Doctor Shopping

[Blainey]

Relating to the Rush Limbaugh situation and a hypothetical situation.  The questions would be best answered in regards to the state of California, but general information, or federal law should it apply, would also be acceptable.

"Joe Smith" is a regular evryday kind of guy.  Looks and actsm and pretty mcuh is the average working class white guy from suburban america.  No criminal history outside of the occasional speeding or parking ticket.  Certainley no felonies.  "Joe" doesn't smoke or drink, doesnt live a reckless lifestyle and really has no vices, save one.

Joe has a history of severe pain problems associated with a neurological disorder that has no real cure.  Due to another health problem "Joe" can not take the new non-addictive pain relievers and has to rely on narcotics and occasionally benzodiazapines(valium, xanax, ativan, etc) for pain management.  Taking the new, non narcotic pains medications could provide deadly side effects.  Point being, "Joe" has a medically legitimate(with the legitamacy being supported by dozens of doctors in several specialists).  He needs the narcotics to manage the pain.  The normal pain medications are DEA Schedule III and IV  medications, usually extra strength Vicodin and then valium or ativan for problems sleeping and tension.  So far "Joe" has not done anything wrong.  So far...

"Joe" has in the past few years begun to use the medications not only to relieve the physical pain but also to "party" and sometimes deal with emotional problems, depression and the likes.  The amount of pain meds prescribed to him by his doctor are enough for the pain but not enough to keep up with his "partying" and self medicating to deal with his depression.  (note: the term "partying" in this story does not really refer to consuming a very large amount of the medications and then hitting the bars and clubs to add to the "high".  "Partying" in "Joes" world usually means taking a few pills before he goes out to dinner or a movie with friends just to put him in a good mood.)

"Joe" is not in an overdose/suicidial situation, he has no intentions of specifically hurting himself or ending his or anyone elses life.  He doesnt put others at risk while he is "high(i.e. driving..etc)  His tolerance is high but has leveld off and he has been in a regular dose range for a long period of time.  He can go for a couple of weeks without the meds but would prefer to use them daily. "Joes" doctor does not prescribe enough of the medications to allow "Joe" to use the meds daily.  So "Joe" has taken additional measures to increase his supply.  Mainly "doctor shopping" which was actually a new term until the Rush Limbaugh story broke.  "Joe" at first would make visits to Emergency Rooms in the large metro area in which he lives.  He would be seen by a doctor who would hear "Joes" accurate and unfortunate medical history and situation and would be made aware of "Joes" current pain situation.  Based on the patient history every MD "Joe" saw would write "Joe" a prescription for the meds "Joe" requested by name.  "Joe" would always spread out to different pharmacies and only repeat the same pharmacy every few months so not to send up any red flags.  After a few months of ER visits, maybe 15, "Joe" realizied that ER vistits were too long, inconvientnet and required too much "acting in pain".  Plus he just felt bad for faking it for drugs.

Then "Joe" discovered several medical clinics that would take walk-in patients that pain in cash and were very efficent.  Maybe an hour to be seen by the nurse, the doctor, gets the prescriptionsd and be out the door.  Most of the doctors asked alot of questions about "Joes" medical history, but "Joe" always had the right answer(which most of the time was the real, legitmite truth).  Most doctors would write him a 1 motnh supply of the meds(which would last "Joe" about 1 week and then see him again in a month to get a new prescription.  Joe found 4 clinics that operated that way and that is how he has and is now getting his medications.  Obviously none of the doctors know about the other doctors or the real quantatiy of meds "Joe" is taking each month.  

So, in short, "Joe" goes to one doctor every week and then sees that doctor every month.  Each new prescription goes to the same pharmacy for that physicain each month.  Four doctors, four pharmacies.  Occasionally a new pharamacy will be added so that his pharmacy records have some space in between pain medication dispensing.  "Joe" uses his real identity with all of the doctors and gives accurate medical history when asked.  His only omission is that he is not admitting that he is seeing onther doctors for the same thing.  The noyl other thing "Joe" does wrong, and "Joe" thinks that this may be a big one....one of "Joes" doctors is a very old man, in his late 70's.  His medical practice is a bit antiquated and his is not current about how to write prescriptions in this day and age.  There is a box in the corner of the prescription pad that is to be filled out for refills.  He always leaves it blank, meaning no refills.  But "Joe" knows how to write the number "2" in medical shorthand(its looks like the sign for the mathmatical symbol for pie).  So "Joe" places the symbol for 2 in the box and the gets 3 times the quanity that the doctor actually meant to prescribe.

"Joe" knows that he is doing the following:  He is doctor shopping, falsifying medical records and lying to doctors and pharmacists(I assume), and altering a written prescription.  "Joe" knows this isnt a good thing. However, "Joe" is no saint but he has not ever sold his meications to a 3rd party, they have always been for personal use.  he has never profitted off of his ilegal activity. "Joe" needs to know the following:

How many laws is he breaking?

Which are misdemenors and which are feloines?

How much trouble can "Joe" get into even though he has a completely clean record outside of this?

Does the state or DEA have some way of catching up to him(State of California)?

What might he do to trip some sort of red flag?

Will the different pharamacies ever check with other pharmacies to see if there is abuse?

What about altering the prescription, what goes along with that?

Clinically "Joe" has a medical problem, chemical addiction, would a court or legal offical see that first and offer treatment in place of punishment since "Joe" never profitted from it..if anything he spent hundreds of dollars on his illness..?

If "Joe" stopped today and only went to one doctor for his legitamte medical issue could this all go away undiscovered?

If "Joe" stopped EVERYTHING today, not even 1 doctor for a legit problem, could this all go away unnoticed?

Where can "Joe" go to find more info about the legalities of what he is doing.

Is "Joe" one of thousands of people who do this or is he pretty much a minority?

Is there anyway to just make all of "Joes" problems go away?  i.e. turning himself in before any law enforcement offical was even looking for him?

Things to keep in mind; after a very tramatic emotional event in "Joes" life he turned to drugs to "help" him through his mental anguish and pain and abused the medications to the point where he ended up in a rehab, but after a friend and family intervention, it had absolutely NOTHING to do with law enforcment.  He would jsty go on "benders" and drug himself out of his problems.  But there is no legal record of that to his knowledge.

"Joes" got problems and he needs to know what is the best direction to turn and the safest place to be.  Right now he is ok but is worried about there being a knock at the door some day and having the face on the other side of the screen showing a badge.  The irony of all of this is that it woul be 100 times "safer" if "Joe" just bought the meds of a street drug dealer...they tend to not keep records....

Thanks.

[Kellach]

Mr. Flannery,

I want to say one thing and you can tell Joe to take it or leave it.  I know how he can totally take care of all his problems...interested.  Good.  Totally, without reservation, 100%, tell him to turn his life over to Jesus Christ.  He will assist him in fixing all these problems.  It may not be on his timetable or the way he wants it done, but that doesn't take away from the fact that Christ CAN and WILL help him if he ask's.  That's not to say that Christ may not want something in return, but, tell Joe to read the Bible and start with Romans 10:9 and then Matthew, Mark, Luke and John.  Now on to the things you were asking about "Joe".

I AM terribly sorry to hear about the pain problems and disorder.  I am not sure how to help other than to tell Joe the honest, brutal truth.  I am sure I do not have the answers he wants, but here goes.

First and foremost. the most important thing above all is, where is "Joe's" personal integrity and moral ethics.  Hmmm...nowhere to be found in this case.  In my opinion it has very little to do with "getting caught" or "how good the rest of his life is" or "how bad the pain is"(although now it's not used just for the physical pain is it) what matters is what kind of person is Joe.  Especially, to himself.  Joe must be looking in the mirror in the mornings and questioning himself, I am sure there is doubt and self-esteem issues, no to mention the guilt. Secondly, "Joe" needs help.  Let's not mince words here.  JOE IS AN ADDICT AND BREAKING THE LAW.  Joe needs help.  No matter how you try to whitewash it and candy coat it, Joe needs serious help.  NOW.  Joe should make the proper calls and get the assistance going now.  Have I made myself clear on that issue.  NOW.

Thirdly, "Joe" will get caught...eventually.  It may not be today or next week, but statistically you know as well as I do the longer Joe does this the better chance he has of getting caught.

I do apologize for the fact of not answering the legal questions Joe wants answered.  I would not feel right about that.  If Joe doesn't have the integrity or self-discipline to stop for the simple fact that it is wrong and he wants to start doing the right thing. If he can't stop so that he can feel better about himself emotionally, then he probably isn't going to stop over a few charges that could "possibly" be leveled against him in the future.  Joe is an addict, addict's don't usually work that way.  They only stop, generally, after they get caught and are forced.  But, when "nobody's" looking they start right back up again.

How important is it to "Joe" to do the right thing?  That's all that matters.  Tell Joe to go get help and stop doing this immediately, find one doctor to go to and get the legitimate drugs.  Hopefully, this would all just go away unnoticed.

I will help in any way I can.  If there are more questions don't hesitate to ask, but keep in mind I am only going to give the brutal honest truth, nothing more, nothing less.

Sincerely,

Sean