Posted on 02/04/2010 2:35:27 PM PST by Second Amendment First
A Montbello mother says her 9-year-old son's death from severe asthma could have been prevented had Denver Human Services resolved problems with his Medicaid pharmacy benefits.
Zuton Lucero said she called Human Services every three days for months last year when she was suddenly unable to get prescription drugs for her son, Zumante.
The boy's health deteriorated without the medication, his doctor said, and he died at Children's Hospital in July after losing consciousness at his house after an attack.
"I don't want anyone else to be sitting where I'm sitting," Lucero said.
Advocacy lawyers who met Wednesday with the Colorado Attorney General's Office hold up Lucero's story as an example of how serious the Zumante Lucero struggled with asthma since he was a baby. In March, his mother went to fill his Advair prescription, but it was denied. Months of calls followed to Human Services to no avail. The boy, 9, got progressively worse and died in July. (Hyoung Chang, The Denver Post) problems are with the state's $243 million computer system that is supposed to manage benefits — and the county human workers behind it.
"The human system fell down," said Ed Kahn, a lawyer with the Colorado Center for Law and Policy, who is among a group of local and national lawyers weighing a lawsuit against the state for delays in getting food stamps and Medicaid benefits to people. "They are responsible for this kid's death."
The Colorado Benefits Management System is run through county human services offices and manages medical and food-assistance benefits for everyone in Colorado. Since its 2004 installation, the system has been beset by problems.
Lawyers advocating for Colorado's needy sat down with state officials Wednesday to discuss the problems that have the lawyers weighing whether to sue the state as they did in 2005 over similar issues.
"They presented us with some new information, and we listened carefully," Kahn said. "We hope to make a decision in relatively short order about how we are going to move forward."
Lucero, who works as a paraprofessional in Denver Public Schools, said Wednesday that she will continue to tell the story of Zumante's death "to enough people so that it won't ever be anyone else's story."
In addition to working with the advocacy lawyers, she has hired a personal attorney and is exploring a lawsuit against Denver.
Zumante had struggled with asthma since he was 3 months old. But when he was 6, the condition became serious enough for his mother to apply for benefits under Social Security, which also entitles him to Medicaid.
Andrew Lieber was Zu mante's physician since birth. He said the boy's lungs were severely inflamed, and his twice-daily medication, Advair, helped control that.
Last March, Lucero went to fill her son's prescriptions at a Walgreens near her home in Montbello. A worker there said Zumante didn't have prescription-drug coverage anymore.
Lucero says she called Denver Human Services every three days for four months trying to get him drug coverage. Each time she called, an automatic computer report was issued and sent to her house usually showing that all of her children — including Zumante — qualified for Medicaid.
But even when she brought in the reports to Walgreens, she was told the computer system showed he wasn't eligible for pharmaceutical benefits.
Throughout months of frustrating phone calls to Human Services' call-center operators, which often left Lucero in tears, Zumante's health weakened. She managed to reach her caseworker only once. The caseworker told her in March that the problem had been resolved.
Just why the system showed Zumante wasn't eligible for the prescription benefit — when in fact he was — still is not clear.
The little boy, who loved karate, drawing cartoon figures and riding bikes with his brothers and sisters, was often caught in spasms of panic because he couldn't catch his breath.
He went to the emergency room in May and June when the inhalers and nebulizers Lucero carried were not enough.
During the June trip to the ER, Lucero told doctors she wasn't able to get him his Advair.
They gave her some samples. When she told Zumante he was going to get to start taking his medicine again, the boy was so relieved he cried.
But it was too late. The medicine works progressively to keep inflammation down, Lieber said.
On July 16, Lucero was home and heard Zumante call her name from upstairs. He was on the nebulizer and told her he couldn't breathe. She called an ambulance. While she was waiting, Zumante lost consciousness.
She cradled him in the front yard while she waited to hear sirens. By the time paramedics got him to Children's Hospital, he had been unconscious for more than 10 minutes.
For four days, he was kept alive on a ventilator, but when Lucero decided to disconnect it, he died within a few minutes.
Denver Human Services officials said the agency "feels the death of any child as a tragic loss," said spokeswoman Revekka Balancier. "And our department tries very hard to prevent these kinds of tragic accidents."
Read more: http://www.denverpost.com/ci_14329527#ixzz0ebpAfnNW
My pharmacist son says this happens all the time. Some woll not pay for medicine, no matter how sick their child is. Most drive nice cars and have cell phones....I just don’t understand how a parent could let a child suffer just because of a Medicaid problem.
That’s truly depressing.
My husband worked for Schering Pharmaceutical for years.
But if my child's life is at risk and I have no alternative, I will gladly beg, borrow or steal to get him the medication he needs.
This is sad. There are many churches in the Denver area which have discretionary funds to help people in the community with these issues. I wish someone would have steered her that way. She could have had help with the cost of meds while waiting for the government issue to be straightened out.
I think most “paraprofessionals” in the Denver Pubic Schools are part-time and not entitled to health benefits.
Bull crap! She could have taken the kid to the ER at any time and he would have been treated and sent home with medication. He would have received the treatment; that’s one reason why illegals come here because they know that they will get medical care with no real obligation to pay for it. She did nothing for how long? That’s neglect.
I know being in those situations can be overwhelming, and we can’t see all of the alternatives. I am surprised the doctors didn’t help direct her toward other assistance. If I worked for that company and knew of her plight, I would have passed it on to the powers that be.
Years ago, after my kids father and I separated, we were on public assistance. From time to time we got caught in bureaucratic hell. But, if the life of my child depended on something, I would have been begging family for help.
That little boy did not have to die. Momma should have gotten off the phone and started begging in the streets if it’s that serious. I am a cash pay patient and my dr give me samples of the rescue inhaler as well as ADVAIR. Never had a problem.
My sister has no coverage and no money. She is asthmatic, has high blood pressure, thryroid issues, bad back you name it. She called me one day just to talk and I could barely understand her. She had bronchitis and didn’t have the money for dr/meds. I went to the store and sent her western union the money she needed. Same with my nephew. He is Bi-polar w/hi BP. Out of work last year w/no meds. I sent the money. My downstairs neighbor too. He’s elderly and his check just keeps(LOL) on getting lost in the mail and he needs money for meds. Sucker me gives it to him.
But the point is there are many ways to work these problems out. Alot of the pharaceutical companies advertise that if you can’t afford the meds and need them, to call and they will arrange something.
What a sad loss of life.
http://en.wikipedia.org/wiki/Medicare_Part_D_coverage_gap
In other words, they actually want you to pay for some of your meds.
Didn’t know it actually had a name.
My 99 yr. old friend, who had four hip operations and 9 hospitalizations in one year, had covered expenses and threshold out of pocket expenses.
Totally makes sense and the %’s look about the same as her coverage.
One of the medical professionals involved in his care surely should have advocated for him, or at least seen that an alternative was tried if they couldn't get the Advair (I speak from experience in the field)
I really feel sorry for this situation, but you are right there is more wrong here that the stupid state.
I would have been in the state office and the doctors office every day until I had the medication in hand. And if that did not work, I would have contacted the Action News, my legislators, the governor, etc. etc.
The primary care doctor should have had samples, and he should have told the woman how to get them directly from the company through the direct medical assistance program.
Low income people can get medicine directly from the company for $10 for a 3-month supply. Our local FQHC even fills out the data and sends in the application for them.
My dad’s primary care physician prescribed advair for him, but his pulmonologist said to stop taking it, because over the long run, it would make his situation worse.
It remains to be seen what all the factors are in this case, but it is so sad - I feel so sorry for this woman.
It is very sad. Like I said, I think there were other avenues for her. But, like many public assistant recipients (remember those in NO without cars to evacuate with a deadly storm was looming down on them because they had become victims of the state), it doesn’t seem like she knew of other avenues. The government knows and does all, you see.
Boy I feel for your situation. But thank you for helping others when you can. I never take samples when I get meds from my doctor because I have good insurance and I know that those meds would do good for others not as lucky as I am.
Hi—
The problem is that this occurred over the course of four months. It’s not like she had to come up with it overnight.
Frankly I think this woman should be charged with child abuse resulting in death because it went on for four months.
I had mentioned that I was surprised that he was not managed with Cheap prednisone pills.
There is little help in healthcare these days, One has to be a knowledgeable advcate. If it is not reportable, it is not necessary. It is not a physican’s problem that there is not access to medication. The nanny state is supposed to and usualy does provide.
Actually, I think that I mentioned about the Prednisone as well in an upthread post.
You are absolutely right about having to be one’s own advocate.
As for it not being the physician’s problem, that’s half right. The physician, nurse, and pharmacist have no control over what insurance, Medicare, or Medicaid pays. However, the physician does have the ability to modify treatment to fit within what the insurance will pay for.
There is a discrepancy in the article. It says that he was taking his “other inhalers and nebulizers”, yet the same article said that the Walgreen’s pharmacist told the mom that he wasn’t eligible for pharmaceutical benefits.
I deal a lot with pharmacies and these types of problems. The pharmacists are inundated with trying to untangle insurance issues for many, and don’t have the time for attention to detail. It’s easier to tell the customer that “the insurance doesn’t cover it”, etc, yet if they make a call, they usually can get it straightened out. I can’t tell you how many calls I get from pharmacists who tell me a Medicaid patient needs a prior auth on a patient, and when I call, it turns out that it was a billing issue. Then again, the way the reimbursement/billing system is set up with Medicaid in my state, a generic message is given, and the pharmacist just dumps the problem on the prescribing doc’s office.
yep, and the poor kid suffered for months, and then paid the ultimate penalty.
I have to allow for facts I do not know. Presuming that everything we’ve heard is accurate and complete, I agree.
It really is mindboggling. I can’t wrap my motherhood-soaked head around it.
Death panels. Even when they’re not even supposed to be doing that”....
While it was CLEARLY the government that let this family down, the family was used to post this video IN FAVOR of Obamacare:
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