night.

We get dispatched for a sick person and arrived to find a woman in her late 40's-early 50's c/o stomach pain.  She tells us that she has two stomach ulcers and that when she has "attacks" related to them, this is exactly how she feels.  She goes on to tell us that they usually give her morphine or fentanyl for it and that she is a hard stick.

We get her loaded up and in the truck, ready to go.  I turn to get in the truck to drive us to the ER, and one of the engine guys asks what I think about the run.  I told him that she was a drug seeker, and why I thought that.

We get her to the ER, into her room, and my partner is finishing up his paperwork.  About that time, the nurse comes over to where we were at to let us know what the patient just told her.  Apparently I was only partially right - she was drug seeking, but she didn't want only narcs for pain, she also wanted all of her prescriptions filled that she had run out of.  She then told the nurse that she didn't really need an ambulance at all, but called 911 because she didn't have enough gas in her car to drive to the ER and then back home.

I am sorry, but I just can't stand it when people abuse the system and try to play it to get whatever they can.  I do feel bad for people that fall on hard times, and are doing all they can to get back on their feet.  Helping them is one thing.  These loosers that only want you to give them anything/everything they can get are another thing all together!  Sometimes I really wish we could refuse to transport.  This woman wanted no medical treatment at all.  She wanted a taxi and free meds.

In fact, this patient asked if we would be willing to wait around for her to get discharged so we could take her back home because she didn't have any other way to get there.  Sorry, not my problem.  

Ok, done with the rant.  <breath in, breath out, breath in, breath out....>


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## mdtaylor (Dec 31, 2007)

Epi-do said:


> I turn to get in the truck to drive us to the ER, and one of the engine guys asks what I think about the run.  I told him that she was a drug seeker, and why I thought that.



I wonder, in afterthought, would you not consider this a violation of HIPAA? Was that information necessary for the Engine crew to care for the patient?

I probably would have thought the same, but I surely would have kept my opinions to myself.


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## skyemt (Dec 31, 2007)

mdtaylor said:


> I wonder, in afterthought, would you not consider this a violation of HIPAA? Was that information necessary for the Engine crew to care for the patient?
> 
> I probably would have thought the same, but I surely would have kept my opinions to myself.



HIPPA is extremely misunderstood... in the setting of QI, to prevent abuse of the system, it is certainly ok to discuss the matter with the crew.

HIPAA was NOT designed to keep pt info confidential from the crew treating them, but to prevent the info from getting to people not at all connected with patient care.


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## mdtaylor (Dec 31, 2007)

I suppose I was assuming that the Engine crew was not a part of the certified caregivers, and was only there for extraction, lift assist, etc.

Every system uses the FD is different ways of course. Here, we would never even consider sharing a diagnosis with the FD for fear that they would then assume the same diagnosis a week later when the same person calls for assistance and alter their response accordingly.


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## Epi-do (Dec 31, 2007)

We were BLS that particular shift.  The staffing on the ambulance varies from shift to shift, thereby varying if it is ALS or BLS.  Our engines are always ALS and serve as a first response unit.  On this particular run, it was the engine from my firehouse, they assessed the patient, and since they know I am in medic class, they often ask me what I think is going on and after the run use it as a teaching/learning experience for me.

On this particular run, it was more me venting my frustration than anything, though.


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## Airwaygoddess (Jan 6, 2008)

It is unfortunate that our system is so abused at times.  It seems to go up more around the hoildays.  As you said Epi-do, Breathe in and out in and out, location and vacation location and vacation......


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## firetender (Jan 6, 2008)

These are people who, propelled by one form or another of desperation, feel there's no where else to turn to except the people who can help them get what they want. To them, the intensity of their needs qualifies as an emergency. By declaring it as such, and being carted away in an official vehicle, they are increasing the odds that they will be seen more rapidly than the people with the same ailments who wait for hours getting their needs met. 

The system has no choice but to support this because it will get sued if it does not heed any and every call. The system also denies lower income people of the luxury of being able to schedule appointments and getting to them, let alone pay their exorbitant fees.

And you know who's at the bottom of the hill that the caca slides down, don't you?


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## MyOpinion (Jan 18, 2008)

*Compassion and Judgement*

Perhaps this woman was a drug seeker and abusing the system for personal gain.  Is it right?  Of course not.  But I have to agree that discussing this with the driver IS a violation of privacy.  Maybe a HIPPA violation or perhaps just unprofessional, I don't know.  

Please don't judge people like this.  Frustrated?  I understand completely.  Get angry with our health care system and all the flaws in it.  Don't judge the patient.  Poor people are often forced to go to the ER for non-emergencies or forgo treatment completely.  Yes, honest tax-payers are paying the tab,  but what would you do if you were desperate?  What if this person had to work in seven hours and could not sit at the ER all night waiting and lose her minimum wage job?

How can anyone possibly tell the difference between a drug seeker and an addict in intense pain?  There is a difference and that is for the doctor to decide, and even they are wrong quite a lot.  Even if it was the 14th time you had picked her up, and the first 13 times were for drug-seeking, how will you know that this call isn't for real?  People with the disease of addiction have a right to pain control, just like everyone else.

Furthermore, the majority of people addicted to opiate prescription drugs became this way because of a real medical condition.  The drugs that treat addiction are expensive and few doctors who treat these people charge outrageous fees just to get in.  By then, the person is often still in pain AND addicted and has probably lost everything they once had.

As you may have guessed, I am not an EMT, and MyOpinion will probably get booted off of here along with this post, which I ran across by accident.  I work with addicts every single day and see the struggles they face.  Please, do your part and try to have compassion for these people and don't judge them.  Or worse, judge the person and be wrong, only to have them suffer as a result.

mdtaylor said it best_..."Every system uses the FD is different ways of course. Here, we would never even consider sharing a diagnosis with the FD for fear that they would then assume the same diagnosis a week later when the same person calls for assistance and alter their response accordingly."_

I'll end this by thanking all of you for the jobs you do.  No need to boot me off of here, I'm not an EMT or a troll, I won't be back.  Peace to you all.


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## Ridryder911 (Jan 18, 2008)

One does not have to judge, just pull up their file and see how many times they visit ED's. I know I work at multiple ones, and see the same familiar faces at different ER's during the same day.  

Medication abuse has became so outrageous, my state has now installed a tracking system, so when one has a narcotic prescription it is filed, and if another one (of the same medication) is refilled within a short period of time, it advises the pharmacist and the state narcotic bureau. The pharmacist will then inform the physician for orders (usually destroy the prescription) 
In fact, I watched a news report yesterday describing that meth and crank abuse has actually decreased in those under 20, but prescribed analgesics abuse has almost doubled, hence they no longer need the illegal substance.

Sorry, I know there are those that are in truly legitimate pain. Unfortunately, it is the abusers that causes such apathy from health care workers. I personally have taken care of 18 patients in the last twelve hours, that requested analgesics in the ED for a chronic condition. If those that did have such condition would follow up with pain management/pain specialist then they would avoid break through pain and not have to await for treatment in the ED. Yes, there are exceptions, but those are rare. 

R/r 911


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## firecoins (Jan 18, 2008)

Sorry, don't see the HIPPA violation.  Don't see anything done wrong by the crew talking with the engine company.  These are people on the same exact call.  They heard the same stuff.  Sharing your opinion with them is not in any way a HIPPA violation.


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## Epi-do (Jan 18, 2008)

I really don't get why people are thinking there is a HIPPA violation here.  Like *firecoins* said, the engine guys were in the apartment with us, heard everything the patient said, did a quick ALS assessment to determine if they needed to do anything for her - I didn't tell them anything they didn't already know.  

I have taken plenty of people to the ER because they wanted narcotics, or they wanted their blood pressure prescription refilled.  It isn't anything new, and it happens way more often than it should.  It just really irked me that this particular patient was so blatant about the whole thing.  I know that the ones that try to deny the fact that they are abusing the system are very aware of what they are doing, but for her to be so open about the fact that she was doing that and just didn't care if it prevented someone with a legitamate need for an ambulance from getting the quickest possible response really struck a nerve with me.

I have been doing this long enough to know there are plenty of people that will call 911 for reasons that I can't fathom - some of them things I wouldn't even bother my family doctor with - but this particular patient, on this particular night just really rubbed me the wrong way.  It happens to all of us, we're all human.  This woman wasn't the first patient I have felt the need to vent about, and I am sure she won't be the last either.  Just like our families, we can't choose our patients, and you have to take the good with the bad.  

Maybe we all need to post stories about that sweet little old lady that just warms your heart even though all you really needed to do was hold her hand and talk to her for a little while more often.  I did have two runs like that before the run that I detailed in my original post here.  It's those patients that remind me why I love this job so much.


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## firetender (Jan 19, 2008)

Ridryder911 said:


> I personally have taken care of 18 patients in the last twelve hours, that requested analgesics in the ED for a chronic condition. If those that did have such condition would follow up with pain management/pain specialist then they would avoid break through pain and not have to await for treatment in the ED. Yes, there are exceptions, but those are rare.  R/r 911


 
It is all a system-complex, an interweaving of the basic needs of a human for comfort, abusive tendencies, a system geared toward one-size fits all medicine, greedy corporations, overworked and abused caregivers, a bureaucratic hellhole and, and, and...

You're right, Rid, the patient is right, the system is right.

Go figure!


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## VentMedic (Jan 19, 2008)

HIPAA:  *H*ealth *I*nsurance *P*ortability and *A*ccountability *A*ct


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## Meursault (Jan 19, 2008)

+1 to spelling! 

Thank you Vent, I didn't have the courage to make unrelated nitpicky posts, but it's been bothering me for several threads now.

To keep this from being an unrelated nitpicky post, this discussion on SDN's Emergency Medicine forums gets more into drug-seeking. 

I have a feeling someone pops up in there and accuses them of lacking compassion too.


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## ffemt8978 (Jan 19, 2008)

MyOpinion said:


> As you may have guessed, I am not an EMT, and MyOpinion will probably get booted off of here along with this post, which I ran across by accident.  I work with addicts every single day and see the struggles they face.  Please, do your part and try to have compassion for these people and don't judge them.


Not that it'll do much good...

You wouldn't get booted from here for those types of comments.  We encourage intelligent discussion in a civil manner from anyone, not just EMTs.  

You're not the only one that works with addicts every day, we in EMS do also.  We're the ones that see them at 0300, 3-4 times a week, because they have no one else that they can call that will come and pick them up, take them to a warm hospital where they can get food, a bed, and their drugs just because they mutter a few key phrases all at no charge.  Sorry, I don't see the drug counselors in the ER at 0300, do you?  All of the local offices around here have regular office hours.  My compassion is saved for those that really need and WANT my help, not my services as a taxi.




> I'll end this by thanking all of you for the jobs you do.  No need to boot me off of here, I'm not an EMT or a troll, I won't be back.  Peace to you all.



Your unwillingness to return and defend your viewpoints does make you a troll, in actions if not intent.  I sincerely hope you return and prove me wrong, but that is up to you.  You have not and will not be booted from this forum as long as long as your follow our rules here.


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## CAMedicJohn (Jan 20, 2008)

*I feel you pain...*

Epi I have the same situation with a Freq. flyer. He has skin rash that requires cortizone cream. Every 2 weeks he calls 911 for 'seizures' at 0130 and is waiting outside at the curb. When ask about the seizure he said it was 3-4 hours ago but he needs his cream prescription filled and needs a ride to the ER. I do the usual assessment/work-up during the ride to the hospital. 

Most times these calls don't get to me, but when you have had a 15 call shift and just want an hour to sleep, my patience begins to get thin. 

The last call on him, he refused all care including vitals. It took all my control to be nice. 

With the rise in costs and so many uninsured in the country, the ER is becoming the only care alternative for many people. 911 abuse is only going to get worse.

:wacko::wacko::wacko:


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## RichmondMedik (Jan 27, 2008)

CAMedicJohn said:


> Epi I have the same situation with a Freq. flyer. He has skin rash that requires cortizone cream. Every 2 weeks he calls 911 for 'seizures' at 0130 and is waiting outside at the curb. When ask about the seizure he said it was 3-4 hours ago but he needs his cream prescription filled and needs a ride to the ER. I do the usual assessment/work-up during the ride to the hospital.
> 
> Most times these calls don't get to me, but when you have had a 15 call shift and just want an hour to sleep, my patience begins to get thin.
> 
> ...



Waiting at the curb?? ask him to read the side of your vehicle where it states " EMERGENCY' my next question would be " what part of this is an emergency?" 

refused all care including vitals?? - sign here and press hard you are making 3 copies and you now have 2 choices, first being don't call unless an emergency exsist and you will allow all treatment that goes with it and second to have local PD involved for abusing 911

If a person calls and won't allow treatment I get PD involved they are usually more than willing to help with the regular abusers.

stay safe
Paul


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## CAMedicJohn (Jan 28, 2008)

PD was there.. My county doesn't allow refusal of care.  
My motto... You call... We haul...
The ED cleared him before I got the paperwork done..
I know I will be seeing him again in a couple of weeks...
:wacko::wacko::wacko:


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