When Fear of Liability Prevents Diabetes Care

This post is a very personal one. I’d like to share a tale of what happens when an insured diabetic needs medication but can’t get it.

Current estimates show there are over 90 million people in the US who have diabetes or pre-diabetes. That equates to almost 30% of the population. Approximately 8 million people have diabetes but are not aware of it. The end result of this epidemic is that diabetes has become a huge liability for the mainstream medical community. In the midst of trying to help everyone they can, the medical community has developed a fear their efforts will result in someone’s death. (This fear exists for other medical conditions, but nowhere is it stronger than in diabetes.)

Three weeks ago my insulin pump stopped working. The manufacturer replaced the pump, yet 12 hours later the same problem occurred. Still assuming the problem was related to equipment, I insisted the pump manufacturer replace the insertion sets I was using. Insertion sets attach the insulin pump to the body and have a short tube – a “cannula” – which sticks into the skin to a depth of about ¼ – ½”. (See Picture of an infusion set showing the cannulapicture. The cannula is the tiny piece of plastic at the far right.) Unfortunately, the new box of insertion sets had the same problem. After about 12 hours, the insulin pump returned error messages stating it could not deliver the insulin. The area where the cannula entered the skin was always inflamed, a bit itchy and very painful, but had no indicators of infection.

I experimented with multiple locations on my body and always had the same problem. Final conclusion? I had developed an allergy to the plastic used in the insertion set’s cannula. This meant I had to take a “pump holiday” and return to using injections to control my blood sugars while I researched insertion sets with a stainless steel cannula. Not using my insulin pump presented a problem because the only insulin I had a prescription for was fast-acting Humalog, which has a lifespan of about two to four hours, This short duration of effectiveness meant I had to inject insulin every two to three hours. It also meant controlling my sugars while I slept was virtually impossible. I needed a prescription for Lantus, a long-acting insulin with a lifespan of approximately 24 hours. This is where the story gets interesting.

I called my GP, who told me she would not give me a prescription for Lantus because the liability was too high since I had never taken it before. I offered to come in for an appointment, but she refused. She told me to go to an emergency room. I called an emergency room and was told the physicians there would be unwilling to prescribe Lantus for a patient whom they had no history on and for whom they could not follow as an in-patient. I called my endocrinologist, whom I had not seen for almost two years*. I knew they could not prescribe for me without seeing me, and I begged for an appointment. The best they could do was to “squeeze” me in ten days later. They also suggested I go to an emergency room to get the insulin I needed.

*Please note: The fact I had not seen my endocrinologist for over two years does NOT mean I was not receiving care. I adjust my insulin levels as needed, and I was getting necessary blood work such as A1C, thyroid profile, etc. from my GP. I was staying on top of things and consistently maintain A1C’s between 5.7-6.0. I want to clarify that I maintain very strict control over my diabetes and always get the blood work needed to monitor my control. I was recently told my experience was “my fault.” Please know it was not and that I was doing everything necessary to maintain perfect control of my glucose levels.

In the midst of this, my blood sugar control went haywire. I typically awoke with sugars higher than 500, even if I got up at 3 am to take insulin. During the day, I had to inject every one to two hours in order to maintain decent control. I quit eating carbs completely and still had to inject frequently. My energy levels plummeted, and I began to fear my poor control would have a permanent effect. At this point, I had gone almost two weeks without my pump. The early days were spent negotiating with the pump manufacturer; the later days were spent begging providers for a Lantus prescription.

Determined to get what I needed, I went to an immediate care center. The triage nurse told me the doctor would not be willing to prescribe what I needed. I begged and confess I bullied a tiny bit. Luckily, the on-call physician was in the reception area and heard my tale. He asked me a few questions and agreed to prescribe what I needed. He was the first physician who had shown more concern for my health than for his own liability. I am forever grateful to him.

Let’s review: I’m fully insured. My glucose levels were above 500, meaning I was in an emergency situation and desperately needed different medication. I have 45 years of experience controlling diabetes, so I am not a new diabetic who presents a large risk. I’m a Naturopath who speaks nationwide on endocrine disorders and controlling diabetes, so I have knowledge and training most people with diabetes do not.

In spite of all of that, not one of the MD’s I spoke with was willing to prescribe what was obviously a medically-necessary medication. Failure to prescribe this medication could have resulted in my death. Even when I shared that my glucose levels were running above 500, no one was willing to incur the liability of prescribing the medication that was desperately needed. My best option for care would have been to allow myself to go into a diabetic coma, at which point they would have gladly assisted. I instead chose to take matters into my own hands and be my own advocate in a very strong way.

If I had any other condition, physicians would have prescribed what I needed without question. ALL medications have side effects. ALL medications can result in death if not taken correctly. Only a diabetic would be denied care due to physician’s fears of liability. Physicians regularly prescribe narcotic pain medication to patients, often without providing adequate instruction. Those narcotics could just as easily cause death from overdose as insulin could, yet getting them is incredibly easy.

There’s something wrong with this picture.

The current medical system has put so many shackles on physicians that a patient in desperate need of care cannot receive it. When an insured patient is refused care by an emergency room, solely based on fears of liability, there is a desperate need for change. Based on current trends, I predict things are going to get worse, not better.

What are your thoughts?

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Dr. Pamela Reilly is a Naturopathic Physician dedicated to helping people improve their health and eliminate symptoms using natural, integrative methods. She has over 25 years of experience and has helped men, women and children improve their health using a holistic, client-centered focus. She sees clients in Indianapolis, does house calls, and also conducts consultations via Skype or telephone. Please feel free to contact her or visit her Consultations page for more information. Dr. Pamela speaks nationwide on a wide variety of health topics and welcomes speaking invitations.

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