Showing posts with label San Diego. Show all posts
Showing posts with label San Diego. Show all posts

Day 3 of our San Diego healthcare nightmare

  June 09, 2012    

The sad saga of an epic #fail in healthcare continued today. Chey Cobb, the disabled 50-something IT professional, former Senior Technical Security Officer at the NRO and author of Network Security for Dummies, is now home and resting after being placed in a psych ward for 3 days. Her pain is still not managed. She has still not received adequate care. She has not been given any follow-up program, process, plan. Nobody medical has committed to call or help, except one very kind nurse whose powers are limited.

Epic failBefore I get to the day's updates I want to thank all of those in the legal community who took my calls on Friday and the many friends who have reached out via phone, social media, and the inter-tubes.

If there is anyone whose call I have not returned, my apologies. I also want to thank the patient advocate from Jewish Family Services, San Diego, who did his best to kick things up a notch, even though the net result from Sharp HealthCare so far has been "we're sorry we can't do anything for you." So please allow me to recap the facts. This will help me document what went down and add some clarity to the previous posts (Day One is here and Day Two is here).

  • Monday, May 28: Chey calls Sharp Rees-Stealy Medical Center to speak to her primary care doctor (PCD) about increased levels of pain she is experiencing, a matter she had previously discussed with her PCD. The PCD is out for the week. Despite several requests, no replacement or locum calls Chey back.

  • Monday, June 4: Chey is out of pain meds and her PCD refuses to prescribe any more, effectively imposing a cold turkey detox from an 80mg per day oxycodone regimen that had been in effect for about a year, established after extensive tests and consultations in New York, before we moved to San Diego (all fully documented in an envelope full of medical records that Chey handed to her PCD in person).

  • Wednesday, June 6, AM: Chey is finally able to see her PCD who confirms that she is not going to prescribe any more pain medication, despite knowing that Chey has been out of said medication for several days and it will take days if not weeks to switch to a different PCD (who will then refer Chey to a pain specialist for a pain assessment and medication).

  • Wednesday, June 6, PM: Chey's psychiatrist is sympathetic and says he can arrange a pain assessment but only if Chey voluntarily admits herself to the psych ward at Sharp Grossmont Hospital. That proves to be a grueling, humiliating, and physically painful experience for Chey who does not get into a bed in the psych ward until around 4AM (we arrived there at 7:30PM). She receives no medication other than Ativan/lorazepam to help/make her sleep.

  • Thursday, June 7, AM: Chey receives no pain consultation and no pain medication all day. Spends a lot of the day sobbing at the way in which her efforts to live with incurable chronic pain have been crushed. As far as I can tell she is not examined by a doctor (they have her dopey on Ativan).

  • Thursday, June 7, AM: When I visit in the evening she gets 5mg oxycodone. I ask if she can leave, since she is not getting the treatment she was told she would receive, is very unhappy and uncomfortable, and she is there voluntarily. I am told that if she attempts to leave she will be put on a 5150, that's a 72 hour hold that is reported to the federal government and results in the automatic revocation of certain civil rights like firearm ownership and/or possession. I test the doors and yes, they are locked all the time so you can't get out and trying to get out sets off a very loud alarm. Chey agrees to stay another day based on the promise of medical treatment.

  • Friday, June 8, AM: Chey has been without adequate pain relief for going on 5 days and yet the nurses are annoyed that she won't sit up and participate in group. (This is not a medical ward, this is a locked psych ward and some of the people there are pretty scary). Chey hurts too much to sit up, much less go anywhere (there's a reason she's in a wheelchair, walking hurts too much at this point).

  • Based on the advice to patients handed out by the hospital, to "tell your caregivers if you are in pain," Chey tries to tell her caregivers she is in pain. No doctor comes, despite the fact that the right to prompt and medical care and treatment is spelled out deep within the version of the California code that they hand to patients. The promised social worker has not shown up (although we're not sure what the social worker is supposed to do for chronic pain). A nurse tells Chey: "We have called your husband to tell him to make you stop bothering us."

  • Friday, June 8, PM: I get news of this about 1PM. I start calling around for patient advocate lawyers. I go over to Sharp Grossmont in evening and have a phone conversation with Chey's psychiatrist who says Chey is free to leave, but he is still hoping to get a pain consultation for Chey. I get the sense he is dumbfounded by the difficulty of moving the process forward and had no idea Chey would be treated in this way when he extended the offer to help her. Chey and I have a long conversation with the deeply apologetic and very sympathetic head nurse on duty. Chey is given some more oxycodone but nowhere near enough to control her pain. I leave her there for the night in the hope of a pain consultation in the morning.

  • Saturday, June 9: I arrive at Grossmont with Chey's wheelchair about 10:30AM. I find a doctor just leaving, apologizing that he cannot refer Chey to a pain specialist but willing to write a prescription for a low dose of oxycodone. The social worker shows up. Still not sure why since she can't actually do anything to help. It takes about 2 hours to process Chey out of there. Her personal possessions are returned to her from the safe. During the entire time she was there, no doctor touched my wife to see if she was in pain.


There will be more tomorrow. I will explain what a pain contract is and why you, dear reader had better pray you are never presented with one (hint: it is not a contract, you get nothing from it except grief). I will also explain how you can be abused and neglected by medical professionals even when your employer provides you with excellent health benefits.

In closing: There is an organization in San Diego called Sharp Healthcare. It's slogan is: San Diego's Healthcare Leader. The title of the Sharp website home page is "Top San Diego Doctors and Hospitals - Sharp HealthCare." Then there is Sharp Rees-Stealy, a collection of medical centers. The nature of the connection between these Sharp entities seems hard to fathom, for patients and employees alike. Frankly, if that is healthcare leadership, we are all in trouble. If a 50-something professional couple with good health insurance can be kicked to the curb like this, it can happen to anyone.

Our experiences this week have shattered all hopes we harbored that San Diego would be a better place to get healthcare. My wife is faced with living out her days in constant and excruciating pain from which she can get no relief. The events of the past week leave us with no hope of that ever changing.

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Day 2 of painful detention in San Diego, the new Cuckoo's Nest nightmare scenario?

  June 08, 2012    

As I start writing this, at 3PM Pacific, my wife is still detained in a secure psychiatric facility where they are not only withholding medical treatment, but alternating between ignoring her pleas for help and harassing her with requests to sit up and get out of her room and participate in activities with others.

What part of "I am in too much pain to sit up" the nurses don't understand, I don't know; but San Diego's self-proclaimed healthcare leader, Sharp Rees-Stealy, is crawling lower in my estimation by the hour. The process of engaging an attorney has begun but I am fearful that a Friday afternoon is not a good time to find an attorney and I am also fearful Sharp will force Chey to stay in there until Monday.

As I said in yesterday's post, some of the people staying in the facility seem to be deeply troubled, but heck, I am deeply troubled by what is going on. You get to be a reasonably respectable professional in your late fifties, you probably don't believe it is possible to be treated like this.  Imagine how getting locked up for the weekend in a place that some people refer to as the mad house would impact your answer to the question: Are you considering ending your life?
Helpful Tip: 9 words you should never utter in a medical facility:  I don't want to go on living like this.

Ironically, a medical facility is one place you may feel like saying: I don't want to go on living like this. Unfortunately, if someone on staff hears you say that, you can find yourself on a suicide watch, that is, someone watching you so you don't commit suicide, even if you try to explain that's not what you meant. That's not exactly what happened to my wife this week, but it happened a couple of years ago.

So why would you say:  I don't want to go on living like this? What does "this" represent that could be so bad? If "this" equals suffering chronic pain 7x24 with no hope of relief from that pain, then the sentiment is surely understandable. If you have no way to work or participate in society, if you wince with pain when your partner hugs you, if you're grinding your teeth with pain, and you have no hope of getting adequate pain relief, then "living like this" if frankly not something most people would want to do.

In fact, my wife went on living with inadequately managed pain for years, but through the practical application of her very considerable intelligence, driven by her dogged persistence, she achieved a pain management regimen involving the following:

  • Breathing techniques

  • Dietary changes

  • Meditation

  • Medication


This last item is what her Sharp Rees-Stealy primary care physician cut off, leaving Chey out of pills and, as it turns out, very much out of luck. Here is what she had been taking:

  • 40mg of OxyContin a day (2 x 20mg pills)

  • 40mg of Oxycodone a day (8 x 5mg pills)


These pills have basically the same ingredient but OxyContin is an extended release so she takes one in the morning and one in the evening, then manages "breakthrough pain" with the other pills on an "as needed" basis. To put this in perspective, 40mg pills are not the largest OxyContin pills (it also comes in 60mg and 80mg) and the FDA allows prescription of  up to 640mg per day.

To get back to the nightmare currently unfolding, my wife has been "allowed" just two 5mg tablets of Oxycodone since Monday, one yesterday evening and one this morning. That's 5mg when she had found 80mg was the minimum necessary. And by necessary I mean so she can get out of a bed, sit in a chair, walk a few blocks with the dog, and get back to the chair, lie down and recover.

Update 1: Was able to contact a Patient Advocate through, I am not making this up, Jewish Family Services. He seems to have drawn some high level attention to my wife's situation It is now about 5pm and I am going over to the facility to see what more can be done.

Update 2: Now close to midnight. Just got back from Grossmont Hospital. Chey will be there overnight and coming home tomorrow. Still no pain assessment, still no adequate pain relief, and clearly some serious violations of ethics, protocols, and patient's rights. Tomorrow I will try to lay out the timeline so people can see what happened and how an upstanding citizen suffering from chronic has been treated worse that a convicted drug addict, and still has not received prompt medical care and treatment.

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Locked Up in San Diego: Doctors opt for painful detention over treatment of pain

  June 08, 2012    

Right now a tale of pain and suffering is unfolding that involves my wife, Chey Cobb, pictured below in happier days. This is a tale so bizarre and unsettling it is hard to believe where it is taking place, not some distant land ruled by cruel forces of oppression and exploitation, but in San Diego County, California, USA.

[caption id="attachment_1575" align="alignright" width="305" caption="Chey and Layla on a good day, before her doctor kicked her off her meds."]Chey and Layla on a good day, before her doctor kicked her off her meds.[/caption]

Even as I write this, the first installment, my wife is locked away against her wishes, spending her second night away from home. Why? Because she asked for pain medication. Surely not? She must have done more than that to warrant detention. I can almost hear the incredulity over the inter-tubes.

Did she lash out in anger? Make threats? No, she did not. She asked her doctor if she could have more pills for her pain and ended up in a locked down facility.

[Update: There are several more posts on this including "Day 2 of painful detention in San Diego" and Day 3 of our San Diego healthcare nightmare. I have answered a number of questions in the Day 4 FAQ. BTW, Sharp HealthCare is the name of the organization to whom the various doctors belong.]
Just so we are clear on the type of person my wife is, she is a highly qualified and well-respected information security professional. The eldest daughter of a Navy pilot who flew carrier-based bombing missions during  the Korean War, my wife has held some of the highest security clearances granted by the American government. She is a wonderful wife and mother. She is almost sixty. She has a great sense of humor (she wrote Network Security for Dummies after working in network security for one of America's top secret spy agencies, get it?).

Apparently, your credentials and character, your demonstrable integrity, don't count for much when you are faced with a doctor who thinks you are lying about your pain to get high and accuses you of "drug seeking" when you say your current prescription is not enough.
Just so we are clear on the type of pain, this is chronic, unrelenting pain we are talking about, pain in the spine, lower back, ankles, knees, hips, wrists, and neck. This is 7x24 pain that fairly consistently runs about 8 on a scale of 1 to 10 if left unmitigated, pain for which doctors say there is no cure. When the pain pills wear off this is gut-wrenching, barely walking, can't climb the stairs unassisted, too painful to sleep so now you have sleep deprivation pain.

Because she is no stranger to pain--she has suffered from migraines since her teens--my wife has learned a lot of pain management techniques, like meditation, special breathing, visualization. Those can reduce the pain a point or two on the scale. But they can't get her down to level 4 or 5, the point at which she can at least walk a block or two, sit upright for several hours, and get some sleep at night. What we know will mitigate her pain to a manageable level is a moderate dose of cheap and well-understood drugs classified as opioids.
Warning! Never ask your doctor for opioids. If you are on opioids, never ask for more, even if your pain levels have increased. The risk? You will be cut off from you pain meds and branded a drug seeker, an addict, a junkie.

What happened to my wife is this: For about six weeks she been experiencing an increase in pain, most likely due to packing ready for our recent move (to another condo/apartment building in San Diego). Chey told her doctor she was not getting enough pain relief and a week ago on Monday Chey called to tell the doctor about it and let her know that she would run out of meds before the prescription was due to be renewed (or she would have to stop all activity and ride out the balance of the 30 days with levels of pain that would prevent sleep). The doctor was on vacation. My wife asked to speak to a different doctor. Nobody returned her calls that week.

Chey's doctor came back from vacation this Monday and was most likely told "Mrs. Cobb has been pestering us for more pills." The doctor finally returned my wife's call that Monday, right in the middle of our apartment move, and told her "I'm cutting you off." My wife was already out of pills and experiencing increased pain. On top of that she was now watching her world crumble. A delicately balanced regimen of pain management that had taken years to put together was about to be smashed. The future, which had finally started to look up, suddenly looked grim. Just how grim we had no idea.

In the next post: How to get yourself locked away and stripped of your possessions, without breaking any laws. Plus tips on avoiding the same painful fate my wife is currently suffering.

Note 1: I am listing this post in the Hemochromatosis category because my wife's pain is very likely related to this condition and I know from my Fighting Hemochromatosis page on Facebook that other hemochromatosis sufferers have struggled to get adequate relief from their chronic pain.

Note 2: I asked my wife if it was okay to write about this situation, even though telling the story will require exposing some very personal facts. Her answer? "Tell them everything you need to if you think it may stop this happening to others."

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So San Diego: Dog bowls and sunsets

  October 02, 2011    

So what happened to September? Not a single September post on the Stephen Cobb Blog? That's right, I was busy settling into my new job here in San Diego at ESET North America. I'm part of the research team and, as it  says on my business cards, my job title is Security Evangelist. But I did blog in September, seven times on the ESET Threat Blog.


Working a blog with multiple contributors is one of the many things I'm loving about this new position. Another nice thing about the job is San Diego itself. I'm sure that San Diego has "issues" that I will encounter (and blog about, right here). No city is perfect, but sometimes a city can feel like a perfect match. For someone who loves to travel--like me--San Diego is both a great place to come home to, and a great place to travel from. I can look out the window and see cars, trains, boats, and planes. Okay, so sometimes these are noisy cars, trains, boats, and planes; but like all modes of transportation, they create this great sense of possibility, of going places.


San Diego Dog Bowls at Baja Betty'sAnd sunsets. San Diego has amazing sunsets. Friends and relatives are already getting tired of me emailing them my San diego sunset pictures, so I decided to illustrate this post with something else that is very San Diego: water bowls for your dog. Such bowls are a common site outside San Diego stores and restaurants (many of the latter welcome dogs in the outside eating areas, of which there are many). This particular eatery caught my eye because they had thoughtfully provided bowls in a range of sizes to suit different dogs.


So, in San Diego you can walk your dog to the local restaurant, enjoy great food in the open air, plus canine companionship and, let's face it, watch a great sunset nearly every day.


San Diego Sunset

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Staying in Downtown San Diego? The Bristol Hotel could be your best bet

  August 22, 2011    

I recently had the pleasure of traveling to San Diego for meetings at a downtown office. My host for this trip booked me into The Bristol Hotel.

Being unfamiliar with this particular establishment, and a trifle miffed that I would not be earning points with one of the 2 hotel brands I normally choose (Hyatt and Marriott), I decided to check out the hotel online.

Nice website, nice pictures, and this view from Google Street View was reassuring (it's so cool that one can now wander the neighborhood around a destination using Street View). The locale was within a couple of blocks of the shops and movie theaters at Horton Plaza. In the other direction is Little Italy and the office I was visiting. All very promising, but the room rates at the Bristol seemed a tad low for an upmarket downtown hotel, so I was still a little wary.

Well, shame on me for doubting my host's taste, The Bristol is an excellent hotel, starting with the friendly staff in the very relaxing lobby. This is equipped with a basic PC workstation and a laser printer, handy for printing out things like boarding passes and last minute reading materials for meetings. BTW, I am not a fan of vast stretches of showy marble and huge shiny chandeliers in hotel lobbies. So when I say relaxing I mean things like comfy seating. Give me the soft and casual touch so I can feel at home.

On the way to my room I started to get a very good feeling--the corridor was wonderfully wide. This boosted my hopes that the room itself would offer what I call "business hotel gold." I'm talking, in hushed tones, about silence, which most frequent business travelers consider truly golden. The main thing I need from a hotel when I'm traveling on business, the thing that beats all manner of other amenities, is a good night's sleep.

Entering the room itself was a revelation: There was a lot of room! A lot more than in a typical cookie-cutter business hotel. This was tastefully decorated space and plenty of it. All behind a solid, sound-deadening door, with a number of nice touches: robes, slippers, lighted magnifying mirror in the well-appointed bathroom, flat-screen TV, big bay windows, and a desk with a proper writing chair (i.e. one that adjusted high enough for me to type in without hunching over).

A great night's sleep was followed by a fine breakfast (one of the best breakfast burritos ever--I confess I could only eat half of it and the staff happily packed the other half to go, which made for an inexpensive supper that evening).

So, I can definitely recommend the Bristol Hotel. Only later did I realize that the Bristol is part of a group of independent hotels, the Greystone Hotels. They have properties in San Diego, San Francisco, Palo Alto, Los Angeles, and Bend, Oregon. I look forward to staying at the Bristol again, and trying some of the other Greystone Hotels.

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Road Trip Tip Number 17: "Holding Onto the Night"

  August 20, 2011    

Tired of the morning sun waking you up too early when you're staying in a hotel? Annoyed that you went to the trouble, before retiring for the night, of pulling the thick curtains together so that you wouldn't be woken up by the sun, only to find that the drapes didn't overlap enough to block that tall strip of morning glory now slanting across your face?

Welcome to my world, at least until I started making a habit of carrying a few binder clips in my travel bag. They work great for holding the drapes in a fully-overlapped, light-blocking configuration.

But recently I switched to an even simpler solution. Finding myself on the road without my trusty binder clips, I rotated one of the hotel's trouser/pant coat-hangers by ninety degrees: Problem solved. The clips on these hangers are usually padded in some way so that they don't damage your clothes, or the drapes. And I always make sure I take the hanger off the drapes and return it to the closet when I get up, that is: when I am ready to get up.

WARNING: This is a safe "use" of a hotel coat hanger. Do NOT hang any kind of anything from a hotel room sprinkler head. The consequences can be VERY costly. I saw this first hand recently when checking into one of the hotels I had been using for my visits to the new Monetate offices in Conshohocken, just north of Philadelphia, the Spring Hill Suites in Plymouth Meeting. This is a dependable hotel for the business traveler but sadly it is sometimes frequented by young--and occasionally foolish--persons; like the kids who hung up their swimming trunks to dry on a sprinkler head in a third floor room above the lobby, causing it to discharge a bunch of water that pretty much ruined the lobby. I arrived late on a Sunday evening to see carpets and wall coverings and ceilings, torn up, peeled back and generally in a mess.

In other travel news: At the end of August I'm embarking on a major road trip: 2,900 miles across our great land, from top right to lower left, towing a small U-Haul trailer. The Jeep is being prepped and I am packing in my spare time. I hope to share some more tips from the road.

My destination is San Diego, to take up a new position: Security Evangelist for ESET, the anti-virus, anti-cybercrime company.

One of the many things that appealed to me about this opportunity was the fact that ESET is truly a global company. Not only are ESET's information security products sold in more than 180 countries, the company itself is based in Bratislava, Slovakia, with offices in Buenos Aires, Prague, Krakow and Singapore, as well as the distribution center for the Americas in San Diego. Call me a traveling fool but I'm hoping to visit them all. Until then, this old trainspotter will always have the San Diego trolley to ride.

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