Aetna to End Payment for a Drug in Colonoscopies

Conscious sedation doesn’t work for me, once you hit my ileum. Not covering propofol would be enough to cause me to drop them like a bad habit. A hot knife slowly working its way through my insides is not something I need to experience again.

Lucky for me, Aetna is not my insurer.

I have had multiple endoscopies and colonoscopies with just Versed, never with propofol or an anesthesiologist. I don’t either are necessary in most cases, however I am not opposed to people being able to pay out of pocket if they desire such and there is not a medical indication.

I don’t think propofol is being used for my patients having colonoscopy either (I practice GIM in WA state). They don’t c/o pain due to the procedure (leading me to conclude that the gastroenterologists doing these procedures are pretty good), they just hate the prep (that’s pretty universal). I say that if a patient wants propofol let him/her pay for it! It’s not just the drug that costs something, it may also be associated monitoring and administrative fees.

The Times corrects, to its credit, a misclassification of Versed as a narcotic instead of a sedative. Then they let stand this dumbs**t statement: “In the traditional colonoscopy, patients are given a combination of a sedative, like Versed, and a tranquilizer, like Valium.” If they are not given propofol, they are given a sedative, such as Versed, and a narcotic, such as fentanyl. They can’t get much of anything right, and they expect people to believe anything that they publish. Sad.

It is true that younger people do seem to have more anxiety than, say, an elderly vet. My first colonoscopy (to the distal ileum) in my late 20′s I had versed (4mg) and demerol. I was relatively comfortable and watched the procedure on the video moniter, at least as much as I remember.

Speaking of vets, “I distinctly remember trying to claw my way off the table, and biting the (large) nurse who held me down.” reminds me of a recent experience my cat had at the vet!

I have a chronic bone infection (probably hospital acquired) in my facial bones and am undergoing a long term course of IV antibiotics. So I went to a hospital in Southern Maryland to have a Central line installed.

They said they started sedation, but I kept telling them I could feel everything, didn’t even feel woozy. I was completely lucid. Perhaps, the line was kinked?
I do not recall anyone checking on me peeping under the covers. I could tell THE DOC was getting ready to start because he kind of pressed down on the edges of the sterile field. I asked them not to start because the sedation had not taken effect.

He locally injected me in the place where the central line exits my body on the right upper chest shoulder/area. This was very painful in itself. He injected me about 4 times with a local anesthetic.

That part worked because I did not feel it when he cut me for the port exit.

However, the entire time and just before he started punching the guide wire through my neck into the jugular. I kept saying, I don’t think the sedation nor the pain killers are working. I am a chronic pain patient, so my tolerance is very high. I am also overweight another indication for a larger dose. The DOCS response was “That’s ok that’s the way I like it.” I replied well it’s not the way I like it. He proceeded despite my screaming and writhing and telling him the versed did not work. He stabbed me in the neck (jugular vein) with the guide wire for the IV tube. At this point, I had no sedation or pain relief. This was extremely painful and I was verbalizing this as I struggle and screamed under the sterile sheets. I switched from struggling to going lax because I was terrified he had that wire in my jugular and I was terrified.

They just held down my head and feet. I was mad, I felt victimized. I felt assaulted. As soon as he was done, I tried to sit up. They made me lay back down. As soon as they moved the Floroscope equipment, I sat up and I told him he was a jerk, an a**hole and was he some kind of sadist. He walked back out of the radiology room and he said,. ” I said I was sorry. ” I said well that is not good enough. I have had versed for a flex sig and a endoscope and I do not remember any of that. I remember every bit of terror and pain for this procedure. I am now sore all over from straining in pain from the procedure despite the fact that I have a muscle relaxant at home.

Also, there is a sign on the entrance to the angio suite that states that a patient can opt out of the procedure at any time. I was not afforded this choice.

I could have walked from the procedure suite but they forced me to lay on the stretcher. I continued to shout my discomfort and feeling of victimization during the procedure.. Of course I was shushed. As we were rolling out of the angio suite, one of the nurse’s. I guess the one in charge of the sedation, said she wanted to give me more and that she looked at THE DOC as if to say…”More?” and the DOC shook his head in the negative.

I was sitting up on the stretcher as we left the angio suite and my husband was laying down on the couch in the radiology waiting area and I was screaming for him, and, I admit shouting some choice words about THE DOCand his brutality. The nurses were all shushing me and trying to cover me up. (I was not fully clothed)

In the recovery room I felt so violated, terrified and outraged. I wanted the central line taken out. It felt like a reminder of the horror of the violation -like a rape victim who is not allowed to bathe after the attack. My husband and the nurses wanted me to keep it in because I need treatment for the bone infection, but I was screaming for them to take it out. Finally THE DOC came back and stood behind my bed at attention ready to remove it. My husband burst in and convinced me to keep it. I need the treatment. Just before my husband came in, I turned around and crawled up to meet THE DOCTOR eye to eye, since he would not look at me. I asked him how many other patients had complained about him in this manner. He replied, “Just ones like you.”

I spoke with Susan a Member of the Chiefs’ staff and verbalized my complaint.

She assured me she had never had a complaint about this DOC before and that he was every bit the professional. I said, “Do you think what just went on in there was professional?” She replied, “No”. I told her she should speak to the cancer patients in the infusion room. I had at least two patients tell me stories about their ports, not being sewn in etc… I had decided to make my own experience with this doc. I should have headed the warnings, but thought the rational thing was and allow him the benefit of the doubt. Now I realize what a mistake it was to trust the man. She apologized for the experience and said my the amount I received was standard or above standard. I replied I was lucid enough to speak with them during the entire procedure.. It doesn’t matter what the standard is, I am a chronic pain patient. I deserve to be treated with respect and have my pain controlled. What happened here was barbaric and uncalled for. The bone infection pain in my face approximates bone cancer and which has damaged my major facial nerves. Since I take oxycodone everyday to control the pain, so I would need something more than a normal patient for a surgery or additional pain control. They assured me I would not remember anything about this. Well, it’s been four days and I remember every second, in fact, it is all I can think about.

Also, He put steri-strips on my jugular. I am allergic to them. The nurse took off the steri strips because I knew they would keloid the wound. As of 8:21 pm 5/28/2008 I was still bleeding from the jugular. I need to have the stitches removed, but I am terrified to let him touch me again.

They said that they gave me the max dose. 2mg. Versedand also fentanyl. However, I believe that is an initial dose and then you are supposed to be continuously dosed through the duration of the procedure. The also gave me benedryl. I may be wrong about this, but benedryl lowers the effectiveness of the benzodiazepam family of drugs and vice versa. For example the treatment for a benedryl overdose is 2mg Xanax.

I am not one to rush to the courts. I actually believe that frivolous lawsuits are ruining the quality of healthcare in our state. In my opinion, this case however, the egregiousness of the situation warrants some kind of action.

The nurses handled themselves very well and were extremely sympathetic. However the doctor did not handle himself well imo during the whole procedure.

If I need concious sedation I will ask for the propofol.

There is no reason a patient should be uncomfortable for any procedure.