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
I think there is some missing info in this piece.
First, why didn’t she keep going to the doctor if this was such a long standing problem? The doc could have done something different. Daily Prednisone perhaps? Not ideal, but it would have managed the inflammation, and once the problem with his benefits was cleared up, he could have gotten back on Advair.
Second, she called every three days for months? That doesn’t seem right; you would think that someone would have done something. And she only spoke with his caseworker once?
Third, why didn’t she go elsewhere? A state or US Rep or Senator? The local newspaper?
The problem is that people dependent on the government think that everything will be done for them, and when it’s time for them to take the initiative, many don’t bother. And when something like this happens, they push the blame on others.
I feel for this mother, as this most likely was a preventable death. But if you bring a child into the world, take some responsibility to do what’s needed to be done.
Y'know, that's the point. The bureaucracy constantly works to dehumanize the process, because actually dealing with people is expensive, time-consuming, and interferes with the actual work of the bureaucrat - wallpapering the bureaucratic maze. People can not live their lives waiting in line for the next bureaucrat to forward them around the circle - thusly the bureaucracy evades responsibility.
You are right, this kid was failed by many adults. It doesn’t make sense. If the doc knew the kid didn’t have the medicine or couldn’t afford it, the doc could have given them samples months earlier. My kid’s doc did that with medicine that wasn’t covered or was expensive. The pharma reps love to have the Dr’s pass out the samples.
I find it hard to believe that the doctor DIDN’T step in. Which causes me to ask; did the mother tell the doc what was going on?
Paraprofessional is a fancy term for teacher’s aide. Low pay (because it’s a position that doesn’t require a college degree) and usually no benefits.
I would not have just done the calling every few days and watch my child deteriorate. I would have been on the phone to every charity agency, news, school officials. Everyone.
Tragic.
You can always pay cash and submit the claim yourself.
There doesn’t seem to be a father around anywhere to help her with her children — and pay for medicine.
Yeah, there is more to this story.
The dr,as i’m reading the comments,would seem to be the link that should have held it together. A family dr will get you the medicine,especially where a child is concerned,and put the bill in for whatever.
That being said never have been stuck in a situation where the govt was paying for me i can’t say she had a family dr or had to run to the emergency room every time something went wrong. If the latter then she might be seeing someone different all the time and not have established the patient dr bond. One would hope the drs in the emergency room would treat everyone the same but you hear so many horror stories about those places. So sad and tragic.
If she was this concerned about him why didn’t she take some of her cash benefits and buy some of his medication rather than make him go without? Get off your butts and quit thinking big daddy gob’mint is going to care for you, do for yourself! There are going to be piles and piles of bodies everywhere if the checks quit coming one day!
Its damn frustrating dealing with any govt agency. They like it like that of course.
IMO, your assessment is justified.
So? She goes back to the doctor for another prescription. Or just calls like I do and has one sent to the Pharmacy. Easy as pie.
Not only will the problem get worse for many Asthmatics it already has.
The EPA declared the original delivery medium, for asthma medicine, a pollutant.
You cannot buy the original formula and have not been able to for over a year.
Why is this a big deal? Many Asthmatics do not respond well to the “New” less polluting formula and many don’t respond AT ALL!
Having asthma is similar to taking a fish out of water. The asthmatic drowns from a lack of open and free breathing lungs.
Many have been forced to buy the original formula underground, online or even traveling internationally, where you can receive the original formula but not the new formula.
The EPA ruling is killing people left and right.
IIRC, the medicine is $130 bucks per tube. That can be a lot of money to low income family.
Still, relying on the government/taxpayer for picking up the tab when a life is on the line is just .....
If you go running around changing your prescription venders you will run afoul of the same sort of thing that hit Rush Limbaugh.
I seriously doubt this mother has the resources to challenge the bureaucracy, nor are the solutions to her problem all that obvious. Remember, she was told MORE THAN ONCE by people in authority that the problem was fixed. Obviously they lied, or, they, themselves, the system experts, didn't know and were unable to find out that they didn't know.
BTW, regarding the particular medicine I had trouble obtaining, I've been using it for 5 years. it works. I have no complaints nor do I suffer any negative side effects. Except for that one instance where I needed an emergency supply somewhere else hundreds of miles away, I have had to check with my physician every time I try to refill the prescription.
The reason is that it is authorized 5 refills, each for 90 days. That exceeds some "standard" in a piece of government software and effectively cancels my prescription every time anyway. This latest one had "1 refill" so I figured I was home free ~ but fool me!
Look, this poor woman got the flimflam from people running a system they can't control.
For instance, if you start a therapy under Medicare, they will only authorize a “Standard of Care” deliverable.
If you go outside the system they will bill you for everything and you will lose benefits.
The Doctor is restricted by law from going outside the system once a patient is in the system. PERIOD.
Her real recourse would have been in the emergency room where he would have been rushed to the front of any line and given a nebulizer.
Would she get a bill? Yes and it would be a big one. But they would have nebulized him and he would have walked out with a new nebulizer.
Depending on the city, the fire department even carries nebulizers and spares. There is no charge for this.
You only get charged when you enter the ambulance or the emergency room.
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