Ameritox Urine Drug Test has destroyed my doctor/patient relationship... literally.

originally posted by: tigertatzen
a reply to: NavyDoc

The OP's situation is not actionable by lawsuit however, as a practitioner is not obligated to prescribe schedule II medications if he does not want to--for any reason

Is that true regardless of therapeutic level? What if sudden cessation resulted in adverse physiological effects and put the patient at risk versus weaning them off the meds gradually...wouldn't that violate the rule of doing no harm to the patient?

If one is transferred care or given a weaning schedule, then it's not abandonment. If someone is say, caught selling their drugs or combining with coc aine and they are on 80mg of oxycontin per day, I'm not obligated to provide them with any more oxycontin but would have to either transfer care to someone else or provide medications to ease the withdrawal symptoms.

originally posted by: annoyedpharmacist
a reply to: new_here

Negative cutoff for this medication is less than 50 ng/ml. You being at 44ng/ml were VERY close to having it be classified as positive. Doesnt look like you were dilute either........normal SG for urine is 1.000-1.030. It is possible you are one of the fast metabolizers through a CYP450 2D6 mutation, but who knows.

I thought that 1.000 was the specific gravity of water. So I assumed 1.003 would be more dilute than 1.030. Is it the other way around?

originally posted by: new_here
a reply to: NavyDoc

I would have gladly done a pill count. What they would have seen was a surplus in the way of bits and pieces where I had not taken whole tablets.

Concerning this:

The OP's situation is not actionable by lawsuit however, as a practitioner is not obligated to prescribe schedule II medications if he does not want to--for any reason.

Yeah, I get that. But what about the false/damaging letter in my file that say "urine drug test that SHOWS you are not taking the controlled substance prescribed."
Not "implies" or even "shows your are not taking it AS prescribed." It says in black and white that I am not taking it at all. That is categorically false and damaging to my ability to secure another doctor. That is Libel.

And forget the fact they won't prescribe any Adderall. They won't even SEE me to check on the status of my BP issue in which they were in the process of trying to regulate the dosage. The day I got the urine screen, it was still high. Nothing was done to alter the dosage of Lisinopril, even though at the previous visit, the doctor specifically said, "We have a lot of wiggle room to increase the dosage, but it hasn't been long enough to tell if this dosage is going to work for you or not. I'll put a note here for the nurse, that when you come in next month for your 'nurse visit' if it's still high, she will let me know, and I'll up the dosage."

Fast forward and I'm drinking a bunch of water for the urine test, and I tell the nurse what the doctor said, and she says, "Oh no, you'll have to see the doctor for any change. If we do it this month, it will look like the nurse made the change." ???

Now they refuse to schedule me an appointment, I have no doctor. Is that not 'patient abandonment?'

I think that the wording "would be glad to refer you and pass along your records" might clear them of an abandonment issue. Also, consider that there are 4 parts that make up a malpractice suit: duty/relationship, breach of duty/relationship, damage, and causation.

You had a relationship:check
He breached the relationship: possible--but then physicians are not obligated to continue schedule II's and there are specific criteria for abandonment. In your case, I'd have to give it a +/- because one could argue that there was abandonment because you were not referred to a specific alternate provider.
Harm: you were not harmed that you said
Causation: that the violations of the above three CAUSED the harm in question.

I'd say it'd be tough to take him to court. However, you should write a letter of complaint, describing everything you explained to us, to the state medical board. Then your complaint and (if they discipline him) will be part of his permanent public record.

How I do it: if a patient comes in low on a UDS, I ask why and if they have a good explanation, such as "I was having a pretty good week so I didn't take my pain pills that week" I bring them in for a pill count and if the pill count matches the explanation, then nothing is done and I document the reason for the UDS being "off." That covers me under the obligation for due diligence and documentation as put forth by the state and federal regulations and keeps you under my care with some personal dignity.

a reply to: new_here

specific gravity of 1.030 means more solutes in the urine, ie not dilute. for example a SG of greater than 1.035 may be indicative of dehydration.

originally posted by: NavyDoc

originally posted by: new_here
a reply to: NavyDoc

I would have gladly done a pill count. What they would have seen was a surplus in the way of bits and pieces where I had not taken whole tablets.

Concerning this:

The OP's situation is not actionable by lawsuit however, as a practitioner is not obligated to prescribe schedule II medications if he does not want to--for any reason.

Yeah, I get that. But what about the false/damaging letter in my file that say "urine drug test that SHOWS you are not taking the controlled substance prescribed."
Not "implies" or even "shows your are not taking it AS prescribed." It says in black and white that I am not taking it at all. That is categorically false and damaging to my ability to secure another doctor. That is Libel.

And forget the fact they won't prescribe any Adderall. They won't even SEE me to check on the status of my BP issue in which they were in the process of trying to regulate the dosage. The day I got the urine screen, it was still high. Nothing was done to alter the dosage of Lisinopril, even though at the previous visit, the doctor specifically said, "We have a lot of wiggle room to increase the dosage, but it hasn't been long enough to tell if this dosage is going to work for you or not. I'll put a note here for the nurse, that when you come in next month for your 'nurse visit' if it's still high, she will let me know, and I'll up the dosage."

Fast forward and I'm drinking a bunch of water for the urine test, and I tell the nurse what the doctor said, and she says, "Oh no, you'll have to see the doctor for any change. If we do it this month, it will look like the nurse made the change." ???

Now they refuse to schedule me an appointment, I have no doctor. Is that not 'patient abandonment?'

I think that the wording "would be glad to refer you and pass along your records" might clear them of an abandonment issue. Also, consider that there are 4 parts that make up a malpractice suit: duty/relationship, breach of duty/relationship, damage, and causation.

You had a relationship:check
He breached the relationship: possible--but then physicians are not obligated to continue schedule II's and there are specific criteria for abandonment. In your case, I'd have to give it a +/- because one could argue that there was abandonment because you were not referred to a specific alternate provider.
Harm: you were not harmed that you said
Causation: that the violations of the above three CAUSED the harm in question.

I'd say it'd be tough to take him to court. However, you should write a letter of complaint, describing everything you explained to us, to the state medical board. Then your complaint and (if they discipline him) will be part of his permanent public record.

How I do it: if a patient comes in low on a UDS, I ask why and if they have a good explanation, such as "I was having a pretty good week so I didn't take my pain pills that week" I bring them in for a pill count and if the pill count matches the explanation, then nothing is done and I document the reason for the UDS being "off." That covers me under the obligation for due diligence and documentation as put forth by the state and federal regulations and keeps you under my care with some personal dignity.

Well I wish the doc was like you, then. I would love to have a pill count. I would love to have my medical file reflect truth. And about breach of relationship, Adderall is not my concern right now. My blood pressure prescription is. There was more to our doctor-patient relationship than ADD diagnosis.

But I'm not out for blood and ruining a doctor. I just want to HAVE a doctor and have my slate wiped clean of wrongdoing.

originally posted by: annoyedpharmacist
a reply to: new_here

specific gravity of 1.030 means more solutes in the urine, ie not dilute. for example a SG of greater than 1.035 may be indicative of dehydration.

Ok, my specific gravity was 1.003 not 1.030
So it was dilute?

a reply to: new_here

I get that. But I'm not on any narcotics. And just to remind everyone, I personally asked the doctor over the past 5 years to lower my dosage of Adderall because I told her I didn't need 30mg 3X/day. Twice I requested it be lowered. Hardly the behavior of someone diverting/selling medication.

Anything that is a Schedule II controlled substance falls under that category, not just narcotics. Adderall is one of those meds, so it's inclusive. It's just not as common as the incidences of overprescribing opiates like hydrocodone and benzodiazapines like alprazolam. Adderall sells for a lot on the street, just like ritalin...it's considered "safer" than meth and of course lacks the nasty side effects like teeth falling out and lesions appearing on the skin, etc. that meth is known for. But it can be a very dangerous drug if it isn't closely monitored, which is why it's classed as a controlled substance.

And sadly, the golden adage in healthcare is : if it's not documented, it never happened. Unless it was charted that you discussed your wish to reduce the dose, it's the doc's word against yours. It's probably even more upsetting to you given the fact that you've trusted this person for a number of years and now all of a sudden, you're being treated badly for no coherent reason. Personally, I'd sue his ass up one side and down the other and make it as public as possible, but I'm scrappy like that

a reply to: NavyDoc

...and to further throw salt in the wound, the only referral they offered was for 'drug rehabilitation.'
For not having enough amphetamines in my system.

And that is in my medical file.
I feel like I just got served divorce papers and I thought my marriage was perfect.

originally posted by: new_here

originally posted by: NavyDoc

originally posted by: new_here
a reply to: NavyDoc

I would have gladly done a pill count. What they would have seen was a surplus in the way of bits and pieces where I had not taken whole tablets.

Concerning this:

The OP's situation is not actionable by lawsuit however, as a practitioner is not obligated to prescribe schedule II medications if he does not want to--for any reason.

Yeah, I get that. But what about the false/damaging letter in my file that say "urine drug test that SHOWS you are not taking the controlled substance prescribed."
Not "implies" or even "shows your are not taking it AS prescribed." It says in black and white that I am not taking it at all. That is categorically false and damaging to my ability to secure another doctor. That is Libel.

And forget the fact they won't prescribe any Adderall. They won't even SEE me to check on the status of my BP issue in which they were in the process of trying to regulate the dosage. The day I got the urine screen, it was still high. Nothing was done to alter the dosage of Lisinopril, even though at the previous visit, the doctor specifically said, "We have a lot of wiggle room to increase the dosage, but it hasn't been long enough to tell if this dosage is going to work for you or not. I'll put a note here for the nurse, that when you come in next month for your 'nurse visit' if it's still high, she will let me know, and I'll up the dosage."

Fast forward and I'm drinking a bunch of water for the urine test, and I tell the nurse what the doctor said, and she says, "Oh no, you'll have to see the doctor for any change. If we do it this month, it will look like the nurse made the change." ???

Now they refuse to schedule me an appointment, I have no doctor. Is that not 'patient abandonment?'

I think that the wording "would be glad to refer you and pass along your records" might clear them of an abandonment issue. Also, consider that there are 4 parts that make up a malpractice suit: duty/relationship, breach of duty/relationship, damage, and causation.

You had a relationship:check
He breached the relationship: possible--but then physicians are not obligated to continue schedule II's and there are specific criteria for abandonment. In your case, I'd have to give it a +/- because one could argue that there was abandonment because you were not referred to a specific alternate provider.
Harm: you were not harmed that you said
Causation: that the violations of the above three CAUSED the harm in question.

I'd say it'd be tough to take him to court. However, you should write a letter of complaint, describing everything you explained to us, to the state medical board. Then your complaint and (if they discipline him) will be part of his permanent public record.

How I do it: if a patient comes in low on a UDS, I ask why and if they have a good explanation, such as "I was having a pretty good week so I didn't take my pain pills that week" I bring them in for a pill count and if the pill count matches the explanation, then nothing is done and I document the reason for the UDS being "off." That covers me under the obligation for due diligence and documentation as put forth by the state and federal regulations and keeps you under my care with some personal dignity.

Well I wish the doc was like you, then. I would love to have a pill count. I would love to have my medical file reflect truth. And about breach of relationship, Adderall is not my concern right now. My blood pressure prescription is. There was more to our doctor-patient relationship than ADD diagnosis.

But I'm not out for blood and ruining a doctor. I just want to HAVE a doctor and have my slate wiped clean of wrongdoing.

Well, put that in your letter to the board--they can make him amend the record. He can't legally remove the discharge letter but he can be made to make an amendment to the record where your side of the situation is explained so that any other doctor who gets your records can see that there was a reasonable explanation for the UDS issue and he was just being a dick about it.

a reply to: NavyDoc

If one is transferred care or given a weaning schedule, then it's not abandonment. If someone is say, caught selling their drugs or combining with coc aine and they are on 80mg of oxycontin per day, I'm not obligated to provide them with any more oxycontin but would have to either transfer care to someone else or provide medications to ease the withdrawal symptoms.

Ok, I think I get it...as long as they don't just leave a patient with no options for continued treatment, they won't be considered to be abandoning their care.

originally posted by: tigertatzen
a reply to: NavyDoc

If one is transferred care or given a weaning schedule, then it's not abandonment. If someone is say, caught selling their drugs or combining with coc aine and they are on 80mg of oxycontin per day, I'm not obligated to provide them with any more oxycontin but would have to either transfer care to someone else or provide medications to ease the withdrawal symptoms.

Ok, I think I get it...as long as they don't just leave a patient with no options for continued treatment, they won't be considered to be abandoning their care.

Right. However, one could argue that they should have at least covered her with her blood pressure medications while she was searching for another provider. BP meds are not controlled and coming off them abruptly can be very dangerous and he really risks nothing by at least keeping her on what she was on as a baseline.

I'd say he was being a bit of a dick--he may be covered legally--but still a dick IMHO.

a reply to: NavyDoc

Right. However, one could argue that they should have at least covered her with her blood pressure medications while she was searching for another provider. BP meds are not controlled and coming off them abruptly can be very dangerous and he really risks nothing by at least keeping her on what she was on as a baseline.

I'd say he was being a bit of a dick--he may be covered legally--but still a dick IMHO.

I agree. And I didn't even think about the fact that she takes meds for hypertension too so yeah, that makes it even worse...especially added in with the stress of what's happened most likely elevating her BP too and it was already high at the last visit.

originally posted by: tigertatzen
a reply to: NavyDoc

Right. However, one could argue that they should have at least covered her with her blood pressure medications while she was searching for another provider. BP meds are not controlled and coming off them abruptly can be very dangerous and he really risks nothing by at least keeping her on what she was on as a baseline.

I'd say he was being a bit of a dick--he may be covered legally--but still a dick IMHO.

I agree. And I didn't even think about the fact that she takes meds for hypertension too so yeah, that makes it even worse...especially added in with the stress of what's happened most likely elevating her BP too and it was already high at the last visit.

I feel bad for her. Tempted to just call in her refills as I've got a SC license too. Technically illegal though, so maybe I'll just try to figure out who to refer her. I don't know a lot of PCMs down there, but I could give a look see if I get a PM with the city or town.

a reply to: NavyDoc

I feel bad for her. Tempted to just call in her refills as I've got a SC license too. Technically illegal though, so maybe I'll just try to figure out who to refer her. I don't know a lot of PCMs down there, but I could give a look see if I get a PM with the city or town.

That's because you're a good doctor You actually care. I feel bad for her too...it really pisses me off when it's blatantly obvious that someone has been lied to or manipulated like that, especially by someone who is in a position of power...which is what a physician is to most patients. Making it look as if she's doing something wrong or illegal, meanwhile leaving her high and dry without medical care she obviously needs. I lived in SC years ago but don't know anyone there anymore to refer her to. This is just so messed up.

originally posted by: tigertatzen
a reply to: NavyDoc

I feel bad for her. Tempted to just call in her refills as I've got a SC license too. Technically illegal though, so maybe I'll just try to figure out who to refer her. I don't know a lot of PCMs down there, but I could give a look see if I get a PM with the city or town.

That's because you're a good doctor

You actually care. I feel bad for her too...it really pisses me off when it's blatantly obvious that someone has been lied to or manipulated like that, especially by someone who is in a position of power...which is what a physician is to most patients. Making it look as if she's doing something wrong or illegal, meanwhile leaving her high and dry without medical care she obviously needs. I lived in SC years ago but don't know anyone there anymore to refer her to. This is just so messed up.

I guess I can see not wanting to continue with schedule II's after a weird UDS, but I already explained how I would have handled the situation and a single weird UDS is not necessarily grounds for an automatic discharge, IMHO. However, the doctor could have just said that he was no longer comfortable giving her schedule II's but kept up with her other necessary, non-controlled medication.



IMHO, the physician needs some retraining on proper schedule II management, which also would be the result of a letter to the board.

a reply to: NavyDoc

I guess I can see not wanting to continue with schedule II's after a weird UDS, but I already explained how I would have handled the situation and a single weird UDS is not necessarily grounds for an automatic discharge, IMHO. However, the doctor could have just said that he was no longer comfortable giving her schedule II's but kept up with her other necessary, non-controlled medication.

The whole thing is bizarre. Have you heard of this laboratory before? If they're misleading the public on what they actually do for these physicians, wouldn't that be enough to get them at least investigated?

You've got a family doc who has prescribed no narcotics, obtaining a urine sample under false pretenses and without permission, documenting test results that are a straight up fabrication, because there is no quantitative result on a UDS yet they're saying they have one, from a lab that specifically works with pain medicine specialists, not family practice doctors. They're offering to refer her to a drug rehab for not taking amphetamines??? They don't even have the means to determine what amphetamine she is or is not taking. Surely, all of these contradictory things warrant an investigation of some sort...nothing that she has posted has made sense, and this is what they are telling her, even going so far to document it...it's not like they're trying to hide it at all. Does this make sense to you at all?

a reply to: Pimpish

That's funny with the tramadol because I had to take my dog to the vet recently to get a tumor removed. They gave me tramadol for her and no one even thought twice about it or made any sort of deal about it or anything. They were 50 mg pills too, not some small ones for dogs, and plenty of them.

Yeah, Tramadol is widely used in veterinary medicine because it's great for controlling pain, yet is not a narcotic drug by classification. Which is also why it's such an awesome pain med for people too. But vet meds aren't regulated the same. Dogs and cats metabolize drugs differently than humans. 50mg is a standard dose for dogs (it's 1mg per kg of body weight and more if needed post-surgery for acute pain)..that's what my pittie takes to manage her arthritis, more if she's really stiff and limping a lot. I think the housemate takes 100-200mg every four hours, so yeah a 30 day supply for him is a huge bottle. Still not worth a hundred dollar office visit though, especially since you can buy them without insurance at any Walmart for $4...it's just his doctor scamming him. Healthcare isn't about health, it's about money. Sad.

originally posted by: tigertatzen
a reply to: NavyDoc

I guess I can see not wanting to continue with schedule II's after a weird UDS, but I already explained how I would have handled the situation and a single weird UDS is not necessarily grounds for an automatic discharge, IMHO. However, the doctor could have just said that he was no longer comfortable giving her schedule II's but kept up with her other necessary, non-controlled medication.

The whole thing is bizarre. Have you heard of this laboratory before? If they're misleading the public on what they actually do for these physicians, wouldn't that be enough to get them at least investigated?

You've got a family doc who has prescribed no narcotics, obtaining a urine sample under false pretenses and without permission, documenting test results that are a straight up fabrication, because there is no quantitative result on a UDS yet they're saying they have one, from a lab that specifically works with pain medicine specialists, not family practice doctors. They're offering to refer her to a drug rehab for not taking amphetamines??? They don't even have the means to determine what amphetamine she is or is not taking. Surely, all of these contradictory things warrant an investigation of some sort...nothing that she has posted has made sense, and this is what they are telling her, even going so far to document it...it's not like they're trying to hide it at all. Does this make sense to you at all?

The trouble is that amphetamines are schedule 2 so to the government, they are the same category as narcotics and subject to the same regulation. They are drugs of abuse and have a high value on the black market so it is not unreasonable to manage them the same way.

What difference does it make the speciality of the doctors? A controlled substance is a controlled substance.

Not having a controlled substance in your test could be an indication of diversion, which is why a follow up pill count is important.

Yes what happened makes sense to me-- of a sloppy physician who does not know the proper management of schedule 2 medications. It may not necessarily be his fault. The regulations from the Feds changed rather drastically this year. Many practitioners are trying to keep up.

originally posted by: tigertatzen
a reply to: Pimpish

That's funny with the tramadol because I had to take my dog to the vet recently to get a tumor removed. They gave me tramadol for her and no one even thought twice about it or made any sort of deal about it or anything. They were 50 mg pills too, not some small ones for dogs, and plenty of them.

Yeah, Tramadol is widely used in veterinary medicine because it's great for controlling pain, yet is not a narcotic drug by classification. Which is also why it's such an awesome pain med for people too. But vet meds aren't regulated the same. Dogs and cats metabolize drugs differently than humans. 50mg is a standard dose for dogs (it's 1mg per kg of body weight and more if needed post-surgery for acute pain)..that's what my pittie takes to manage her arthritis, more if she's really stiff and limping a lot. I think the housemate takes 100-200mg every four hours, so yeah a 30 day supply for him is a huge bottle. Still not worth a hundred dollar office visit though, especially since you can buy them without insurance at any Walmart for $4...it's just his doctor scamming him. Healthcare isn't about health, it's about money. Sad.

Tramadol was made a schedule 4 by the Feds recently. It is now considered a narcotic. Of course, as a combined narcotic agonist/antagonist it does have some narcotic properties.

originally posted by: NavyDoc

originally posted by: tigertatzen
a reply to: NavyDoc

I feel bad for her. Tempted to just call in her refills as I've got a SC license too. Technically illegal though, so maybe I'll just try to figure out who to refer her. I don't know a lot of PCMs down there, but I could give a look see if I get a PM with the city or town.

That's because you're a good doctor

You actually care. I feel bad for her too...it really pisses me off when it's blatantly obvious that someone has been lied to or manipulated like that, especially by someone who is in a position of power...which is what a physician is to most patients. Making it look as if she's doing something wrong or illegal, meanwhile leaving her high and dry without medical care she obviously needs. I lived in SC years ago but don't know anyone there anymore to refer her to. This is just so messed up.

I guess I can see not wanting to continue with schedule II's after a weird UDS, but I already explained how I would have handled the situation and a single weird UDS is not necessarily grounds for an automatic discharge, IMHO. However, the doctor could have just said that he was no longer comfortable giving her schedule II's but kept up with her other necessary, non-controlled medication.

This is my point. I honestly thought the doctor cared about me. Fifteen years. And suddenly the trust is broken. How can I ever really feel safe to trust another one? How will they ever trust me when they read that letter? I can't explain how surreal this is to me. And frightening. What if no doctor will accept me as a patient? Like I said, it's a small town. They probably all know each other.