EMERGENCY SITUATIONS - HOW TO DEAL WITH ER's

[AGV10]

I have some "do" and "do not" tips from an ER doc with 16 yrs experiance on how one should/should not conduct themselves if forced to go to an ER when one is desperate to get meds to carry them through till re-fill date, or your usual source is back on line.

Hospital ER's are constantly on the alert for drug-seekers, and recognise the signs, often before the "patient" knows they are giving themselves away. But you can increase your chances of success significantly in how you conduct yourself, and what you say and what you don't say.

Worth publishing these tips for all to read?


AGV10

[I-Nod]

Shit, I thought there would be tips here...



Edit: Please do publish these do's and don'ts... I really doubt a poll is necessary, everybody is going to want to hear these. Thanks for offering your knowledge!!

[AGV10]

If there is enough positive response I'll write it all up .....

[antigonemuse]

If there is enough positive response I'll write it all up .....


well if you know it all why even start the thread... to make sure you are right?

[pharmboy]

I guess you would be that ER doc? :rolleyes::cool:;)

[SurfRat]

Worth publishing these tips for all to read?

yes

[moviebuff927]

I have some "do" and "do not" tips from an ER doc with 16 yrs experiance on how one should/should not conduct themselves if forced to go to an ER when one is desperate to get meds to carry them through till re-fill date, or your usual source is back on line.

Hospital ER's are constantly on the alert for drug-seekers, and recognise the signs, often before the "patient" knows they are giving themselves away. But you can increase your chances of success significantly in how you conduct yourself, and what you say and what you don't say.

Worth publishing these tips for all to read?


AGV10

What are you waiting for???? Post the motherfuckers!!!

[Dirtyrockstar]

post 'em already, don't just tease.

[Ghost666]

No shit, enough already and let's see the list! What are you waiting for?

I saw a video on YouTube done by a doc or nurse telling you how to get the meds that you want. Pretty interesting and I thought funny. I'll see if I can dig it back up...

Sorry, no go. Couldn't find it anywhere dammit.

[GOLD N DIEMONDS]

GEE I DON'T KNOW, WHAT DO YOU THINK? This isn't a site for birdwatchers you know.
Agree with above, must be a Doc , lets see how much red tape we can add to this :D

[freedomclub]

is this that letter the snarky e.r. Doc posted on Craig's list a few months back?

[moviebuff927]

I have some "do" and "do not" tips from an ER doc with 16 yrs experiance on how one should/should not conduct themselves if forced to go to an ER when one is desperate to get meds to carry them through till re-fill date, or your usual source is back on line.

Hospital ER's are constantly on the alert for drug-seekers, and recognise the signs, often before the "patient" knows they are giving themselves away. But you can increase your chances of success significantly in how you conduct yourself, and what you say and what you don't say.

Worth publishing these tips for all to read?


AGV10

I call BULLSHIT on you motherfucker.

[zenpunk]

is this that letter the snarky e.r. Doc posted on Craig's list a few months back?

I actually found some of that letter to have some good advice. I ended up in the ER the following week from accidentally slicing my finger down to the bone and I was sure to rate my pain a 7 out of 10.

At least that letter had more advice than this bullshit thread. I thought we were actually going to get some information here!

[I-Nod]

I call BULLSHIT on you motherfucker.

Uh oh! Moviebuff's Bullshit-Radar is spiking!! :D
I knew this thread was too good to be true :( Who knows though, maybe he just didn't have time to write it all up before work? Or it's reeally long and he wanted to validate all the typing? Ok... maybe I'm really fishing here...



EDIT: To the original poster, I'm just bustin' your balls a little bit. :D No ill feelings man, hope not to offend anyone here actually... life's too short. <handshake>

[BLOODY]

dont babble around!give us da facts IF u have them.of course were intrested.u remind me of my dad,just emty promises.PLEASE PROOVE ME WRONG.

[CIIORNOTHING]

Here it is real simple.


Step 1. Take steel mallet from tool box.

Step 2. Lay hand on hard surface.

Step 3. Begin to beat the living shit out of said hand and/or fingers until its a bloody mess.

Step 4. When you come to and can talk again, call 911.

Step 5. After being released from the er, enjoy your 10 Lortab 7.5s and referral to the Orthopedic.

[Ghost666]

Here it is real simple.


Step 1. Take steel mallet from tool box.

Step 2. Lay hand on hard surface.

Step 3. Begin to beat the living shit out of said hand and/or fingers until its a bloody mess.

Step 4. When you come to and can talk again, call 911.

Step 5. After being released from the er, enjoy your 10 Lortab 7.5s and referral to the Orthopedic.

No shit...ER visits are so not even worth your time. Last time I HAD to go to one, after a kitchen fire which splattered flaming grease on my hand and gave me 2nd degree burns which hurt like a BITCH he sent me home with 12 Lortab 5's. Thankfully I went to my primary care doc the next day and he was actually pissed about what they gave me and wrote for 30 percs. I remember once my now Xwife had horrible gall stones after having a baby and was in severe pain. They did give her a shot of morphine but that lasts only a couple of hours, and they sent her home until the ultrasound tech was scheduled to be in much later in the day. They only gave her 6 Lortab 5 samples. That was such crap, she could barely breathe the pain was so bad. When she went back for the ultrasound there were numerous gall stones and she had to have her gall bladder taken out. I semi bitched at them when they saw the gall stones and got a different doc that finally wrote for 30 percs. I'm sorry, but some things are just obvious, like 2nd degree burns and a new mother in obvious severe pain....

[aj11]

SWIM goes to the urgent care centers with a testicle problem and it works for atleast (30) 7.5 percs
good for when nothing else

oh yeah you can't be scared to show your wedding tackle to a female doc
not for the embarreseed types

[bronyraur]

If there is enough positive response I'll write it all up .....

Oh quit the bullshit...

Are you pretending to be an ER doc? Please give us your precious knowledge... And don't copy the Craigslist letter, that's already been posted here.:rolleyes:

[OPticrazi]

i can not begin to express how fuck'in piss off I am at the "phoney assholes" that joined this once informatve, supportive and real folks that use to be here. I am so fucking discussed, that I am going to walk away for a while, collect my thoughts and then decide if this all worth the effort. I look to see who is on line and the majority are "lurkers" Ie guests I say we tighten this shit up and get back to th original premise.
Sorry for the rant, but this dude has had about enough!:mad:

[GoddessofRATs]

Arghhh, he's just waisting our time. I think most of us already know how to score in the ER, for most of us have done it tons of times.

The basics:

Never say your allergic to non-opiates. If they suggest Torodol don't say your allergic, take the torodal and say it isn't working 20 minutes later.

Never say your pain rate is a 10. If someone's pain is a 10 they can barely talk, say your at a 7.

Be nice to the doctor, don't aggrevate him, he's busy and above all else be nice to the nurses, they are the one's who pretty much control how you are treated in the ER. Don't give them a hard time.

Those are the basics and i figured these out long before i ever read the craigslist crap or the Yourube video.

GOR

[Synack]

BAN THE FUCKER! :)

[smojo]

BAN THE FUCKER! :)

EXACTLY!!! :D

[xecutrex]

BAN THE FUCKER! :)

LMAO

ABG you already knew the answer to your question before you asked it, your just looking for attention no? Of course people want to hear about it. Your not by chance related to InsaneIke are you? He pulled the same shit like 4 months ago and ive yet to see anything come of it.

[WarmCyanide]

I am so fucking discussed,

are you a celebrity? J/K i know it was a typo:)

[limitless_euphoria]

I posted my own thread entitled "12 Guidelines for Scoring at The ER" in response to so many of you being irritated by the lack of info. in this thread.

http://forum.opiophile.org/showthread.php?t=11114

I mean, it's no work of art but even if it inspires a little thought or gives you an idea of something you coudl do better, there you go...

[poonwhalla]

I posted my own thread entitled "12 Guidelines for Scoring at The ER" in response to so many of you being irritated by the lack of info. in this thread.

http://forum.opiophile.org/showthread.php?t=11114

I mean, it's no work of art but even if it inspires a little thought or gives you an idea of something you coudl do better, there you go...

I doubt that they could come up with better or they would have said it already. that right up was awesome Lim_E

[pharmboy]

Hay AVG10 Come Back! Were all a bit edgy this month, Sept. SUCKS.

But really if you have something good to post, post away and prove us
all wrong.

[AGV10]

I should have guessed, how stupid of me ...... I completly forgot - oh dear, oh dear .......

No, I am not the author, and no, I have/had nothing to do with any “craigslist” posting on the subject (why the fuck would anyone want to post such a subject on craigslist?), and no -I am not a doc (conspiracies …..) – they are observations from an ER doc with 16 yrs ER experience, who himself is a user of fentanyl (Duragesic)! As Al Capone said - narcotics don;t discriminate -- they get everyone, irrspective of social/economic background.

Some of the points here are only but obvious, and some readers I have no doubt could add more to this – fine, it is a collection of comments I recall (I wasn’t sitting there pen & paper in hand). It can all be sumarised under 2 headings: having a plausible story and knowing enough to avoid conflicts in it withoutrealising it, and creating a positive impression.

First thing - have your story worked out carefully.
It starts with the ER nurse who takes your vitals. They are so used to dealing with drug-seekers they get sick of it. While some are plain downright daft, most are sharp when it comes to recognizing drug-seekers. They are your first interaction with the ER staff, and you can bet if get off on the wrong foot with them they will convey it to the doc in a forceful way. You will then be faced by a doc who will be in “alert” mode, for no other reason other than because the nurse said something and docs don’t like to be conned.

Say nothing at this stage, absolutely nothing to the ER nurse about using narcotic analgesics - keep that for the doctor. Yes – by all means tell the nurse what else you are taking, and complain of pain, but don’t overdue it. There are a number of “red flags” ER staff look out for. One is a lot of emphasize on pain medication. Tell her what you use for pain if she asks, otherwise leave this for the doc.

It’s quite likely the first doc you see could/will be a junior doc. Many hospital ER’s have a policy regards “walk-ins” and narcotic analgesics: Treat with caution in the first instance, and if it is a junior doc, chances are he may be bound to get permission from a more senior doc to prescribe a narcotic. Where these policies are in place, they are in place to avoid the ER earning a reputation in the community as being a soft touch for narcotics. The lower the income area is in which the hospital ER you are attending is, the more alert it will be to drug-seekers. You will find much the same attitude in private hospitals versus state funded hospitals – the latter are more conservative

Having got through the front door and past the ER nurse without raising questions, is to do well, as although most drug seekers don’t realize it, they often have come unstuck with one or more of the above without realizing it.

Next:

1) Do not, do not put emphasize on your narcotic analgesic usage. The less you say about this the better. This is really the single most important point. It is big “warning sign” of drug – seeking behavior, and asking for a particular type of narcotic analgesic and dosage – before the doc has examined you or asked you what you usually take adds to suspicions. Rather, explain your “complaint” to the Doc – and say nothing about narcotic meds till they ask. If they accept you are in pain, it wont be long before they ask.

2) When it comes to meds versus why you take them (i.e. the medical problem) – be careful – here is where drug-seekers often come unstuck without realizing it. Long term narcotic users are opiate tolerant. Opiate tolerance does not come from usage for acute conditions i.e. giving the ER doc a complaint story that is acute, but which has a high narcotic dosage tagged on the end will have him thinking. e.g. if you are using MS Contin 100mg twice a day you are more than likely a long term user, as no doc in his right mind is going to start you off on 100mg morphine sulphate. In acute versus chronic terms it will mean your condition is chronic i.e. you have had the problem for sometime It wont be something that started last week. You’d be surprised how many drug-seekers go to ER’s and “present” with an acute story. As well, chronic patients know what meds they are taking, when, why and exactly how much. Chronic patients often genuinely have a better grasp of their condition than the ER doc – and ER docs acknowledge this – so if you have a good understanding of the “problem”, don’t be scared to go into detail. Its entirely consistent with chronic condition patients. By contrast many acute patients will not have as detailed an insight. In summary: better to have a chronic condition versus acute if on a strong/high narcotic dosage, and it goes without saying that you will more than likely not only be on narcotic analgesics. As a chronic patient the chances are you will be taking other meds as well – possibly a strong anti-inflammatory steroid if your problem stems from back damage. Asking for just pain killers, is as already said, in an ER a red flag. Stay away from anything that the doc is going to read as primarily muscular pain.

Another hurdle - by it’s nature an ER environment is unlikely to have a record of you or your medical history i.e. the doctor will be working from a blank sheet of paper so to speak – they will be needing to make an evaluation of you based only on what you are telling them. The first thing that counts against you is in many cases unavoidable.

It is the lack of patient history. If you have an established relationship with a doc and are on narcotic meds, then the chances of you turning up at an ER (unless genuine) are pretty small to start with in any case. So – yes, these notes are not for you, they are for the users who having come unstuck somewhere else are now down to their last options. Of course, for these very same reasons ER’s are attractive to drug-seekers, as not having a patients’ history on file means that it comes down to what is decided there and then.

In summary its all about how well you present yourself. As the doc said, it is very seldom a single point or issue that qualifies or disqualifies the drug-seeker, rather it is the overall impression they give – the pieces in the puzzle and how well they stitch together to create a logical story that will determine how well the patient pulls it off.


3) Timing – while drug-seekers can turn up at an ER at any time, stats show that certain times are much more popular than others. Try to avoid late nights, weekend nights, and public holidays. Turning up at 10am in morning, clean, and neatly dressed makes a far better impression than turning up at midnight – 4am in a disheveled or smelly state. While it is quite possible for a genuine user to turn up at this time of the night, stats show that drug-seekers are more likely to turn up late at night and over public holidays. Arriving at ER smelling of alcohol or sweat will have the doc considering all sorts of social issues regards your circumstances and lifestyle, none of which will help create the impression needed.

4) This last point is almost so obvious it shouldn’t need mentioning – do not, do not go in pouring with sweat and or vomiting – whatever the complaint. The chances of getting any narcotic pouring with sweat, going to the toilet every 30minutes, or vomiting are quickly reduced to almost zero. This needs no explaining – it’s obvious. You laugh – you have no idea how many folk leave it so late, that by the time they get to the ER they can’t hide it. Get to the ER before this all starts.

Jump through the above hoops successfully and the odds shift to your favor. Fail any one of them and things can quickly start stacking up. Whatever you do, do not behave impatiently, or display any frustration. Be courteous. Shake their hand, greet them and smile when they come in. ER doc’s seldom get a patient that’s shakes their hand and smiles – sound crazy? Believe me, it’s not – a handshake with a pleasant greeting and a smile goes a long way to creating the image - and that really is what it is about at the end of the day: giving the doc a good impression and having a story that makes medical sense.

Take it all for what you think it worth.





:

[I-Nod]

I should have guessed, how stupid of me ...... I completly forgot - oh dear, oh dear .......

Well I, for one, owe you an apology sir. Sorry AGV. That was an excellent write up, no doubt, man.

Hopefully you kind of see why that reaction was given... we're a vulnerable bunch, so easy to tease like that for a good laugh. Again, very good pointers in there and thanks much for posting it!!

Take care and welcome to the board :D

[smojo]

Good advice, for those that need it.
I myself have been to the ED/ER approx. 7 times I believe in the past 6-7 months.
I have successfully managed to receive IV Dilaudid, Ativan, and Phenergan...every trip. Mind you, after the first trip I then verbally asked for the 3 IV Drugs, every trip thereafter, I received all 3, YUM YUM!
Now, could it be that I was a discharge planner/social worker at this hospital 5 years FT and 2/12 years PRN...POSSIBLY!!! Could it be that I KNOW the name of the GAME, POSSIBLY.
Your #2, so true, I spit out, ugh, yes I have "Cauda Equina Syndrome, Arachnoiditis, Central Pain, and Wind-Up", NOT ONE OF THESE DOC'S/PA'S HAVE A CLUE, They look at me CLUELESS.
It is a Dance, and how fluid, graceful, you are... will be how well rewarded you are!!!

[AGV10]

Dont worry about it, no prob;s - I had a pretty good idea what was coming. I'll write up Part 2 when everyone else has aplogised ............

[AGV10]

Good advice, for those that need it.
I myself have been to the ED/ER approx. 7 times I believe in the past 6-7 months.
I have successfully managed to receive IV Dilaudid, Ativan, and Phenergan...every trip. Mind you, after the first trip I then verbally asked for the 3 IV Drugs, every trip thereafter, I received all 3, YUM YUM!
Now, could it be that I was a discharge planner/social worker at this hospital 5 years FT and 2/12 years PRN...POSSIBLY!!! Could it be that I KNOW the name of the GAME, POSSIBLY.
Your #2, so true, I spit out, ugh, yes I have "Cauda Equina Syndrome, Arachnoiditis, Central Pain, and Wind-Up", NOT ONE OF THESE DOC'S/PA'S HAVE A CLUE, They look at me CLUELESS.

It is a Dance, and how fluid, graceful, you are... will be how well rewarded you are!!!

Thats a good one - no ER doc is going to bother arguing with you on that - its an almost dead cert they'll do whatever you want.

[I-Nod]

I'll write up Part 2 when everyone else has aplogised ............

now, don't hold your breath...






EDIT: are you reserected? an old ophile re-joined under new guise? sound familiar... but then, I've been up 2 days too.

[GOLD N DIEMONDS]

now, don't hold your breath...

EDIT: are you reserected? an old ophile re-joined under new guise? sound familiar... but then, I've been up 2 days too.

Hahaha- WOODS IS THAT YOU -WOODS? :D

[limitless_euphoria]

3) Timing – while drug-seekers can turn up at an ER at any time, stats show that certain times are much more popular than others. Try to avoid late nights, weekend nights, and public holidays. Turning up at 10am in morning, clean, and neatly dressed makes a far better impression than turning up at midnight – 4am in a disheveled or smelly state. While it is quite possible for a genuine user to turn up at this time of the night, stats show that drug-seekers are more likely to turn up late at night and over public holidays. Arriving at ER smelling of alcohol or sweat will have the doc considering all sorts of social issues regards your circumstances and lifestyle, none of which will help create the impression needed.


See, while I agree that one should not show up drenched in sweat or smelling like booze or marijuana, I also think that timing might working in your favor for the quantity of narcotics you will end up scoring. For those of us who have insurance and have a PCP listed on the card, it looks suspicious if you show up during the middle of the week let's say at like 10 AM in the morning. The first red flag that goes up is "Why didn't you make an appointment with your doctor?"

I'm not here to discredit you or start a fight I'm just saying for certain people, when they go might have a lot of bearing on how many pills they will walk away with in the end. Please, anyone who has been through this, feel free to share your thoughts.

[GOLD N DIEMONDS]

Dont worry about it, no prob;s - I had a pretty good idea what was coming. I'll write up Part 2 when everyone else has aplogised ............

WELL IF YOU HAD A PRETTY GOOD IDEA OF WHAT WAS COMING,why would you even post the thread in such a manner? You could have just initially posted the write up in full ,like a decent guy with a will to share the knowledge with your group of peers What would have followed would have been 3 pages of praise and thanks,
Instead now your treating everyone in a very condescending manner, like a bad group of school children that have to stay after and write "I'm sorry" 100 times on the black board.
I-NOD being the decent stand-up guy he is has already apologizes without being prompted to do so. KUDOS TO I-NOD! And that alone should be more than enough for you.
Now you in return can either dispense with all this drama and show everyone that you really are a decent guy and Finish Part 2 of the write up without further a-do.
OR Take part 2 and stuff it into your coffee cup. Oh I AM SORRY, I didn't mean to say 'coffee cup'

[rachamim18]

Couple of things to add although I found it a capable guideline for those unfamiliar the situation.

A) Sometimes showing up sweating and in W/D is not a negative. If one is knowledgeable about the game it is often a plus. Two ways actually. First, the original poster was correct to make the point about Attending MDs,etc. In every part fo the world I have been to it is the same. The ER is almost always tended to by Residents, fresh out the box. they often have great text book knowledge but their street smarts are almost always non-existent.

They are taught for sure about both Addiction Medicine and about Drug Seeking, but do not have the here to all to differentiate same or similiar presentations or to make a highly critical call.

When I say "critical" I mean it two ways:

I) Critical because if the MD (DDO or NP as the case maybe) labels you as simply Drug Seeking, and you in fact did have acute pain it will almost always mean, in the very least, a brutal talking down to by the Senior or higher. Having probably witnessed himself or comrades getting these dressing downs, he or she might very well opt for the path of least resistance.

If he is wrong in labeling you as Genuiine, it is just another addict/user basically continuing on their well paved path to destruction and at least he or she will not face such dressing downs.

II) Critical also because not properly diagnosing pain can very often least to aggravation of symptoms or simply making a patient suffer needlessly.

B) The original poster offered that timing IS important and of course indeed it is.

However, sometimes coming in on those holidays or very late nights/early morning is just what the fence sitting MD needs to get up and make the call you pray for. It is perfectly reasonable to addume a person is having quite the time getting hold of the of their medical provider. If it is 3 AM Labor Day it is quite believable to figure a patient in acute pain, let us say ongoing disc herniation, is not going to wait until Doc returns the messages before seeking relief of the pain. Acute conidtions often have breakthrough pain. One needs to properly study all aspects of their purported conidtion so as to walk a new MD through the process.

I cannot honestly even make a loose estimate of how many medical professionals I had to school so that I could obtain what I need. As long as you are not combative or feigning a superiority complex, I have found most medical staff (swhen alone, NEVER in group settings) to be quite agreeable. They find a knowledgeable individual to be a sort of comfort when they themselves are so untested and unsure of their abilities.

If picking the best time to go I would offer Saturday early evening as the time hands down. Most do yard work that day and lower (i.e. almost always unreadable via xray) back pain waits a couple of hours to truly present and at time it does show up a couple of hours later, it does so with a vengance.

ALWAYS stick to your script. Nevet make even slight changes. ALSO, NEVER hit another hospital in close proximity or same city in small towns. If you get turned down you easily find the hospital alerting others in many small towns.

If complaining about a less than moderately chronick condition, you will be better off not seeming knowlegeable about painkillers, but neither sound like a moron. Yes, you have heard about codeine even had it in cough meds when a child (if 05 or older) but only once once or twice so you cannot remember how it felt or if it even worked.

In American ERs I find it almost always worthwhile to give it a shot (no pun intended). If you are not an obvious junkie you will wlak away with Tylox, Norco, or some other inane substance (not worth it for me but for many others, they might find it worth the trouble).

[AGV10]

Couple of things to add although I found it a capable guideline for those unfamiliar the situation.

A) Sometimes showing up sweating and in W/D is not a negative. If one is knowledgeable about the game it is often a plus. Two ways actually. First, the original poster was correct to make the point about Attending MDs,etc. In every part fo the world I have been to it is the same. The ER is almost always tended to by Residents, fresh out the box. they often have great text book knowledge but their street smarts are almost always non-existent.

They are taught for sure about both Addiction Medicine and about Drug Seeking, but do not have the here to all to differentiate same or similiar presentations or to make a highly critical call.

When I say "critical" I mean it two ways:

I) Critical because if the MD (DDO or NP as the case maybe) labels you as simply Drug Seeking, and you in fact did have acute pain it will almost always mean, in the very least, a brutal talking down to by the Senior or higher. Having probably witnessed himself or comrades getting these dressing downs, he or she might very well opt for the path of least resistance.

If he is wrong in labeling you as Genuiine, it is just another addict/user basically continuing on their well paved path to destruction and at least he or she will not face such dressing downs.

II) Critical also because not properly diagnosing pain can very often least to aggravation of symptoms or simply making a patient suffer needlessly.

B) The original poster offered that timing IS important and of course indeed it is.

However, sometimes coming in on those holidays or very late nights/early morning is just what the fence sitting MD needs to get up and make the call you pray for. It is perfectly reasonable to addume a person is having quite the time getting hold of the of their medical provider. If it is 3 AM Labor Day it is quite believable to figure a patient in acute pain, let us say ongoing disc herniation, is not going to wait until Doc returns the messages before seeking relief of the pain. Acute conidtions often have breakthrough pain. One needs to properly study all aspects of their purported conidtion so as to walk a new MD through the process.

I cannot honestly even make a loose estimate of how many medical professionals I had to school so that I could obtain what I need. As long as you are not combative or feigning a superiority complex, I have found most medical staff (swhen alone, NEVER in group settings) to be quite agreeable. They find a knowledgeable individual to be a sort of comfort when they themselves are so untested and unsure of their abilities.

If picking the best time to go I would offer Saturday early evening as the time hands down. Most do yard work that day and lower (i.e. almost always unreadable via xray) back pain waits a couple of hours to truly present and at time it does show up a couple of hours later, it does so with a vengance.

ALWAYS stick to your script. Nevet make even slight changes. ALSO, NEVER hit another hospital in close proximity or same city in small towns. If you get turned down you easily find the hospital alerting others in many small towns.

If complaining about a less than moderately chronick condition, you will be better off not seeming knowlegeable about painkillers, but neither sound like a moron. Yes, you have heard about codeine even had it in cough meds when a child (if 05 or older) but only once once or twice so you cannot remember how it felt or if it even worked.

In American ERs I find it almost always worthwhile to give it a shot (no pun intended). If you are not an obvious junkie you will wlak away with Tylox, Norco, or some other inane substance (not worth it for me but for many others, they might find it worth the trouble).


I'd go along with that .... yes, fair comment

[AGV10]

WELL IF YOU HAD A PRETTY GOOD IDEA OF WHAT WAS COMING,why would you even post the thread in such a manner? You could have just initially posted the write up in full ,like a decent guy with a will to share the knowledge with your group of peers What would have followed would have been 3 pages of praise and thanks,
Instead now your treating everyone in a very condescending manner, like a bad group of school children that have to stay after and write "I'm sorry" 100 times on the black board.
I-NOD being the decent stand-up guy he is has already apologizes without being prompted to do so. KUDOS TO I-NOD! And that alone should be more than enough for you.
Now you in return can either dispense with all this drama and show everyone that you really are a decent guy and Finish Part 2 of the write up without further a-do.
OR Take part 2 and stuff it into your coffee cup. Oh I AM SORRY, I didn't mean to say 'coffee cup'


......... frustration frustration frustration - sense of humour is not your strong point, now is it.

[GOLD N DIEMONDS]

......... frustration frustration frustration - sense of humour is not your strong point, now is it.

Hahha- OK I am sorry, I really enjoyed reading your post, thank you for contributing, and I look forward to reading more from you. Again thanks for sharing

[Paregoric Kid]

go early in the morning, dress nice, be polite, don't ASK for anything play fucking stupid about drugs you don't know anything about them;) , pain level of 7 or 8, you won't get more than a script for vicodin, percocet, or maybe a shot of morphine or demerol in the ass. you are not going to get anything good but you can get something to hold you over.

[AGV10]

Hahha- OK I am sorry, I really enjoyed reading your post, thank you for contributing, and I look forward to reading more from you. Again thanks for sharing


No prob's - all understood

[AGV10]

go early in the morning, dress nice, be polite, don't ASK for anything play fucking stupid about drugs you don't know anything about them;) , pain level of 7 or 8, you won't get more than a script for vicodin, percocet, or maybe a shot of morphine or demerol in the ass. you are not going to get anything good but you can get something to hold you over.

Correct - it acute, but if chronic, the doc would expect you to know your subject - as most chronic patients much a good insight to the problem - often better than the ER doc.

What the "patient" needs to get straight in their is are they going to present with an acute condition or a chronic condition? The former, on balance, yes, more likelygoing to get you your Perc's or Vicodin. The latter - well, how longs a piece of string - you could say just about anything and it would be quite plausible as chronic implies long term use and opiate tolerence.

I think something that should have being made clearer when I posted the do's and don't s is: is one going in to the ER get relief to get through the rest of the day/night, or is one wanting to walk out the door with a prescription.

If someone is chewing up 6 x 40mg OC's p/day they're going to be hacked off with a prescription for 15-20 Perc's or Vicodin - which on balance is what is going to happen (if "acute").

Moral of story: if you are happy with Perc's - fine, present as acute (or chronic - wont make dot differance) , but if you want to walk out the door with a prescrip for 15-20 high dose MS Contin or Oxy's (or similar equivilant), then you really need to "present" with a chronic complaint, as these are pretty much the only plausible circumstances behind high dosage narcotic analgesic useage.

[AGV10]

ONE MORE POINT:

This too is very important - it is another classic drug-seeker potential "red flag" that ER staff watch for.

Such is the nature of the beast, it is a habit that most try to hide - hence, most "drug-seekers" will turn up at the ER alone.

By its self this is not a "negative" - but in conjunction with other factors it draws a image in the mind of the ER doc that will play into his decision taking.

Docs are trained to take social circumstances into consideration when evaluating a patient - it will not go un-noticed if the paperwork indicates you are employeed in the same job for the last 10 yrs, you are married, the wife is at home - and you came by taxi to the ER at 5am (i.e. whats up with the missus - most wives wouldn''t hesistate to take their sick husband at 5am in the morning to the ER if he was that unwell).

Sure, of course this scenario is plausible - just pay attention to the image you create regards your social circumstances - docs are trained to read between the lines - in particular ER docs, who get lots of practise taking social factors into consideration because of the broad spectrum of patien types they see.

[GoddessofRATs]

in all my ER visits i always went alone. And thats mostly because i didn't have anyone to stay with me. When they asked me "Are you driving home" I'd say "No my Grandma is picking me up" even though i was drving. But, me being alone never affected the outcome of my ER visits.

GOR

[wafflehead77]

When going the "chronic" route, and you really do have a history of potent narcotics, would it be beneficial to take in old script bottles to the visit? I dont exactly mean current scripts, as this could back-fire if they would contact the prescribing physician at a latter time, but for example, taking old bottles of MScontin and Roxicodone from an old PCP/PM doc.
Would they use this as a reference point when deciding what you recieve, or see it as a "seeking" behavior?
(In most cases anyway. Obviosly every situation is unique.)

[Paregoric Kid]

if you use insurance and/or if it or the er is part of a network of hospitals that your specialist or gp is a part of they probably have your records, but I guess this depends on where you are and where you go. it probably is good to bring someone that is family or a spouse, can't hurt. if you are going in and they don't have any records you could bring a copy of your medical records or an empty bottle but I've never tried that. friends of mine that have gone to the er when they ran out or had doctor troubles tell me they usually get a shot of morphine or demerol if that and tell them to go to a specialist or find a new gp. one time me and a friend went to the er with a friend of ours when he ran out of his methadone and his regular pain doctor wouldn't fill it till after the weekend. they didn't write him anything and they gave him what they told him was morphine and wrote a note to his doctor saying he was being under-prescribed and that he recommended raising the amount. this is another good reason to bring a friend or if you go at night, they told my friend he wouldn't administer the shot of morphine unless he had a ride home, good thing we drove him. he didn't get a buzz but he wasn't sick anymore.

[I-Nod]

Such is the nature of the beast, it is a habit that most try to hide - hence, most "drug-seekers" will turn up at the ER alone.

Very good point, man! Something so simple, never even thought about it... damn that's a good one. True though, what do ya got to hide coming alone... you're so sick you drag yourself to the Emergency Room in the middle of the night, but don't have a friend or family in the world. Haha, can't believe something so simplistic and I didn't even think of that. Great one... keep 'em coming!! :D

[aj11]

one of my most succesful trips to get meds from an ER was on Christmas eve. went in with a terrible "tooth ache" and got an IM of demoral and 35 10mg Oxycontins, there was absoultly no one in the ER.
It also helps to have a slightly elevated pulse and slightly high blood pressure, becasuse those are soome of your body's natural reactions to bad pain

[limitless_euphoria]

ONE MORE POINT:

This too is very important - it is another classic drug-seeker potential "red flag" that ER staff watch for.

Such is the nature of the beast, it is a habit that most try to hide - hence, most "drug-seekers" will turn up at the ER alone.

By its self this is not a "negative" - but in conjunction with other factors it draws a image in the mind of the ER doc that will play into his decision taking.

Docs are trained to take social circumstances into consideration when evaluating a patient - it will not go un-noticed if the paperwork indicates you are employeed in the same job for the last 10 yrs, you are married, the wife is at home - and you came by taxi to the ER at 5am (i.e. whats up with the missus - most wives wouldn''t hesistate to take their sick husband at 5am in the morning to the ER if he was that unwell).

Sure, of course this scenario is plausible - just pay attention to the image you create regards your social circumstances - docs are trained to read between the lines - in particular ER docs, who get lots of practise taking social factors into consideration because of the broad spectrum of patien types they see.

Good point. When I was in VA and I threw my back out real bad from the long drive there, my aunt brought me to the ER. I scored 16 percs hardly any questions asked. They got me right in and everything. This was a couple of years ago.

I rarely go to the ER these days unless absolute need be but my wife usually does/would come in (the only problem is the kids). I usually show the doc/aprn a pic of my family. That actually helped me overcome a red flag at one particular hospital (I had gone there last for tooth pain). Playing the whole family man/woman thing definitely can help. If you seem like a withdrawn loner, yeah, you're more likely to be a seeker I suppose.

[AGV10]

When going the "chronic" route, and you really do have a history of potent narcotics, would it be beneficial to take in old script bottles to the visit? I dont exactly mean current scripts, as this could back-fire if they would contact the prescribing physician at a latter time, but for example, taking old bottles of MScontin and Roxicodone from an old PCP/PM doc.
Would they use this as a reference point when deciding what you recieve, or see it as a "seeking" behavior?
(In most cases anyway. Obviosly every situation is unique.)..


Thats a good question - to be honest I don't know. On balance I would have thought not, but I did ask him about this issue of ER docs contacting primary physicians.

In summary - next to no chance of that happening - and it won't be to verify medication. If there is an issue about you meds, you are going to get quized.

ER docs want to things to move fast and smoothly - contacting a patients primary physician then and there (never mind any time later) is an added complication that they are not going to bother about unless.

The issue is always the damn insurance companies: insurance companies have departments that do nothing but keep their eyes open for drug-seekers and narcotic users.

The problem here is finding a balance: by that I mean the temptation to use ER's comes from getting away with once, then twice, then 3 times .. and on and on it goes - till one day you get blown out.

Why? because the fucking insurance companies all have small sections staffed by people whose job it is to do nothing except spot drug-seekers and abusers, and if you have fallien into the trap of hitting ER's for your med's on insurance it will get recognised quick quick. Believe me - the people who work in these sections are trained to spot drug-seeking behavior/claims and patterns - and they are good at it.

The first "red-flag" is goes up when the computer notices the patient is using different ER's on a regular basis- which drug-seekers do to avoid getting challenged. Another indicator is refilling before the due date - and there are some other indicators the insurance companies recognise. They are ultra sharp at this game. Don't ask me what the cut off point is before you get flagged - they keep that very confidential for obvoius reasons - but be sure the flag will go up long before you think it will, and once you are flagged you have a mess on your hands - you wil get challenged every single time. Pay cash and leave. Some hospitals do not insist on ID - good if you know before hand which ones they are - get in and out on a false name, and be gone (and then of course make sure you know which parmacies also do not ask for ID - most small pharmacies don't but some of the big chains have a policy of asking for ID).

Keep insurnce out of the ER/drug-seeking equation - its a cash game if you want to stay below the radar.

[pharmboy]

Well done AVG10. I'm looking forword to part 2.

In Philly we have Temple University Hospital, it's in a real bad part
of the city, other hospitals send doctors there to get experiance with
gun shot wounds, and its in the middle of crack central.
I have never been to the ER there but I can tell you ALL the doctors
I have ever met that came from there made the Marquis de Sade
look like a boy scout. Some of them I really belive enjoy seeing , (and
doing nothing to help ) people in pain. The place breeds monsters.

Also I agree Friday nite or any time Friday before a holiday is BAD
timeing for a ER visit. . . Good going. . .:drinkit:

[tonyk]

yes! an excellent post! As a health care worker I agree 100%. AVG10, you have covered all the bases !! Thank you.

[NastyZilla]

I hate to be the bearer of bad tidings, but the ability to visit ERs on any sort of regular basis to score drugs is rapidly becoming a thing of the past. The proliferation of electronic medical records, coupled with hospitals' ability to share patient information for treatment, payment and administrative services, is resulting in the "death" of ER shopping.

In the name of improving patient care, preventing medical errors, and increasing the ease/speed with which health care providers have access to important patient information, "community health information networks" "regional health information origaizations" and similar organizations are creating community-wide databases that house substantial patient information. For example, when you arrive unconscious in the ER following a car accident, a hospital participating in one of these health information database organizations will be able to pull up your health info (using your drivers license/other ID). Patient health information is jointly created by, maintained, and accessed by community health care providers and health insurers.

The goal of the US Dept of Health and Human Services is to eventually have a nationwide health information network, so that when you move or travel, your health records will be accessible immediately by the hospital or physician treating you.

Much like how voting without ID is becoming a thing of the past, I imagine that you will not receive treatment beyond the basic screeing required by EMTALA unless you present a picture ID. And no, this is not being done to catch drug seekers - we're pretty inconsequential in the grand scale of things on the health care industry's radar. It's simply a step to catch the hospital/insurance industy up technology-wise with the rest of the business world; also, it will reduce medical errors (for example, easy access to records should prevent problems that would arise from not knowing the patient was diabetic or allergic to penicillin).

With each passing day, it becomes increasingly impossible to remain anonymous. Cash and a fake name won't work much longer. Sorry, folks

[Duckfeet]

My pet peeve, and if I were the resentful type, I wouldn't sleep at all the changes computer databases have brought in just the last 20 years. Used to be you would start over when you moved...no more...you are tracked...V.A. is slow, but they've pretty much got their computers up to speed, and that is the *main* reason I don't go thru the V.A. to get my methadone, since they put it on your computer and it will follow me for life, and V.A. docs would rather see u in agony, then give out drugs if you are a druggie...

Insurance companies, same thing,

Driver's licenses, again, u can't leave state and start over.

The total knowledge and power now held over us is unbelievable, and at the same time, people seem to be addicted to passing more and more laws...but everything u now do, or say, is on a computer somewhere, and following you around...that is the biggest change that has happened in my lifetime, bar none...

I hate to be the bearer of bad tidings, but the ability to visit ERs on any sort of regular basis to score drugs is rapidly becoming a thing of the past. The proliferation of electronic medical records, coupled with hospitals' ability to share patient information for treatment, payment and administrative services, is resulting in the "death" of ER shopping.


<snip>

With each passing day, it becomes increasingly impossible to remain anonymous. Cash and a fake name won't work much longer. Sorry, folks

[antigonemuse]

I hate to be the bearer of bad tidings, but the ability to visit ERs on any sort of regular basis to score drugs is rapidly becoming a thing of the past. The proliferation of electronic medical records, coupled with hospitals' ability to share patient information for treatment, payment and administrative services, is resulting in the "death" of ER shopping.

In the name of improving patient care, preventing medical errors, and increasing the ease/speed with which health care providers have access to important patient information, "community health information networks" "regional health information origaizations" and similar organizations are creating community-wide databases that house substantial patient information. For example, when you arrive unconscious in the ER following a car accident, a hospital participating in one of these health information database organizations will be able to pull up your health info (using your drivers license/other ID). Patient health information is jointly created by, maintained, and accessed by community health care providers and health insurers.

The goal of the US Dept of Health and Human Services is to eventually have a nationwide health information network, so that when you move or travel, your health records will be accessible immediately by the hospital or physician treating you.

Much like how voting without ID is becoming a thing of the past, I imagine that you will not receive treatment beyond the basic screeing required by EMTALA unless you present a picture ID. And no, this is not being done to catch drug seekers - we're pretty inconsequential in the grand scale of things on the health care industry's radar. It's simply a step to catch the hospital/insurance industy up technology-wise with the rest of the business world; also, it will reduce medical errors (for example, easy access to records should prevent problems that would arise from not knowing the patient was diabetic or allergic to penicillin).

With each passing day, it becomes increasingly impossible to remain anonymous. Cash and a fake name won't work much longer. Sorry, folks


sorry to debate this, but i know for a fact that this is not legal. I used to work as a closed medical record supervisor... a part of this position was training other staff on hippa... I aslo needed to know these laws as a part of my job

if this were to happen, then the patient would have to sign a disclosure of medical information in order for different entities to view their records. They just can't ask a non affilated medical practice for your records, you have to give permission... and the most protected info (meaning you would have to indicate if you were willing to share) is AIDS / HIV records and drug treatment... since this is a federal law, it applies to all medical practices

just wanted to share to clear up the conspiricy therories about a nation wide database to entrap patrons to the medical system

[AGV10]

I hate to be the bearer of bad tidings, but the ability to visit ERs on any sort of regular basis to score drugs is rapidly becoming a thing of the past. The proliferation of electronic medical records, coupled with hospitals' ability to share patient information for treatment, payment and administrative services, is resulting in the "death" of ER shopping.

In the name of improving patient care, preventing medical errors, and increasing the ease/speed with which health care providers have access to important patient information, "community health information networks" "regional health information origaizations" and similar organizations are creating community-wide databases that house substantial patient information. For example, when you arrive unconscious in the ER following a car accident, a hospital participating in one of these health information database organizations will be able to pull up your health info (using your drivers license/other ID). Patient health information is jointly created by, maintained, and accessed by community health care providers and health insurers.

The goal of the US Dept of Health and Human Services is to eventually have a nationwide health information network, so that when you move or travel, your health records will be accessible immediately by the hospital or physician treating you.

Much like how voting without ID is becoming a thing of the past, I imagine that you will not receive treatment beyond the basic screeing required by EMTALA unless you present a picture ID. And no, this is not being done to catch drug seekers - we're pretty inconsequential in the grand scale of things on the health care industry's radar. It's simply a step to catch the hospital/insurance industy up technology-wise with the rest of the business world; also, it will reduce medical errors (for example, easy access to records should prevent problems that would arise from not knowing the patient was diabetic or allergic to penicillin).

With each passing day, it becomes increasingly impossible to remain anonymous. Cash and a fake name won't work much longer. Sorry, folks

Er .... hospitals are not permitted to share info - that is federal law. Sorry, let me be a bit clearer on this.

Hospitals in the same group (e.g. different parts of UCLA) are permitted to centralise there patient records on a common database yes, but if you are sugesting that attenddence of UCLA one day will be linked to attendance of Mission Hospital tomorrow - or even Harbour UCLA - which is a state hospital - then no, the law prohibits that, and there is no way your records can be linked.

You are correct when you say the Dept of Health wants records that move with you when ever you go - but that is only in so far as you rely on the Us Dept of Health for health care - yes, in that sense your records will move with you.

Also - an addition piece of info that is important to bare in mind - it is the words "participating hospitals". When the USD of H comes in being with computer based sharing of patient health records in about 10 - 20 years time there will be a clause that permitts hospitals and more importantly, the individual patients to opt out.

Now, as far as patient record sharing goes between insurance companies - things here are slightly different. While you reserve the right to stop insurance company sharing your information with another insurance company, abuser practises are not protected by this confidentuality clause - there is a specific FDA form that insurance companies can fill in to legaly establish if you have a track record of abuse. This form is submitted to the FDA - who keep a record of the name and address of EVERY single patient prescribed narcotic analgesics. Doctors too, are legaly allowed to use this form to gain access to your use of prescribed narcotics - whoever prescribed them, whenever they were prescribed.

That said, the process is lethargic - it cannot be done over the phone or via a database - both insurance companies and doctors have to submitt the form to the FDA and wait for a reply back: the whole process takes 14 - 21 days and what they get in reply is a list of the docs that have prescribed narcotics for you, and when they wrote the prescritons as well as for what and how many. It will not come back with the words "Drug Abuser" - that is a judgement the applicant has to make fo rthemselves. In reality, docs and insurance companies seldom use this form, unless a problem is glaring at them i.e. docs don;t go down this route just because they have a niggling feeling.


Where your real life risk lies is with the FDA - who are pro-active, especialy when it comes to chasing ddrug-seekers who manipulate loop holes so that they can get sufficient to trade with on an ongoing basis. Watch out - the posse is coming!

So what flags you up at the FDA side?
Not "doctor shopping" by its self - Repeated refills from different doctors - called doctor shopping: as a rule, no action is taken as you are within your constitutional rights to seek medical help from whoever you wish, unless you are doctor shopping to do the following:

a) refill before your previous prescription finish date is up. Keep doing this and you will flag up in due course.

b) the second thing that results in being flagged up - for which you will be chased down if you do is if you fuck around with your prescription - change a 3 in 30 to look like an 8 as in 80, or any similar change. That is a federal offence. Doing in conjunction with "doctor shopping" before the previous script ran out or was finsihed - that is an indicator you are trading.

The FED posse is coming sooner orlater and you will have a federal charge for narcotic dealing hanging over you - serious shit if you are found guilty!

Do not fuck with your prescription: 1 year back I did not know how serious this was. No, I have not done this, but I have looked into the consequences and FDA policy in detail, and I know they will hammer you if they get you on it - ytou will be in serious shit

[wafflehead77]

sorry to debate this, but i know for a fact that this is not legal. I used to work as a closed medical record supervisor... a part of this position was training other staff on hippa... I aslo needed to know these laws as a part of my job

if this were to happen, then the patient would have to sign a disclosure of medical information in order for different entities to view their records. They just can't ask a non affilated medical practice for your records, you have to give permission... and the most protected info (meaning you would have to indicate if you were willing to share) is AIDS / HIV records and drug treatment... since this is a federal law, it applies to all medical practices

just wanted to share to clear up the conspiricy therories about a nation wide database to entrap patrons to the medical system

I agree. This has t be the case. An agency automatically pulling your med records, when you have not signed a release is a textbook example of a HIPPA violation. In order for this system to be legal, there would have to be serious changes that create a more liberal use of records; but if anything, privacy laws regarding medical records, especially drug treatment, mental health, and AIDS, are becoming more stringent.

[JonnyMohawk]

We actually have a board member who faked a script for CII opiates and got caught... he is going to court but luckily for tmtb it doesn't look to serious.


and you'd think they would catch the script when they call up the doctors to approve 80 oc's instead of the regular 30.. thats where Id try to make it look like both on the offhand they think its an 80 and dont catch it hehe :rolleyes:


Er .... hospitals are not permitted to share info - that is federal law. Sorry, let me be a bit clearer on this.

Hospitals in the same group (e.g. different parts of UCLA) are permitted to centralise there patient records on a common database yes, but if you are sugesting that attenddence of UCLA one day will be linked to attendance of Mission Hospital tomorrow - or even Harbour UCLA - which is a state hospital - then no, the law prohibits that, and there is no way your records can be linked.

You are correct when you say the Dept of Health wants records that move with you when ever you go - but that is only in so far as you rely on the Us Dept of Health for health care - yes, in that sense your records will move with you.

Also - an addition piece of info that is important to bare in mind - it is the words "participating hospitals". When the USD of H comes in being with computer based sharing of patient health records in about 10 - 20 years time there will be a clause that permitts hospitals and more importantly, the individual patients to opt out.

Now, as far as patient record sharing goes between insurance companies - things here are slightly different. While you reserve the right to stop insurance company sharing your information with another insurance company, abuser practises are not protected by this confidentuality clause - there is a specific FDA form that insurance companies can fill in to legaly establish if you have a track record of abuse. This form is submitted to the FDA - who keep a record of the name and address of EVERY single patient prescribed narcotic analgesics. Doctors too, are legaly allowed to use this form to gain access to your use of prescribed narcotics - whoever prescribed them, whenever they were prescribed.

That said, the process is lethargic - it cannot be done over the phone or via a database - both insurance companies and doctors have to submitt the form to the FDA and wait for a reply back: the whole process takes 14 - 21 days and what they get in reply is a list of the docs that have prescribed narcotics for you, and when they wrote the prescritons as well as for what and how many. It will not come back with the words "Drug Abuser" - that is a judgement the applicant has to make fo rthemselves. In reality, docs and insurance companies seldom use this form, unless a problem is glaring at them i.e. docs don;t go down this route just because they have a niggling feeling.


Where your real life risk lies is with the FDA - who are pro-active, especialy when it comes to chasing ddrug-seekers who manipulate loop holes so that they can get sufficient to trade with on an ongoing basis. Watch out - the posse is coming!

So what flags you up at the FDA side?
Not "doctor shopping" by its self - Repeated refills from different doctors - called doctor shopping: as a rule, no action is taken as you are within your constitutional rights to seek medical help from whoever you wish, unless you are doctor shopping to do the following:

a) refill before your previous prescription finish date is up. Keep doing this and you will flag up in due course.

b) the second thing that results in being flagged up - for which you will be chased down if you do is if you fuck around with your prescription - change a 3 in 30 to look like an 8 as in 80, or any similar change. That is a federal offence. Doing in conjunction with "doctor shopping" before the previous script ran out or was finsihed - that is an indicator you are trading.

The FED posse is coming sooner orlater and you will have a federal charge for narcotic dealing hanging over you - serious shit if you are found guilty!

Do not fuck with your prescription: 1 year back I did not know how serious this was. No, I have not done this, but I have looked into the consequences and FDA policy in detail, and I know they will hammer you if they get you on it - ytou will be in serious shit

[Duckfeet]

And of course, Veteran's hospitals can and now *do* pull up your records from one hospital to the next. Not only that, but over the last 5-10 years they have been punching in all the paper records for at least the last twenty years into these databases. And from what I've seen, they'll find a way to do the same for all hospitals: they'll pass these laws the same way they pass seatbelt, helmet, and anti-smoking laws: to protect you from yourself. Anybody who banks on the secrecy of their medical records, and particularly the prescribing of shedule II narcotics, hasn't been paying atttention to what's been going on, or is engaging--like I often do--in wishful thinking.

[OPticrazi]

I am sorry for the rant dude, but when your around for a while, ( i personally was a lurker for at least a year before I signed on, only after carefully checking out the nuts and bolts of this site, i.e. the law) you will see that more BULLSHIT flies around here then a cattle yard! Don't get me wrong not all the members here are assholes, not even most, but the bottom line is I take the the stuff I read on this site seriously, these are people lives, not some fucked up playground for want-a be's !
SO SORRY DUDE Your PIECE WAS WELL DONE! But the other have mentioned, wisely I might add, that a trip to the ER is real last ditch now a days........................Peace

[AGV10]

I am sorry for the rant dude, but when your around for a while, ( i personally was a lurker for at least a year before I signed on, only after carefully checking out the nuts and bolts of this site, i.e. the law) you will see that more BULLSHIT flies around here then a cattle yard! Don't get me wrong not all the members here are assholes, not even most, but the bottom line is I take the the stuff I read on this site seriously, these are people lives, not some fucked up playground for want-a be's !
SO SORRY DUDE Your PIECE WAS WELL DONE! But the other have mentioned, wisely I might add, that a trip to the ER is real last ditch now a days........................Peace


...... which is exactly what I said right at the start - ER's are where you go when you fast running out of options, they should not be your regular supplier.

[OPticrazi]

....I hear ya dude, there a lot of different kind of "opies" on the site. As you can see by my avatar( a actual pic of my shoulder, butchered by surgery. and resulting in a total replacement surgery 2 years ago and the fucker hurts 24/7 365). I have been in pain management for 3 years. My PM supplies me with the drugs I need to keep pain free and I admit readily recreation. When I run low it's my fault! not anyone else. So I guess the key is self control! But thats me. Thanks though again for the thread, maybe if they read it carefully the will understand that if your in real pain there are ways to get help, but bull shitting is not one of them!

[BLOODY]

d.feet+opti are 100% right.same BS here in germoney.if u have to stay stationary,u get 40mg done if ure hooked.dat not enuff for u?bad luck.

[NastyZilla]

sorry to debate this, but i know for a fact that this is not legal. I used to work as a closed medical record supervisor... a part of this position was training other staff on hippa... I aslo needed to know these laws as a part of my job

if this were to happen, then the patient would have to sign a disclosure of medical information in order for different entities to view their records. They just can't ask a non affilated medical practice for your records, you have to give permission... and the most protected info (meaning you would have to indicate if you were willing to share) is AIDS / HIV records and drug treatment... since this is a federal law, it applies to all medical practices

just wanted to share to clear up the conspiricy therories about a nation wide database to entrap patrons to the medical system

You can debate if you want, but I'm sorry to say you'll lose on this issue. First of all, anyone who cannot spell HIPAA doesn't know much about it. It's HIPAA (two As) which stand for the Health Insurance Portability and Accountability Act of 1996, and the regulations you're referring to are the Standards for Privacy of Individually Identifiable Health Information, 45 CFR Parts 160 and 164. These Standards (the "Privacy Rule") were published by the U.S. Department of Health and Human Services (HHS) in response to a requirement in HIPAA (the Congressional Act, that is); namely, if Congress failed to enact sweeping federal privacy legislation within two years, HHS was required to promulgate federal privacy regulations. The Privacy Rules (adopted by HHS in December 2000 and revised in August 2002) apply ONLY to "covered entities" (CEs) and there are three types of CEs - health insurers, clearinghouses (e.g., billing companies) and health care providers who conduct covered transactions electronically (i.e., the hospital or physician submits payment claims electronically or check patient insurance eligibility electronically).

The HIPAA Privacy Regulations permit covered entities (e.g., hospitals, physicians, nursing homes, etc.) to use and disclose "protected health information", or PHI, for ANY AND ALL treatment, payment and health care operations (i.e., administration) purposes of the covered entity, subject only to the requirement that only the "minimum necessary" PHI be used or disclosed to achieve the purpose for the disclosure. (Actually, the "minimum necessary" requirement does not apply to disclosures for patient treatment purposes).

45 CFR 164.506(c) EXPRESSLY permits covered entities such as hospitals to share patient information with other covered entities for (1) the treatment purposes of the entity receiving the info; (2) the payment purposes of the entity receiving the info; and (3) certain operational purposes of the receiving entity, such as quality improvement (but in the case of operational uses, both the disclosing and receiving entity must have or have had a relationship with the patient prior to the disclosure).

Getting the idea I might know what I'm talking about? :rolleyes:

The Privacy Rule does not preempt (trump) state law if the state law provides greater privacy protections or greater privacy rights to the patient. So, if a state requires that a patient sign an authorization prior to a hospital's use/disclosure of information that HIPAA would otherwise allow, then State law still applies, and the entity must get the patient's authorization. For example, records concerning substance and alcohol abuse, HIV status, mental health treatment, genetic information, etc. tend to be more protective of patient rights than the HIPAA privacy regulations; however, this "super sensitive" information is simply excluded from the databases to which I am referring, unless express patient authorization has first been obtained.

Please note, many states permit - without prior patient authorization - health care providers to share/disclose patient information for a patient's treatment. There are currently numerous regional and community projects THAT I WORK WITH RIGHT NOW who are permitted by state and federal law to share patient information for treatment and payment purpose, and even many administrative services, such a quality improvement. Also, those "Conditions of Admissions" forms we sign when we go to the ER? Guess what? It likely says the hospital can use/disclose your info in accordance with State law and the hospital's HIPAA Notice of Privacy Practices - which includes 45 CFR 164.506(c) disclosures, so you already have given the hospital the right to disclose your info for treatment, payment and perhaps other things as well. In States where "prior patient authorization" is required for certain disclosures, insurers and hospital participating in "community health information networks" simply have incorporated into their admissions forms a statement that the patient acknowledges and agrees that his/her info will be part of the database.

Anyone who believes that no portion of your medical record can ever be disclosed without your express permission is sorely mistaken. There are many "exceptions" to the rule that a patient must authorize a disclosure. For example, the hospital can and will disclose everything necessary to your insurance company to obtain reimbursement for your care. Some other obvious examples include communicable diseases, gun shot wounds, child abuse/neglect - in those cases, health care providers MUST disclose your info. In other cases, they are simply permitted to disclose your information if they decide to do so. For example, HIPAA's regulations permit covered entities to disclose the "minimum necessary" information for the provider's treatment, payment and administrative activities... which is an extremely broad range of disclosures. Also, hc providers must disclose patient info pursuant to court orders, as well as subpoenas (but only if the patient does not object in a timely fashion to the subpoena).

I could go on, but I think I've made it clear that the creation of databases containing some subset of patient information can occur and is occurring in many States. Even when "patient authorization" is required, most patients have provided sufficient permission by signing facility admissions forms - just read the last one you signed.

I am not aware of anyone using these systems to look for "drug seekers" - that is never the "goal" of these systems, which are aimed at increasing the efficiency of patient care and reducing costs; however, I have no doubt that preventing ER shopping will be a by-product of such systems.

ONE MORE THING: HIPAA's privacy regs did provide patients with the right to request that their information not be use or disclosed in certain ways... but HIPAA does not require the health care provider to abide by your wishes. So just because you say, "don't disclose this to my insurance company" doesn't mean they won't or can't.

Er .... hospitals are not permitted to share info - that is federal law. Sorry, let me be a bit clearer on this.

Hospitals in the same group (e.g. different parts of UCLA) are permitted to centralise there patient records on a common database yes, but if you are sugesting that attenddence of UCLA one day will be linked to attendance of Mission Hospital tomorrow - or even Harbour UCLA - which is a state hospital - then no, the law prohibits that, and there is no way your records can be linked.

Wrong, for the reasons described above. I have worked with the UC system, and many of their records are in fact linked. Fortunately, HIPAA's security regulations require that access to the PHI in these systems be accessed only on a "need to know" basis - so no, not everyone working at a facility will have access to all records there or at any other related facility. Most of the hospitals systems I work with have linked systems, such that (at a minimum) certain demographic and diagnostic information can be shared for patient payment and treatment purposes. This is common knowledge and industry wide practice.

You are correct when you say the Dept of Health wants records that move with you when ever you go - but that is only in so far as you rely on the Us Dept of Health for health care - yes, in that sense your records will move with you.

Again, not correct. HHS has several pilot projects to fund these types of community/regional databases to prove that all providers and insurers can share access to patient info to improve patient care. It has nothing to do with Medicare or any other gov't sponsored benefits program.


- there is a specific FDA form that insurance companies can fill in to legaly establish if you have a track record of abuse. This form is submitted to the FDA - who keep a record of the name and address of EVERY single patient prescribed narcotic analgesics. Doctors too, are legaly allowed to use this form to gain access to your use of prescribed narcotics - whoever prescribed them, whenever they were prescribed.

WTF? Sorry, but the FDA (Food and Drug Administration) has nothing to do with whatever you're describing. Are you talking about the DEA?

- That said, the process is lethargic - it cannot be done over the phone or via a database - both insurance companies and doctors have to submitt the form to the FDA and wait for a reply back: the whole process takes 14 - 21 days and what they get in reply is a list of the docs that have prescribed narcotics for you, and when they wrote the prescritons as well as for what and how many. It will not come back with the words "Drug Abuser" - that is a judgement the applicant has to make fo rthemselves. In reality, docs and insurance companies seldom use this form, unless a problem is glaring at them i.e. docs don;t go down this route just because they have a niggling feeling.

Again, not the FDA. Do you have some citations for this? I have never heard of such, and don't believe it exists. No company or the gov't would ever slap "DRUG Abuser" on a file! They would be sued for defamation! How ridiculous.

Guys, I'm not trying to rain on people's parades, I'm just trying to make everyone aware that ER shopping is going to end in the near future. It simply won't be possible because of the availability of your medical records for treatment purposes. Think about it - this is a type of "fraud prevention" that makes sense. It may piss us off, but it does make sense if you're trying to prevent folks from gaming the system.

[Duckfeet]

Thanks Goddess. Like I said, we are all susceptible to wishful thinking...but when information availability bumps against "our right too privacy..." (which btw, is a presumed, not an actual, right) privacy almost always looses.

Again, over the last 20-30 years, with the advent and perfection of online databases, docshopping and ER shopping are slowly becoming things of the past. We can find little quotes and laws all over the place, but they don't care, they access the computers and know damn well we aren't going to go get a lawyer and sue them for it. And anybody who will take the time to read all the paperwork they have signed, going into Doc's Offices and Hospitals knows this.

[AGV10]

You can debate if you want, but I'm sorry to say you'll lose on this issue. First of all, anyone who cannot spell HIPAA doesn't know much about it. It's HIPAA (two As) which stand for the Health Insurance Portability and Accountability Act of 1996, and the regulations you're referring to are the Standards for Privacy of Individually Identifiable Health Information, 45 CFR Parts 160 and 164. These Standards (the "Privacy Rule") were published by the U.S. Department of Health and Human Services (HHS) in response to a requirement in HIPAA (the Congressional Act, that is); namely, if Congress failed to enact sweeping federal privacy legislation within two years, HHS was required to promulgate federal privacy regulations. The Privacy Rules (adopted by HHS in December 2000 and revised in August 2002) apply ONLY to "covered entities" (CEs) and there are three types of CEs - health insurers, clearinghouses (e.g., billing companies) and health care providers who conduct covered transactions electronically (i.e., the hospital or physician submits payment claims electronically or check patient insurance eligibility electronically).

The HIPAA Privacy Regulations permit covered entities (e.g., hospitals, physicians, nursing homes, etc.) to use and disclose "protected health information", or PHI, for ANY AND ALL treatment, payment and health care operations (i.e., administration) purposes of the covered entity, subject only to the requirement that only the "minimum necessary" PHI be used or disclosed to achieve the purpose for the disclosure. (Actually, the "minimum necessary" requirement does not apply to disclosures for patient treatment purposes).

45 CFR 164.506(c) EXPRESSLY permits covered entities such as hospitals to share patient information with other covered entities for (1) the treatment purposes of the entity receiving the info; (2) the payment purposes of the entity receiving the info; and (3) certain operational purposes of the receiving entity, such as quality improvement (but in the case of operational uses, both the disclosing and receiving entity must have or have had a relationship with the patient prior to the disclosure).

Getting the idea I might know what I'm talking about? :rolleyes:

The Privacy Rule does not preempt (trump) state law if the state law provides greater privacy protections or greater privacy rights to the patient. So, if a state requires that a patient sign an authorization prior to a hospital's use/disclosure of information that HIPAA would otherwise allow, then State law still applies, and the entity must get the patient's authorization. For example, records concerning substance and alcohol abuse, HIV status, mental health treatment, genetic information, etc. tend to be more protective of patient rights than the HIPAA privacy regulations; however, this "super sensitive" information is simply excluded from the databases to which I am referring, unless express patient authorization has first been obtained.

Please note, many states permit - without prior patient authorization - health care providers to share/disclose patient information for a patient's treatment. There are currently numerous regional and community projects THAT I WORK WITH RIGHT NOW who are permitted by state and federal law to share patient information for treatment and payment purpose, and even many administrative services, such a quality improvement. Also, those "Conditions of Admissions" forms we sign when we go to the ER? Guess what? It likely says the hospital can use/disclose your info in accordance with State law and the hospital's HIPAA Notice of Privacy Practices - which includes 45 CFR 164.506(c) disclosures, so you already have given the hospital the right to disclose your info for treatment, payment and perhaps other things as well. In States where "prior patient authorization" is required for certain disclosures, insurers and hospital participating in "community health information networks" simply have incorporated into their admissions forms a statement that the patient acknowledges and agrees that his/her info will be part of the database.

Anyone who believes that no portion of your medical record can ever be disclosed without your express permission is sorely mistaken. There are many "exceptions" to the rule that a patient must authorize a disclosure. For example, the hospital can and will disclose everything necessary to your insurance company to obtain reimbursement for your care. Some other obvious examples include communicable diseases, gun shot wounds, child abuse/neglect - in those cases, health care providers MUST disclose your info. In other cases, they are simply permitted to disclose your information if they decide to do so. For example, HIPAA's regulations permit covered entities to disclose the "minimum necessary" information for the provider's treatment, payment and administrative activities... which is an extremely broad range of disclosures. Also, hc providers must disclose patient info pursuant to court orders, as well as subpoenas (but only if the patient does not object in a timely fashion to the subpoena).

I could go on, but I think I've made it clear that the creation of databases containing some subset of patient information can occur and is occurring in many States. Even when "patient authorization" is required, most patients have provided sufficient permission by signing facility admissions forms - just read the last one you signed.

I am not aware of anyone using these systems to look for "drug seekers" - that is never the "goal" of these systems, which are aimed at increasing the efficiency of patient care and reducing costs; however, I have no doubt that preventing ER shopping will be a by-product of such systems.

ONE MORE THING: HIPAA's privacy regs did provide patients with the right to request that their information not be use or disclosed in certain ways... but HIPAA does not require the health care provider to abide by your wishes. So just because you say, "don't disclose this to my insurance company" doesn't mean they won't or can't.



Wrong, for the reasons described above. I have worked with the UC system, and many of their records are in fact linked. Fortunately, HIPAA's security regulations require that access to the PHI in these systems be accessed only on a "need to know" basis - so no, not everyone working at a facility will have access to all records there or at any other related facility. Most of the hospitals systems I work with have linked systems, such that (at a minimum) certain demographic and diagnostic information can be shared for patient payment and treatment purposes. This is common knowledge and industry wide practice.



Again, not correct. HHS has several pilot projects to fund these types of community/regional databases to prove that all providers and insurers can share access to patient info to improve patient care. It has nothing to do with Medicare or any other gov't sponsored benefits program.




WTF? Sorry, but the FDA (Food and Drug Administration) has nothing to do with whatever you're describing. Are you talking about the DEA?



Again, not the FDA. Do you have some citations for this? I have never heard of such, and don't believe it exists. No company or the gov't would ever slap "DRUG Abuser" on a file! They would be sued for defamation! How ridiculous.

Guys, I'm not trying to rain on people's parades, I'm just trying to make everyone aware that ER shopping is going to end in the near future. It simply won't be possible because of the availability of your medical records for treatment purposes. Think about it - this is a type of "fraud prevention" that makes sense. It may piss us off, but it does make sense if you're trying to prevent folks from gaming the system.


I had a feeling I was going down a route I didn't know to much about ... okay point taken, you certainly appear to know what you are talking about, no question about it.

Regards FDA - actualy, I am right on this - but like the info you have detailed, this too is not as staright forward as it first appears. The program is an FDA initiative, but its implementation is a state decision e.g. in California it is implimented by the Office of the Dept of Justice through the Office of the Attorney General and is known as PAR - a Patient Activity Report.


IN turn this whole program was implemted under what is known as CURES - Controlled Substance Utilization Review and Evaluation System (Assembly Bill (AB) 3042). Cures is was originaly an FDA initiative (CURES and PAR are Federal terms).

Both Doctors and Insurance companies have legitimate access to this program - and access it at a State level. States are at liberty to adminster CURES/PAR through which ever part of the State government they wish. In California it is managed by the Office of the Attorney General, in New York it is managed through the Department of Health, State Office of Alcoholism and Substabce Abuse ...... and we could get on line and list all states (no point).

Lets try and get the subject back on track. Whie its clear from what you have said that hospital A and hospital B can link (and I did conceed that in a subsequent posting when refering to all that damn paperwork one has to sign when going to a hospital), my point is (badly qaulifed against detail that you have corrected) more so that one is not likely going to be flagged up on the spot while at ER trying to score. Not saying its not possible - saying its not likely. Speaking for myself. I have never being flagged up.

So while in theory, yes the mechanisms are in place to facilatate exactly what you say - my point is: are those mechanisms actively used to catch-out drug-seekers at ER's? Not much if at all.

As for the future, hell who knows whats going to happen. As harware an software based systems close loopholes the more ingenous drug-seekers are sure to find ways of beating the system - it is after all one of the very skills of a drug-seeker (deception).

As for your comment regards my spelling mistake - well spotted, but like your comment "ridiculous" in referance to claiming it was an FDA ..... well, what can I say - you had some good input, but you yourself made some errors in what you said.

I passed on some info for the benefit of all, I am not an expert on the legal details, it was inevitable that the subject would drift off into technicalities and detail that while accurate I dont think make dot differance to what actualy transpires on the ground at ER's. By all means spin it off as another thread, but lets try to keep this side of it practical and relivant to what happens in the ER at the "dreaded" moment.

[Duckfeet]

AGV10: Tho me and others might have quibbled about some minor points, I know I do appreciate the effort you put into how to deal with ER situations. I found many useful items, and realized that it was a well documeted, thoughtful attempt to help people negotiate what can be a really obnoxious situation... You know Opiophile, we argue about everything, but this was a good, useful piece of work, and it's appreciated.

[mikells43]

ive been to the er over 300 times in my active addiction. i had a shoulder that i could pop out myself and pop in. hell i had one doc who would write me perocoet 10s if i just put it in myself and got out of there. that was allways nice, id go in there he would walk in , say u want perocet, i say yes, he say ill leave for 5 mins, he come back shoulder fine but Painful lol and he give me script of 30 perc 10s then id leave after signing dc papers. i had varous other ers id go to sometimes 2 a nite hell sonmetimes 3 a nite. it was a bad thing i did but o well its done now. in the beginning id get dialudid shots and pills , at the end it was put to sleep put shoulder in, NARCAN then send home with nothing dope sick cause they used narcan to reverse the sedatioin. that sucked. hell i even burned myself once on purpose, got alot of dope for that and a skin graft, it wasn't a big one but the doc stuck it on there so id remember hwo fucked up it was to do that. thank god i dont have to do that shit anymore:-D

[Strike_3]

http://www.youtube.com/watch?v=t-puapocmBQ

http://www.youtube.com/watch?v=pG0Wl-iMeYY

I did not see anyone post the links to the old you tube videos to go with the craigs list post...

[rachamim18]

Opticrazy: "Self control and it being your own fault if you run low..." Not everyone though lives in your nation. I too am legally supplied with opiates/opioids (12,000 mgs morphine IR tablets, and 3,000 mgs. or Demerol injectable amp every 30 days). However, and I have talked this to death so forgive me others who already know, these substances are very difficult to locate in my country of residence.

Sometimes I run low to no fault of my own and on one occaison so far I was forced to go to an ER over the situation. I did find relief after a painful and worried 24 hours but the point is not everyone is in the same situation. There are also those with chronic conditions that cause breakthrough pain (mine is one) but I manage on that aspect.

[OPticrazi]

I did not mean to infer that ALL people have our situation. What I was trying to get across is that one aspect of being a Opiophile is common sense. NOBODY likes going through WD's But after fucking up enough time and having to suffer, I changed my ways. Where I live in Florida, if you show up at and ER looking for opiates, you better have been brought in on a stretcher, or you are pretty much up shit creek! Plus if you get tagged by the Florida narcotic system as "seeker" your best move at that point is to find a new state to reside in! and believe me this is no bullshit!

[AGV10]

ive been to the er over 300 times in my active addiction. i had a shoulder that i could pop out myself and pop in. hell i had one doc who would write me perocoet 10s if i just put it in myself and got out of there. that was allways nice, id go in there he would walk in , say u want perocet, i say yes, he say ill leave for 5 mins, he come back shoulder fine but Painful lol and he give me script of 30 perc 10s then id leave after signing dc papers. i had varous other ers id go to sometimes 2 a nite hell sonmetimes 3 a nite. it was a bad thing i did but o well its done now. in the beginning id get dialudid shots and pills , at the end it was put to sleep put shoulder in, NARCAN then send home with nothing dope sick cause they used narcan to reverse the sedatioin. that sucked. hell i even burned myself once on purpose, got alot of dope for that and a skin graft, it wasn't a big one but the doc stuck it on there so id remember hwo fucked up it was to do that. thank god i dont have to do that shit anymore:-D

You burnt yourself once deliberately!

Thats the power of addiction.........

Shit, I hope I am never in that position, I dont know what I'd do. Interesting to note that you resorted to self harm and not crime.

I watched the uTube vid's - was trying to work out if that guy is a user or a nurse (or a using nurse!)?

[AGV10]

AGV10: Tho me and others might have quibbled about some minor points, I know I do appreciate the effort you put into how to deal with ER situations. I found many useful items, and realized that it was a well documeted, thoughtful attempt to help people negotiate what can be a really obnoxious situation... You know Opiophile, we argue about everything, but this was a good, useful piece of work, and it's appreciated.


Understood - actualy correcting me on those points I have not being accurate with is a good thing, no objection at all. I just dont want a useful thread to de-generate into a mess as it nearly done at the start. Opiophile is as you say, a forum and a subject that is going to attract a lot of argumentation.

[Ghost666]

http://www.youtube.com/watch?v=t-puapocmBQ

http://www.youtube.com/watch?v=pG0Wl-iMeYY

I did not see anyone post the links to the old you tube videos to go with the craigs list post...


OMG, I looked everywhere for those videos the other day and couldn't find them...youtube search engine SUX!

[mikells43]

You burnt yourself once deliberately!

Thats the power of addiction.........

Shit, I hope I am never in that position, I dont know what I'd do. Interesting to note that you resorted to self harm and not crime.

I watched the uTube vid's - was trying to work out if that guy is a user or a nurse (or a using nurse!)?


yea i did burn myself intentionally, i used radio controlled car fuel. its nitromethane with oil init. i said my rc car blew up all over me. the doc that did my skin graft caught on tho. i dont member when i was in the burn unit for a few days. i also had 3 surgeries i didnt need on my shoulder cause i can pop it in and out, i said it was loose. and i honestly beleived my own lies. im clean now tho:). and addiction is POWERFUL!!!!!!!

[mikells43]

LOOK at this shit. check out his hand!
http://www.youtube.com/watch?v=GRHV_awWV00

[antigonemuse]

ummmm, can i say fuck off for judging me based on a fucking typo... I trained my co workers on hipaa laws, i was head of the closed record department... this is a fact, i was the one who reviewed requests for PHI, and reviewed all the open case files in the east coasts largest mental health facility to make sure they were in accordance with OMH's standards. my job was QI and i took it serious. On top of that i worked with patients and their records in one of the nations best hospitals, and provided direct care in another facility. So lets just agree that i know a thing or two about what im doing and PHI

but obviously your a bit egocentric, bacause you cant handle differing opinions. so fuck off, kiss my ass, and shake around the large key chain that obviously makes you feel like your important. Im glade im not in your head, cause paranoia has never been an issue of mine.

sorry to be defensive, but you were a bit to quick to throw out insults, and judgements based on a few sentance

grow a penis, try a bit harder to agree to disagree, and bit my left tit... see it dont feel so good to have someone put u down does it....

the patient has to be aware of what they put a signature to, and im not so stupid to think there are not exceptions

You can debate if you want, but I'm sorry to say you'll lose on this issue. First of all, anyone who cannot spell HIPAA doesn't know much about it. It's HIPAA (two As) which stand for the Health Insurance Portability and Accountability Act of 1996, and the regulations you're referring to are the Standards for Privacy of Individually Identifiable Health Information, 45 CFR Parts 160 and 164. These Standards (the "Privacy Rule") were published by the U.S. Department of Health and Human Services (HHS) in response to a requirement in HIPAA (the Congressional Act, that is); namely, if Congress failed to enact sweeping federal privacy legislation within two years, HHS was required to promulgate federal privacy regulations. The Privacy Rules (adopted by HHS in December 2000 and revised in August 2002) apply ONLY to "covered entities" (CEs) and there are three types of CEs - health insurers, clearinghouses (e.g., billing companies) and health care providers who conduct covered transactions electronically (i.e., the hospital or physician submits payment claims electronically or check patient insurance eligibility electronically).

The HIPAA Privacy Regulations permit covered entities (e.g., hospitals, physicians, nursing homes, etc.) to use and disclose "protected health information", or PHI, for ANY AND ALL treatment, payment and health care operations (i.e., administration) purposes of the covered entity, subject only to the requirement that only the "minimum necessary" PHI be used or disclosed to achieve the purpose for the disclosure. (Actually, the "minimum necessary" requirement does not apply to disclosures for patient treatment purposes).

45 CFR 164.506(c) EXPRESSLY permits covered entities such as hospitals to share patient information with other covered entities for (1) the treatment purposes of the entity receiving the info; (2) the payment purposes of the entity receiving the info; and (3) certain operational purposes of the receiving entity, such as quality improvement (but in the case of operational uses, both the disclosing and receiving entity must have or have had a relationship with the patient prior to the disclosure).

Getting the idea I might know what I'm talking about? :rolleyes:

The Privacy Rule does not preempt (trump) state law if the state law provides greater privacy protections or greater privacy rights to the patient. So, if a state requires that a patient sign an authorization prior to a hospital's use/disclosure of information that HIPAA would otherwise allow, then State law still applies, and the entity must get the patient's authorization. For example, records concerning substance and alcohol abuse, HIV status, mental health treatment, genetic information, etc. tend to be more protective of patient rights than the HIPAA privacy regulations; however, this "super sensitive" information is simply excluded from the databases to which I am referring, unless express patient authorization has first been obtained.

Please note, many states permit - without prior patient authorization - health care providers to share/disclose patient information for a patient's treatment. There are currently numerous regional and community projects THAT I WORK WITH RIGHT NOW who are permitted by state and federal law to share patient information for treatment and payment purpose, and even many administrative services, such a quality improvement. Also, those "Conditions of Admissions" forms we sign when we go to the ER? Guess what? It likely says the hospital can use/disclose your info in accordance with State law and the hospital's HIPAA Notice of Privacy Practices - which includes 45 CFR 164.506(c) disclosures, so you already have given the hospital the right to disclose your info for treatment, payment and perhaps other things as well. In States where "prior patient authorization" is required for certain disclosures, insurers and hospital participating in "community health information networks" simply have incorporated into their admissions forms a statement that the patient acknowledges and agrees that his/her info will be part of the database.

Anyone who believes that no portion of your medical record can ever be disclosed without your express permission is sorely mistaken. There are many "exceptions" to the rule that a patient must authorize a disclosure. For example, the hospital can and will disclose everything necessary to your insurance company to obtain reimbursement for your care. Some other obvious examples include communicable diseases, gun shot wounds, child abuse/neglect - in those cases, health care providers MUST disclose your info. In other cases, they are simply permitted to disclose your information if they decide to do so. For example, HIPAA's regulations permit covered entities to disclose the "minimum necessary" information for the provider's treatment, payment and administrative activities... which is an extremely broad range of disclosures. Also, hc providers must disclose patient info pursuant to court orders, as well as subpoenas (but only if the patient does not object in a timely fashion to the subpoena).

I could go on, but I think I've made it clear that the creation of databases containing some subset of patient information can occur and is occurring in many States. Even when "patient authorization" is required, most patients have provided sufficient permission by signing facility admissions forms - just read the last one you signed.

I am not aware of anyone using these systems to look for "drug seekers" - that is never the "goal" of these systems, which are aimed at increasing the efficiency of patient care and reducing costs; however, I have no doubt that preventing ER shopping will be a by-product of such systems.

ONE MORE THING: HIPAA's privacy regs did provide patients with the right to request that their information not be use or disclosed in certain ways... but HIPAA does not require the health care provider to abide by your wishes. So just because you say, "don't disclose this to my insurance company" doesn't mean they won't or can't.



Wrong, for the reasons described above. I have worked with the UC system, and many of their records are in fact linked. Fortunately, HIPAA's security regulations require that access to the PHI in these systems be accessed only on a "need to know" basis - so no, not everyone working at a facility will have access to all records there or at any other related facility. Most of the hospitals systems I work with have linked systems, such that (at a minimum) certain demographic and diagnostic information can be shared for patient payment and treatment purposes. This is common knowledge and industry wide practice.



Again, not correct. HHS has several pilot projects to fund these types of community/regional databases to prove that all providers and insurers can share access to patient info to improve patient care. It has nothing to do with Medicare or any other gov't sponsored benefits program.




WTF? Sorry, but the FDA (Food and Drug Administration) has nothing to do with whatever you're describing. Are you talking about the DEA?



Again, not the FDA. Do you have some citations for this? I have never heard of such, and don't believe it exists. No company or the gov't would ever slap "DRUG Abuser" on a file! They would be sued for defamation! How ridiculous.

Guys, I'm not trying to rain on people's parades, I'm just trying to make everyone aware that ER shopping is going to end in the near future. It simply won't be possible because of the availability of your medical records for treatment purposes. Think about it - this is a type of "fraud prevention" that makes sense. It may piss us off, but it does make sense if you're trying to prevent folks from gaming the system.

[rachamim18]

Opticrazy: Fair enough. I lived in DelRay Beach, and thenTampa for a total of 3 odd years when I first went to America. In Tampa I was on MMT and I worked as a truck driver for a sanitation hauler and used to work to work, leaving my home at 3:30 to 4:00 AM every day save Sunday. I also lived in College Hill Homes, and anybody knowing Tampa will know that the housing project was THE worst in central Florida was the worst bar none, maybe even worse than Liberty City in Miami,etc.

I had just finished two IDF terms for a total of almost 6 years and really thought I was invincible and laughed when people's jaws dropped that I lived in THAT neighbourhood. Unlike NYC,etc., Floridian bolacks look at Hispainics as whites unless fully black as well so that is how racially polarised the entire 22nd St. part of Tampa was.

Stupidly, quite amazingly really, I used to read while I walked. I was reading a copy of the Alan Jenning's book, "Aztec" when I was knocked unconscious by a piece of concrete wiileded by some apprent crack head (I say crack because I) there was really no heroin to be had outside of Miami abnd that point even that was rare believe it or not, and II) the ghetto grapevine told me it was a woman (a notorious crackhead who used to sell herself for it illustrating just how into it she was) who "set me up" for it.

I had my take home (one a week and of course it had to be THAT day of all days that week) with me, in my uniform pants pocket. I woke up only seconds after being hit and gave chase but to be honest I was reeling and staggering. I am lucky I guess that I was not killed all things considered but people always said I had a hard head (still do actually) (sic). When I reached down to check for my wallet (usually, througout my life I did not carry any cash , relying instead on bank withdrawals,etc. I was looking to make sure my ID was on me and then discovered 2 things in short order: I) He had taken my bottle...and sad to say this, truly am, II) that he had also taken my apartment keys which at the time was a less important ramification for me...

I began walking home, thinking my lover (and mother of one of my illicit children, who actually was 8 months pregnant at this point) would baby me, etc. As I walked back home a cop car caught me in the ehadlights. I can only imagine what that pig thought, seeing me staggering and blood falling all over my face and onto the ground, on E Lake Ave in Tampa! He slammed on the brakes and using the PA had me lay faceedown,etc.

Of course his first stupid question was, "What are you doing in this neighbourhood (as if he did noi swear on his mother that I was buying crack)?" After yelling at him that I lived there and that I had been mugged, he changed tact and had me get in the cruiser. Truning around to drive me home I could see why he was all of a sudden so much friednly.

As we turned down my streetr, 31st Ave., the early dawn hours were illuminated by several sets of blue and reds. Rushing into my apt. I found my lover who had been sleeoing in the nude had been attacked. Amazingly the crack head only threatened her with a broomstick and asked for the drugs. I actually was a dealer but not for some time after that and in another area of town. She told him to "f" off apparently and he instead just grabbed a single beer in my fridge that a customer had given me (I do not drink but had friends that did).

He took the single beer and grabbed some garbage found radio and hauled a:S. She called 911 and voila!

After filling out the reports and doing the sitdowns in the apt., I called in for an absence at work and was driven to the city's main hospital out on Davis Island. The attending saw me, did not even blink and asked me why I was there...HELLOOOOOO...Actually, and this is aslo sad to say, I did not give a damn about possible concussions, or even if Santos (my ex g/f), all i cared about what that bottle of methadone.

I was polite, very coherent (I have at least average intelligence and am able to articulate/communicate my thoughts quite well. The doctor cut me off howevcer and said, "I am not giving you methadone so do not waste your and my time." I said that I had a prescription for it and that I had been on it for more than 6 years (at that time I believe). He did not care. I maintained my calm demeanour but was persistent. "What about diabetics?" "Had i been walking down that avenue cradling my insulin would you also deny me that substance?

I would like to offer up my whole discussion but I have hijacked this one too much as it is so I will wrap it up. He did not care, and would not even discuss it. He made me feel so bad and guilty for being on OST, although I had been placed on it by the army and was clean cut, articulate, and in a stable environment in every sense of the word.

Had it been now I would have nailed him trhough his supervising but as I said I felt like the lowest of the low.

Why did I just bother to post all this that most will not even read, and if they do will find it boring? Because I can certainly commisserate with your subjective experience in Florida. the state is as* backwards in so many things, unionisation, voting, infrasructural fraud, and of course the Rehab Industry (indeed drug rehabs are a hige buisness).

[OPticrazi]

Not boring at all brother,In fact is sheds glowing light on this fucked up state. Believe me as soon as momma retires, we are our here like I shot. I was born and raised in Michigan, and came here in late 90's. Here in central Florida I have never met a ignorant bunch of hypocritical, ignorant bunch of humans in my life! Italy is most likely where me and momma will wind up, likely around Tuscany.
So, thanks for the thread brother and enjoy the Philippines! Peace and I mean it!

[OhJoy]

I am so fucking discussed, :mad:

Disgusted->Filled with disgust or irritated impatience.

[OPticrazi]

the LATTER.............and a little of the first........................Peace

[Duckfeet]

Excellent account of a terrible day. I had gun pulled on me on Scott Street, in Houston, and a similar outcome...but anyway, this should be required reading for people just playing around with the dope lifestyle...

Only disagreement, is with you and others who think this is a "Florida" situation. This might have been true, twenty, maybe even ten years ago, when changing states, meant things were really different. The advent and success of databases, and online interconnectedness, means it doesn't change anymore, when one changes states. I lived in Gainesville for many years, and left Pensacola, to move out here to Southern California, and find no major differences, other than the fact that the Pacific Ocean has consistently bigger waves.

When I was younger, one could change states, and start over, even get a different drivers license, and begin a new life, but again, most things we find obnoxious are no longer limited to one state or another, but are nation wide. Idiots can access each other very easy, and just punch in their miserable information on the computer, and they all get it.

I will spare you all some of my experiences, like attempting to get a pardon, and how quickly the Parole Office in Louisiana obtained my records in Florida and California...or how the V.A. hospital quickly told me I had been doing "too many" opiates in Florida. Even ten years ago, this was unheard of...but all the bad guys are hooked together now...frightening business....


Opticrazy: Fair enough. I lived in DelRay Beach, and thenTampa for a total of 3 odd years when I first went to America. In Tampa I was on MMT and I worked as a truck driver for a sanitation hauler and used to work to work, leaving my home at 3:30 to 4:00 AM every day save Sunday. I also lived in College Hill Homes, and anybody knowing Tampa will know that the housing project was THE worst in central Florida was the worst bar none, maybe even worse than Liberty City in Miami,etc.

<snip>

Why did I just bother to post all this that most will not even read, and if they do will find it boring? Because I can certainly commisserate with your subjective experience in Florida. the state is as* backwards in so many things, unionisation, voting, infrasructural fraud, and of course the Rehab Industry (indeed drug rehabs are a hige buisness).

[OPticrazi]

Your straight up right dude. I can tell ya though when I came to Florida, I had a really fucked up license in Michigan. BUT i WENT in to DMV looking as straight lace I can, Fuck I even shaved off my stash which had worn for years. I walk out of there with a clean license, with even this fuckin " Safe Driver" note and my motorcycles endorsement with no test no nothing! And here is the real mind blower a re-up date not due for 7 years! I was fuckin freaked! Now maybe it was my age 50+ but what a deal.
Now as far as the med deal goes it took me about 3 years to get that mess fixed. but every time I went to the GP's until found a good one I ALWAYS had the medical record in tow.
And I never fuck around going to the VA. If you get in that data base your FUCKED ROYAL!
The doc I have now, the GP is a cool guy who knows my pain is for real, in fact he jokingly refers to me as an orthopedic train wreck. Now the PM guy, which I might add I lucked into after my total shoulder replace meant surgery is cool to, it might that almost when down for the dirt nap as a result..
I never get any shit from him and he treats me like a human being. But the one thing I NEVER do is Doctor shop. That a red flag you can NEVER shake!
That's it in a nut shell.................Peace

PS bro the stash is back and the long hair is still there so............................Oh BAH dee OH blah DA life goes on bra

[Duckfeet]

Exactly. Used to be, in Louisiana, when you got bad DUI, or other problems, u'd go to FL and get new license, or AL, same thing...but again, now they're all hooked together...I have class A CDL, and I'm alright now, for most purposes--except getting into Canada--since DAC, which is where truck companies check, only goes back five years...but reading your post made me think...see I use the V.A. for just about everything, but I've also got Soc.Sec, and this year, I paid the xtra 90 bucks a month, so I can use the Medicare Class B, and I'm going to start hitting up a pain clinic, see if I can find something better than the goddamn methadone I'm slowly detoxing off of..and you know V.A.'s best I can get--so far--is 120 generic Vicodins a month...but I figure outside pain clinics might be a better shot.....


Your straight up right dude. I can tell ya though when I came to Florida, I had a really fucked up license in Michigan. BUT i WENT in to DMV looking as straight lace I can, Fuck I even shaved off my stash which had worn for years. I walk out of there with a clean license, with even this fuckin " Safe Driver" note and my motorcycles endorsement with no test no nothing! And here is the real mind blower a re-up date not due for 7 years! I was fuckin freaked! Now maybe it was my age 50+ but what a deal.
Now as far as the med deal goes it took me about 3 years to get that mess fixed. but ever time I went to the GP's until found a good one I ALWAYS have the medical record in tow. And I never fuck around going to the VA. The doc I have now, the GP is a cool guy who knows my pain is for real, i fact he jokingly refers to me as an orthopedic train wreck. Now the PM guy, which I might add I lucked into after my total shoulder replace meant surgery is cool to. I never get any shit from him and he treats me like a human being. But the one thing I NEVER do is Doctor shop. That's it in a nut shell.................Peace

PS bro the stash is back and the long hair is still there so............................Oh BAH dee

[OPticrazi]

I have family in So Cal....But anyway Duck If can help ya out just email me or PM me and I help ya out, I mean what are brothers for?................................Peace out.....for now


Ya know now that think about it Mich may now have reciprocity with FL>
Fuck the "METHADONE" That shit made a fuckin mad man!

[Duckfeet]

That's kind of funny: I just got thru emailing u, and then logged on here, and saw this...yep, I'm out here in Cali, but sounds like you might have some ideas, since I want to switch away from V.A., if possible, and need to know if I'll need to get outside primary care doc before seeing PM...also, so far, I've managed to keep methadone clinic off the charts in V.A., but going to outside clinic, not the one V.A. will pay for, which of course, costs me xtra 300 bucks a month, but I'm just constitutionally and politically to opposed to fucking methadone to do anything but bitch about it LOL....slowly dropping down...once I hit zero, next move is attempt to either sneak into Canada, or fly to England, and try once again, to get on heroin maint...but thats in future....

I have family in So Cal....But anyway Duck If can help ya out just email me or PM me and I help ya out, I mean what are brothers for?................................Peace out.....for now


Ya know now that think about it Mich may now have reciprocity with FL>

[rachamim18]

Duck: For sure it is an American thing, and maybe even in other nations.

On databases, actually i should not complain because that shared info saved me a 3 year bid. I sat in Riker's where they had predicated me based on my flat-4 in Jersey. To make it a short story, they offered me time served IF my charge that got me those 4 years (only did 34 months on it) equalled a charge that was misdepeanour in NY. My charge, if you can believe it, was for 8 bags of heroin and 2 vials of crack (4 years for what is a ticket in NYC-just going 5 minutes over a bridge changes so much).

Of course i snatched theoffer with glee. However, sentencing day arrived. I am first on the calendar, amped up and ready to roll, and the judge asked the DS for proof of my charge in Jersey."Uh, we do not have ut your honour..." The judge was livid and said that if they did not produce it by the end of the day they would rescind my offer (which I do not think would have upset the DA too much, as if, but make my knees buckle).

Spent all day in Manhattan tombs bullpens and was out of my mind by my 430 PM call back. They had gotten it faxed and after getting my token 9no Metro Cards yet) I walked out a happy and shocked man...promptly headed up to 123rd and a couple of bags but that is neither here nor there. Point is that the shared data helped me to avoid, at the very, very least another 4 months in Rikers waiting to be proven correct.

It has its ups and downs.

I have no experience of course with the VA but I am sure outside providers would help you alot more. Theyhave a built in porofit incentive. Happy patients means more money. The VA could not care less and even has a built in incentive to decrease Rx and patient costs.

[OPticrazi]

Not true about the VA bro I know a dude that even beat a rap on narcs and now has a hard time getting a fucking Tylenol from the VA!

[Duckfeet]

Yeah, I'll be honest: I used to think I had the V.A. *wired.* I mean, I knew just how far I could go, and would I could obtain, and how to do it...but the database thing, changed *everything* mostly in the sense that any fool could see my history, and what I was about, and make their own conclusions...often correct, sadly...

But I actually got hurt in Nam, and was 50 percent disabled coming out of there, and like most vets, over the years, got it increased, and now am 100 per cent...which is nice on the money side, and I've schooled a couple other guys into getting that, as I feel anybody who was in during these fucking fucked up wars, deserves every penny they can get, regardless of what, or where, they were, but anyway, the reason I think sometimes people have different impressions, is because these last few years so much has changed, with the databases, *and* the bidding process. They always like the primary care docs to perscribe the opys they have most of. Right now, that is hydrocodone. At one time it was Tylenol3's, so there has been some improvement.

The nice thing, is that docs *can* override it and give out better...oops, I'm late for dentist, back later...





Not true about the VA bro I know a dude that even beat a rap on narcs and now has a hard time getting a fucking Tylenol from the VA!