Schedule II Stories

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I have so many stories I don’t even know where to start. I work in Pain Management in both an inpatient and out patient setting. I find it ironic that I can not sign a HCP Rx, however inpatient I am trusted to order PCA’s and dilaudid IV pushes, manage epidural catheters/intrathecial pumps, order methadone and even order IV Fentanyl! All of which are far more risky than hydrocodone. I have seen many delayed discharges. On more than one occasion I have been in an office without a MD on Friday afternoon when someone’s grandmother comes in with her 2nd or 3rd compression fracture and all I can give her is a lidoderm patch and tramadol. I can only hope that she is the grandmother of some legislator, maybe she can talk some common sense into them.

However, I don’t believe that necessarily every PA should have schedule II privileges. New grads may not have the experience or intestinal fortitude to say no to a persistent drug seeker. Hopefully we could reach some-sort-of compromise giving at least limited schedule II rights(maybe hydrocodone and oxycodone) to Surgical, Pain Management, ER Experienced rural PC etc.. PA’s

We now have a database to help curb ‘provider shopping’ and abuse, lets utilize it and not punish the suffering patient!!

– OMG, Mariettia,GA (Intervential Pain)

4000 plus P.A.’s in the state of Georgia—-many in RURAL AREAS in a second or third office that one physician had the forethought to open and staff with PA’s— to help the underserved people in these regions—-now limited in appropriate care due to the new Class II drug laws, and the inability of our lawmakers to pass perscripitive rights for Class II drugs by P.A.’s

I’ve worked in these areas, and P.A’s are sometimes the only source of healthcare that is available within a 50 mile radius. I’ve prescribed pain meds and hydrocodone type cough meds for 36 years and have never had a problem, until the recent limitations by the New Class II Laws. I now work in neurology/chronic pain, and provide a quality of life to people that otherwise would be bedbound with horrific pain–if not for my help with their pain meds and needs.

Take these 4000 P.A.’s and multiply them by 30 patients a day, (average for most P.A.’s across all specialties) and you have 120,000 people in the state of Georgia, per day, that may or may not have adequate treatment due to the lackluster ability of the lawmakers at the Capitol.

This Schedule II Bill was passed last year by half of the lawmakers at the Capitol —then sat on a desk of one House of Representatives person—(my guess is she didn’t get a favor returned), until the session was over.

What a pity that so many have to suffer for one person’s act!!!!

Hopefully, this year with so much at stake for the general healthcare of The Great State of Georgia—our Legislators will come together and pass the Bills necessary for P.A.’s to prescribe class II medications.

– W.G., Atlanta, GA (Neurology)

I work at a Ryan White funded HIV clinic in Savannah, Georgia. We service primary care for uninsured or under-insured patients; these patients do not have access to physical therapy or surgery as options secondary to lack of payment (Ryan White funds will cover diagnostic testing, but not surgery). I cannot even get screening colonoscopy services despite our mandate to provide primary care for these patients. Many of these patients suffer chronic pain due to a lifetime of hard labor in conjunction with a lifetime of HIV now as a chronic disease. We have one MD who covers multiple district locations and is now fully invested in research, which means her time and availability are limited to nonexistent. Since losing Schedule II prescriptive authority, our clinic now is struggling to cover our patients with chronic pain. It is requiring way too much time chasing down the doctor and fielding phone calls with irritated patients flooding our p hone lines and voicemail. This takes away time from other services and priorities. I also see urgent care visits/walk-in visits, and, like many, can now only provide Tylenol 3/4 and Tramadol. Presently I am the sole provider at the clinic for my patient load, and was the one who insisted on more regulation of schedule II medications and routine drug screening, but do not get to follow through with goals of care/treatment plan. The Georgia Drug Monitoring Database was also something I insisted my clinic to monitor for our patients on Schedule II medications, it does not take an MD to understand and take responsibility for management of these medications.

– MRS, Savannah, GA (HIV/Primary Care)

I practice in a general and trauma orthopedic practice and only have 1.5 days of co-clinic with my supervising physician. Other days the I am responsible for all the management of our hospitalized patients and/or in an independent clinic. The antiquated Georgia law plus the change in DEA reclassification of schedule II medications has directly impacted my ability to appropriately care for about 25% or more of the patients I contact on a daily basis.

Outpatient: The PAs in our practice see all pre-op and initial post-op visits to maintain a higher level of access for new patients to see our surgeons and because I have many independent clinics to cover the service area, our practice is unable to efficiently and appropriately plan for pre-op management and/or provide post-op pain control without significant strain on the patient and/or our practice. I routinely see non-operative fractures that I now am mandated to write Tylenol with codiene or tramadol. This is not adequate pain control for most patients and dangerous for some. Therefore, I have some patients driving 30 plus miles to pick up a hydrocodone pr oxycodone prescription because I am now apparently not compitent enough to prescribe them according to [Someone in the state of Georgia]. Additionally, I have NEVER condoned patients presenting to the emergency department for orthopedic complaints other than appropriate emergencies but recently I have found myself sayi ng, “I’m sorry. You have to go the ER if the tramadol (or T#3) isn’t working because I can’t help you.” It absolutely disgusts me to say that because it is not, and should never be, the standard of care and underminds our patient’s trust in my supervising physician an me.

Inpatient: There have been many cases of delayed discharges on patients that have made better than expected gains in a short period of time. Normally, I would discharge the patient home (improving morale of the patient and reducing nosocomial infection potential), save the hospital money and have less work to do the following day. Instead, I am keeping the patient in the hospital, driving to my clinic to get a prescription signed and discharging the patient the next morning. Why don’t I drive back to the hospital to discharge the patient after obtaining the prescription? Because I see as many patients as my physician during clinic and I don’t have the physical time to drive that extra 70 miles to and from the hospital. This is so illogical and causes excessive burden on providers as I’m fully capable of writing ALL schedule II medications within the hospital setting as delegated by my physician.

I routinely explain to patients that the change in my ability to care for them is a direct result of politics and is not supported by medical literature and in no way reflects the core knowlede of PAs providing for their care. I thought the inability to prescribe oxycodone was limiting and unfounded being that the federal government and other states I’ve practiced in have not had this limitation, but the removal of hydrocodone has become outright debilitating within orthopedics.

The bottom line is that fractures hurt. Surgery hurts. Acute back pain and other injuries hurt. There is a place for narcotic pain medications and we PAs need the ability to care for our patients within the standard of care and within the scope that our supervising physician’s delegate.

– NM, Braselton, GA (Orthopedic Surgery)

I work in a busy Urgent Care Center in which (just two providers see 80-110 patients per day); NUMEROUS TIMES, I have had a patient which had a fracture (ankle, wrist, hand etc…) or kidney stone who were obviously in a great deal of pain. What could I offer that patient? Yep, Tramadol or Tylenol #3 – (which makes most patients sick to their stomach). We go to school obtain all of our training, and get Rx privilage taken away from us. The person who is truly suffering is the patient. I feel we are giving our patients sub-standard care, and our compassion goes right out the window. I do agree the new law has maybe made it more difficult for obtaining Rx’s in Illegal ways (people phoning them in); but on a clinical side, it has hurt the quality of care that we deliever to the patient.

– PB, Snellvile, Georgia (Urgent Care)

I work in a very busy orthopedic practice. There are days in which my supervising physician is at another office from where I am practicing for the day. If I have a post op patient or if I have a new patient with an injury that requires a pain medication other than Tylenol 3 or Tramadol, I have to stop my work flow and interrupt one of my physician’s partners to get a prescription for that patient. Although I do explain this to the patient (s), it is fairly unprofessional. Pre-signing prescriptions is not a viable option for my supervising physician.

– JK, Atlanta (Orthopedic Surgery)

I work in pediatric ENT. The advanced Practice providers do all of the pre-op visits which include prescribing postoperative prescriptions. Not having the ability to prescribe hycet for my patients undergoing tympanoplasty, cochlear implants, and tonsillectomy has put an extra strain on clinic flow and the physicians who now have to write for them. This is also challenging in the hospital when we are trying to discharge a patient with peri tonsillar abscess or any other condition that may require a schedule II pain medication. I have to wait on my doctor to finish surgery or leave the hospital and walk over to clinic to have a physician not involved in the patient’s care write for it. This has held up discharges which has a negative impact in other patients being admitted.

– AO, Atlanta (Pediatric Otolaryngology)

My supervising physician had a death in the family and was unable to make it to one of our rural clinics (where no other physician is available.) Of course there were still patients to be seen, so I took over clinic by myself in his absence. One of our postoperative patients was having severe pain issues and unfortunately there was NOTHING I could do to help them. The only advice I could provide was to drive to our main clinic (45 minutes away) and have a physician (who has never participated in their care) write a pain script for them. Why is this a better option than being able to write for it myself? I was thoroughly aware of this patients postoperative course and able to make the judgement that a HCP prescription was needed. This is not quality care for our patients!

– AB, Georgia (Orthopedic Surgery)

Last night, I worked up a patient in our Evening Urgent care clinic. The patient presented with sudden onset severe shoulder and arm pain. After a thorough workup and x-ray evaluation, I realized my patient had a pathologic fracture through a very large metastatic lesion in his humerus. My patient’s chief complaint was Pain. Unfortunately, I was unable to administer any type of effective pain relieving medication to this patient because of the new changes in HCPs. Normally I could fax a prescription to his pharmacy or I could write this prescription for him. The patient lives 45 minutes outside of town in a rural area. The new law forced the patient to wait almost 20 hours before he could pick up a prescription signed by a MD. During the course of waiting for his Pain medicine, he had a bone scan, as well as CAT scans with and with out contrast of his abdomen, pelvis, and chest. However he had to endure all these studies without sufficient pain medicine. This is not quality patient care. The law and our legislators failure to realize the unnecessary burden that this places on the patient, has significantly detrimentally limited access to quality care in the state of Georgia.

– MV, Savannah, GA (Orthopaedics)

How about this as a slap in the face from the “Good ole’ Boys” medical establishment.  By limiting Physician Assistants to Schedule III and lower medications I am no longer competitive in the Job Market.  Wellstar, Cobb County’s largest employer (and one of the states largest as well) no longer even includes Physician Assistants as potential candidates for mid-level positions at their various locations.  Apparently all future positions for mid-will be filled by Nurse Practitioners at Wellstar facilities.

– ER, Acworth, GA (General)

While working in a satellite office my supervising physician was called away to the ER. I finished seeing patients including the last one who was a 1 week post op rotator cuff repair. She needed a refill of her HCP medication so her family had to drive her 45 minutes to our main office to obtain a prescription from another physician. This was frustrating to her family and an uncomfortable drive for the patient.

I also saw a patient last night in our “After Hours Clinic” who had a distal fibula fracture with syndesmosis disruption. I gave her Tramadol for pain however due to her lack of pain relief she ended up going to the ER for a HCP to relieve her pain. Unfortunately, this was an extra cost to her and her insurance carrier as well as a nuisance to the ER staff who was overwhelmed with their own emergencies.

Both of these issues as well as MANY more could have been prevented and resolved with PA’s ability to write for Schedule II HCP medications!

– DV, Savannah, GA (Orthopaedics)

I am an Orthopedic PA-C in North Carolina and work at a satellite clinic close to GA once a week. Due to the close proximity, I have patients who are residents of GA. In NC, I have the ability to write for Schedule II narcotics, and as I usually do during preoperative exams, I prescribed Percocet for postoperative pain for two patients in particular this week. The following day, the patients had called our office stating that they could not fill my Rx in GA because I was a PA-C and not an MD. Since this was done at a satellite clinic and we were at our main office by this point, we couldn’t easily provide them with a new Rx written by my supervising physician without them driving many miles. Neither of them could afford the expense or time out of their day. We ended up giving them their postoperative pain medication Rx the day of surgery. This was inconvenient and less than ideal because they then had to fill the Rx after surgery when they are in pain, instead of obtaining it prior so that they could go directly home after surgery. It was also a hassle for myself and my supervising physician, and will continue to be as long as the GA law stands that PA-Cs can’t prescribe Schedule II narcotics.

– HM, Franklin, NC (General Orthopaedics)

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