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 am on Medicare/disability and have never heard of such a thing. I just went through a full yr of treatment for breast cancer and never had a problem. Some of my meds were not pd for since I was in the donut hole and my prescription INS didn’t cover them but I just pd for them with no problem.
I took care of my mother for 4 yes and she was medi/medi, best INS anyone can have they pay for everything. For 4 yes the only thing they didn’t pay for that there was no generic for was Advair. She was a breast cancer patient so lots of doctors and treatments. She was never denied a doctor, treatment, or type of medication except the Advair and we just pd for it.
I will put money on her being on public assistance. Then she wouldn’t have $175/month available to purchase it outright.
And the article states that they were getting treatment, including his getting so ill after an attack he never recovered.
When I was between insurance, Primatene was what I could afford. Also, none of the new drugs were around either.
I don’t use Primatene currently. It’s been years since I’ve used it, as a matter of fact.
Now, I make more money and can afford Advair at full price, even without insurance.
Another angle is maybe this woman...isn't all that bright.
Like most have mentioned here....we don't have the whole story. And we probably won't ever.....
There was an article recently here about the highest % of recipients of public assistance in MO, I believe. The article was trying to slam Walmart, but looking closely at the numbers, the employers with largest % of employees on public assistance is the state itself.
Exactly. It’s called “White Coat Syndrome” and people ar intimidated by other people wearing white coats.
You have to be the single biggest advocate for your self or find some one who is stronger and well read on your condition.
To many people suffer from just doing what a doctor says and not all thera pies work the same for each person.
One thing I want to point out, when you buy prescrips from Canada, you are cheating the company that developed and brought the drug to market. Because Canada forces drug companies to sell their products in Canada at lower costs (to reduce Canada’s public health expenditures), the companies lose money in Canada and have to recover the money on US sales.
Primatene mist should be banned.....IMO.
kimmie7 might want your help.
like I said, my experience is different.
Wasn’t big deal. got the meds the next day but I would have started getting agitated if they weren’t there the next day.
on the procedure, I don’t recall the specifics of what or why there was a limitation but, I do remember my response being on the order of “WTH”
why?
What’s “the Donut Hole”?
That is what I didn't get either.
Back when I didn't have health insurance my doctor gave me an entire bag of samples. Why didn't she call his doctor and ask for help?
I don’t discount your theory at all. But if this woman WAS asking for help, why didn’t anyone see it through so the child got his med?
Very thoughtful, however my asthma has recently taken a turn for the “oh my gosh” and Advair no longer helps. They have moved me to Symbicort full strength.
They put me on Pulmicort first, but I began having severe anger issues and demonic nightmares. Thank the Lord they got me off that fast. LOL
http://www.freerepublic.com/focus/news/2443993/posts
You seem to think that there is some sort of system in place to make sure things like this do not happen. The only way things like this wont happen is to privatize everything. The state cannot meet people's needs because bureaucracies cannot flex.
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