Can a medical refuse to treat / disclosure of hep C

[Mmorgan856]

Hi everyone.. I have been under Orotho. care for some years.  Currently under pain management M.D. For continuing care including nerve blocks.  Because of pain meds. Am tested regularly for compliance. I have a wonderful relationship with both Doctor an nurses.  3 mths ago, when I disclosed that I was treating for hep C an had been prescribed anti anxiety meds as needed for bad irritability, Friday when I went to see md., I was met with a mouth swab, urine test an required to release med. records from PCP.  I'm certain I wasn't imagining a coldness in the room.  I am not judging anyone that contracted hep c by IV drug use, but that is not my case, I believe they are assuming I have a past drug abuse problem from the way I'm being treated.  I have never had a dirty drug screen an my initial paperwork with this M.D. I would have disclosed hx. Of hep C.  I'm wondering if they ever read my chart.. Has anyone ran across this attitude before an can he refuse or drop me as a patient.  I'm worried an wondering.  Mary

[patra_]

Iforgot to thank you for the information on the non-A, non-B hep.  I am thinking saw that in svc Med Rcds from WWI and post WWIII when helping clients file Appeals, but, with my post INF brains, I might have remembered the time frame incorrectly.  

Again, thanks for the info!  Pat

[Mmorgan856]

Oops, your absolutely right, went back an read my post, I'm obviously the nutty one not understanding.  It's like I read a few post an in my mind they kinda get jumbled,  I'm assuming that's the brain fog people talk about. I feel I'm running on all cylinders today, brain wise.  You brought a good point up, about informed consent.  I really don't remember signing anything like that, but I'm guessing I did at one point.  I was aware of random urine tests, an before today, I was suspicious of the mouth swab having something to do with my hep C diagnosis. BUT , found out today that I'm not the only patient being swabbed now.  I'm going to bring up at the next appointment my concerns.. The consent issue.  Thanks Lynn for all your input.   Take care. Mary

[Mmorgan856]

You brought a great point up.  I did find out that my meds had been reclassified beginning of this month.  I was not aware. This past wk. a friend that goes to same pain management as me was also surprised with a mouth swab.  Was no big deal to me since I know I'm compliant, but felt I was being treated differently since I disclosed starting treatment 3 mths before for hep C.   That being said, apparently was a coincidence that disclosing treatment fell within a time period of all these changes with narcotic pain meds.  I'm relieved but still feel that the coldness in their actions towards me was not imagined.  An yes, I am seriously thinking about finding another physician to go to.

[Idyllic]

RE: Pain Management

I understand the administration of pain management has undergone a serious change starting in August to Now.

I was wondering if your drug test had more to do with the rescheduling
of hydrocodone combination products (HCPs) from Schedule III to the more-restrictive Schedule II.

I would ask since it is highly possible this has nothing to do with Hepatitis C and everything to do with the stricter regulations on most of the drugs used to manage pain


http://americannewsreport.com/nationalpainreport/dea-rescheduling-hydrocodone-8824530.html

One person in the comments says:
The new law isnt just going to change the classification, there are also regulations that require drug testing on anyone receiving these medications and there is a drug registry..........

Maybe that person doesn't know what she is talking about or maybe this varies from state to state

[hrsepwrguy]

1960-1970’s
Scientists developed blood tests to identify hepatitis B (1963) and hepatitis A (1973), but many of the blood samples taken for post-transfusion illness tested negative for hepatitis A and hepatitis B. Given that the mode of transmission (blood transfusion) was the same, scientists classified the unidentified cases as non-A, non-B hepatitis. It is now believed that
approximately 90-95% of cases previously classified as non-A, non-B (NA/NB) were actually hepatitis C.

1980-1990’s
In the 1980’s, investigators from the Centers for Disease Control (headed up by Daniel W. Bradley) and Chiron (Michael Houghton) identified the virus. In 1990, blood banks began screening blood donors for hepatitis C, but it wasn’t until 1992 that a blood test was perfected that effectively eliminated HCV from the blood transfusion supply. Now the risk of contracting hepatitis C through a blood transfusion is approximately .01%. Prior to the screening of the blood supply for hepatitis C, approximately 300,000 Americans contracted hepatitis C through blood transfusions or blood products.

http://hcvadvocate.org/hepatitis/factsheets_pdf/Brief_History_HCV_2006.pdf

[patra_]

Dee: You make a GREAT Point!  

Mary:  DID you talk to the Dr about this?  Could be, this is not Office procedure, but some staff member who NEEDS additional training!

[Dee1956]

Hi there, I am sorry you were made to feel that way.  I wonder what the mouth swab was for.  I don't think they can refuse to treat you, plus you have been a patient for a while.  I am assuming that you needed to tell your pain doctor because a anti anxiety medication had been added so you needed to tell him in case they tested you for drugs he was not prescribing.

I am sorry to say that I have experienced a lot of ignorance mainly from the medical community.
I had surgery in December and was denied the correct pain medication due to the fact that a mistake was made and it said I had HCV.
At the time I had been cured for 2 years so did not understand why I was not being given appropriate pain medication.  I asked, the nurse said, "well you have HCV"
I denied having it but it did me no good.  Even though I told them I was on more pain meds at home than they were giving me; they would not help me.  Luckily I was just in pain until I got home and could get to the medication the doctor had given me.

After being dx with HCV I was very open with everyone.   I soon learned that there was still such a stigma to the virus that people just assumed I got it from IV drug use if I did not get it from blood.
Well...I did get it from a blood product but no one cared about that.

I have been told that the attitude about HCV is similar to how it was with cancer 40 years ago or HIV/Aids.

It will get better but in the mean time I have stopped being so open with people.  It is better than it was 20 years ago, back then I had a co worker that had been dx and people were worried that they could catch if from her

Can you talk to your doctor about the incident?
Take Care
Dee

[dontworry_behappy1]

Pain doctor is going to test you for drugs and bill you for it.  They deal with lots of addiction.   Many sent for treatment  by the court. I personally know of a doctor that runs a pain management clinic.  This is standard practice and the nature of the business.  

Best to you

[patra_]

K:  It wasn't just since 79 that there was tainted blood.  My transfusion was in 1974.  If what I read and have heard anticdotally (spelling?), is true this strain has probably been around since at least WWII, known back then as NonA-NonB Hepatitis.

Lynn: Doesn't matter where it came from - you deserve to be free of this Dragon!  No one should pay for the rest of their life, or WITH their life, for things that happened in the past.

Mary, I think part of what we are trying to say is that, even though you had a signed consent form, they should have told you they were doing the test as YOU are footing the bill, either through your Ins or, personally, w/co-pay.  I don't think you have to worry about being dropped.  If the Dr is a pain Dr, that may be a routine, every so often thing, to make sure some patients are not over medicating.  My Mother in Law went and their rules were VERY strict about what you took, reporting, treating w/pain meds even from other MDs, etc.  If, on the other hand, they just did this because they thought they had found out you were hepc, especially since you have been a long time patient, I, to, would be concerned, but not because they might drop me - more like because I am not sure I would want to be treated by a practice WHO KNEW ME and then treated me like I was a recalcatrent patient.  It would all be in how they went about it, I guess - in private? with explaining they needed to check this, etc.  Any chance of other good pain drs in your area?

Pat

[flyinlynn]

Hi Mary

I not sure what you think I ment. I was only really concerned that they had not provided you with informed consent as I believe that is the law. If you felt I was implying anything that was not my intent in any way shape or form. No one likes to be blindsided by their doctor or unexplained testing.

And just to put it out there I probably did catch Hep C form bad behavior. I was in the Army I was 19 years old my roommate in the barracks was a drug user and I did try the needle all of 3 times.

So like they have said in some of the literature about Hep C even if you only tried it once or twice in your youth. Or maybe it was the GI bar tattoo shop with no autoclave in sight. That is how I guess the date of infection of either 1977 or 1978. But nope haven't done anything like that since then just youthful indiscretion but I don't think for that I should pay with my life.

So no I didn't catch Hep C from a blood transfusion, or Army airgun shot or from unknown cause for me. My own doing. But that was a lifetime ago or 37 years anyway. So I hope none of you all think any less of me for being a wild child once upon a time, long ago in a galaxy far, far, away.

I agree with Livelife777 also that they cannot discriminate against you for your medical condition heck they HAVE to treat HIV patients what would happen if someone with HIV showed up in the ER and they were refused treatment.

Best to all
Lynn

[keepingOnkeepingOn]

They'll get over it. In the end it doesn't matter. All that matters is getting rid of it. It needs to be common knowledge that the blood supply was 'bad blood' especially from 1979-1982. Hep C, as you all know, is a very misunderstood parasite. That's nothing new. I'd focus on getting well. It's here. Many of us are or will be virus free if not now then soon and all with the help of those doctors. What they think is not as important as you using them to help you get free of Hep C. We roll with it.

[Livelife777]

Mary
The Code of Medical Ethics cannot discriminate against race, religion, sexual orientation or any other criteria including communicable diseases.  If they chose to do so they will lose their practicing Medical License. This is the law.
....Kim

[Mmorgan856]

Hi Lynn,, I think you misunderstood or maybe I worded my question wrong.  I have absolutely no problem with random drug testing.  I signed a paper authorizing that years ago.  What shocked me is the obvious insinuation that I contracted Hep-C by IV drug use.  Not realizing there was some kind of stigma related to hepatitis, I've always been very honest with my medical care especially phlebotomist drawing blood.  Now that I've educated myself somewhat on this virus, I'm realizing the stigma attached to I guess any strain of hepatitis.  I'm sure there are people out there that would forgo treatment or keep secret from maybe family an friends.  I wouldn't begin to know how to fix a social attitude towards a potentially deadly disease.  Personally, I could care less about something like that because I realize it's just ignorance, but I'm worried this Doctor could drop me as a patient....on second thought, plenty more doctors out there where he came from, I guess.  Wondering if I'm the only one that has run into this narrow-mindedness. Take care. Mary

[patra_]

I was NOT trying to persuade other s to follow my lead, only show that there are all kinds of people in the world.

Each person has to choose what is right for him/ her.

I guess I just find it very sad that Drs Offices still have staff who do not just mask/ glove routinely - not just for hepc patients ANd who would even dream of treating heppers differently!!  Of ALL people who should know about the disease and how it can/cannot be transmitted, medical staff should!  Pat

[susan400]

I am open about my diagnosis (or hopefully past diagnosis) with Hep C, at my doctor's and dentists offices.  However, years ago, I switched hair stylist because the hair stylist who I 'dumbly' told about my HCV, then, decided that he would bring it up at every appt., right there in the room with every other stranger sitting around us.  My intention of telling him, wasn't because I wanted to discuss it every appt. and in front of all these other customers with their uninformed pre-judgements.  So, I quit going to him.  My new hairdresser, I did not tell.  Reason being, because I am not getting manicures or pedicures there and there is no reason why she should cutting herself and me, by giving me a simple haircut.  If she does, than, I feel like it's her own carelessness that caused it in the first place.  Now that I'm undetected, I feel like I have even less desire to share this information, except on a need to know basis.  I don't want to have to tell every hairdresser and (potential customer listening in), about this diagnosis.  One time when I was in a Sun. school class, I opened up in prayer requests about my Hep C upcoming blood work.  Everyone who had been in the class, knew about it, except this one new girl who had chosen a seat next to me.  When she heard me mention it, she stands up and walks across the room to sit in another chair (away from me), right next to the door.  It was so blatantly obvious that she thought she was being exposed to Hep C by sitting next to me.  It was ignorance on her part, but it also hurt.  This is not to say that I am going to be walking around on eggshells always trying to avoid bringing it up with everybody, but at the same time, I'm going to be more selective in who I tell.  Susan400

[patra_]

I am VERY blessed or others have had really bad luck!  I have been open about my diagnosis and subsequent treatment in my private life, church, workplace and all drs offices since I was first diagnosed.

At drs offices, I asked to speak privately with the Dr when I first did it.  At first, it was kind of hesitanty, but I always followed up with, "....if you choose not to comtinue treating me, I will understand, but I want everyone to be safe.  If you contunue, please be very careful, use gloves, etc". I have not had one doctor who expressed a concern or turned me away.

At work, I believe my Boss set the standard by his behavior, since we were not touching clients, other than shaking hands it didn't present a problem.  As I said on other posts, I told the ladies I worked with why I would not be sharing combs, lipstick, etc as we had done in the past (I see those looks of horror - remember this was 40 years ago in a small work group who had been together for a long time) and, as I said on those other posts, I became a go-to person when any of our Offices had a client come in w/hepc - and usually freaking out.  I was our best example of 'this is not the end of your life.....' as there I was, 'healthy' (except for the hepc, which did not show), and working full time.

Whether I was just blessed in my drs, Boss or whether they responded to my attitude, I don't know, but I am glad.  I still try to be open to discussion in any setting where that might come up, to let people kmow that there are LOTS of ways of getting hepc, and that it is nothing to be afraid of.  Also that what people did in the past doesn't matter, it is what they NOW that counts and should be looked at!!

I wish you ALL that kind of blessing and support in all phases of your lives.  Pat

[flyinlynn]

Man I hate spell check soundtrack grrrr

wouldn't

[dontworry_behappy1]

Did you look at the lab test sheet when you took it to get the test done.  If
you gave the lab slip to the lab then you gave your permission.  Most likely you signed it too.  If they did the blood draw in the office.  I would ask where it says you authorized "random" drug testing.   My guess is it doesn't say that.  Unless its a condition of your treatment.  

Best to you

[Livelife777]

Lynn
When I ended up popping into the reception area at my Drs for an unrelated event I questioned this drug screening and subsequential bill.  She mentioned that I had given permission on some form I signed months ago and obviously not paying attention to.  Guess Lesson learned, "Read before you Sign".
Stay well
....Kim

[flyinlynn]

I see dictots and nurses using gloves with every patient it has been standard protocol for years ever since HIV. I do remember years ago one dentist advising his nurse to double glove as I was the patient but that is just for their own safety. I use to do mechinical work and when I would get a cut that bleed freely occasionally I was afraid for anyone to get near me to help we are contageous and I soundtrack wish this on my worst enemy

But yeah in this more enlightened time the treatment you perceived you were getting did sound a little strange did you ask them about it?

Also I believe to be drug tested you have to provide informed testing you have to be informed you are being tested for drugs. Don't know if that is just a state thing but again that does sound strange also.

[Livelife777]

Hi Mary
Glad you brought this subject up.  Yesterday received a bill in the mail for
$720.00 from a lab.  Minus my insurance I needed to pay $180.00.  The bill stated it was for drug testing.  Confused I said, "I've never submitted blood for testing".  They replied "Well we sent your urine in for drug testing". What????  I thought I was only giving urine to see if I had an infection.  Couldn't believe they could do that as it was my regular MD.  Talk about discrimination.
They cannot deny you care or drop you as a patient.  I will say tho that everytime you go there the rubber gloves will suddenly appear and you will likely get a bad vibe.  The stigma is there and will remain so for many years to come.  This is why I don't mention my Hep C status to anyone anymore unless its relative to my Tx especially since I'm supposedly cured.  It's very sad that we will in my opinion always be considered a prostitute or a heroin addict.
Lets hope with new Tx protocols underway, that Media will shed light in a positive way on this horrendous disease that's killing and destroying so many
lives.
Take Care
...Kim

[dontworry_behappy1]

Hi Mary.  I know it may seem like your being singled out.   But yes I don't think doctors/nurses really look close at what to write in history.   It's funny how when you verbally bring it up they look shocked you even did.   Not sure if this response is shocked your not afraid to talk about it or their just uneducated about Hepatitis C in general.  Both of these can be true and it's shocking the medical profession has these issues.   But to their defense one of the tests you would want done if you are Hepatitis C positive is a HIV test.  
I know....I was kinda upset when I was asked if I wanted to be tested for HIV
when tested for Hep C.   In fact a little insulted it even was suggested. My GP said that people often are infect with both at the same time and it's to my benefit to find out right now.  Having Hep C is one thing.  But aiding HIV complicates the options.  Also medical professions want to protect themselves and like many just getting the full blown wave of baby boomers with Hep C.....they now are doing what should have been done years ago.  I don't think they can refuse to treat you.   At least they cant for Hep C.  My guess is their are just trying to cover all their bases.   The medical profession does need to be careful.  I do believe they are responsible for keeping us and others safe.   Don't take it to personal.  There just doing their job and that's a good thing.

Best to you