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
Yep, if you can’t afford the kid then be responsible. Don’t put the burden on the taxpayers.
Give you an example ~ I need a certain medication. I went on a trip and forgot to take my pills. I went to a pharmacy and asked if they could call my pharmacist and get authorization for 14 pills ~ a very minor fraction of what I needed.
They did that. I got my pills and it was all good.
Little did I know that "the law" requires that when I change pharmacies, even under the conditions I described, I have effectively made a permanent change and will have to go back to my doctor for a new prescription to restart service at my old, local pharmacy.
The "law" that did this to me is called MEDICARE. The bureaucrats don't care one way or the other if I pay for my medications out of my pocket, or the taxpayer's, they've decided that my acquisition of life sustaining medications is a very secondary issue next to the question of WHERE I GO for those medication.
This little boy's medication is more carefully monitored than the stuff I use ~ probably because it costs more AND can be dangerous to some people. It's unlikely his mother could have gotten the medicine ever again if she changed the payment method since that would disrupt the activities of the sleuths looking for misuse.
Someone at Denver's Human Services probably knows the answer ~ and that's going to be that Medicaid reporting requirements supercede the needs of the patients, even in cases where absence of the medication will cause death.
There's no reason Medicaid should be less stringent than Medicare.
This is true, the welfare set aren’t usually afraid to use the ER as personal doctor’s office and a life threatening emergency like that would push the case to the front of the line.
I can’t believe she didn’t just have the prescription transferred to another pharmacy. That would have been my response to showing Walgreens the reports that said she had benefits. If they wouldn’t have followed up, I would have found a pharmacy that would.
BUMP that.
Democrat parasites have no concept of working, or paying for anything themselves.
They entitled!
The other thing I forgot about Advair is that it is not a “rescue inhaler.” For Advair to work, it requires a daily regimen.
If the kid had gone months without using Advair, it wouldn’t be instantly effective.
I’ve gotten by with a Primatene rescue inhaler. It’s rather nasty, but, it’s better than nothing.
Even at $175/mo., most parents can find it in their budget, if their child needs medication that badly. Plus, if the kid was in that much distress, time to head to the emergency room.
Sounds like she had the script in hand, but wasn't willing to pay for it.
It’s really hard to blame someone for taking a goodie that the law itself provides for.
ew primatene.
I’ve done that one myself. Nasty stuff.
The Symbicort I just started is almost as bad, though. lol
Remember, live sustaining medicines are more dangerous than Marijuana ~
‘Ms. Lucero needs to be a little concerned as to why she couldn’t provide for her son.’
And where is the child’s father.
I am very sorry for this boy, it must have been a horrible death.
But the responsibility for caring for him lay with his PARENTS. They are the ones who failed.
If his father is dead or somehow seriously disabled, my apologies in advance.
Advair 2x/day costs about $150/mo. If she worked, I’m sure she paid that much in taxes, but the gov’t of course knew how to spend her money better than she did. Even if she worked, $150/mo might have been out of reach for her. It is for a lot of people. For example, I couldn’t pay that on top of my minimal health insurance that I’ve managed to keep. That’s after my small business went belly-up, again largely thanks to taxes and gov’t stupidity wrecking my customer’s businesses. (Gee, for some reason that really seemed to start happening a lot in 2007 and got worse from there. It’s almost like something happened in late 2006 that was really bad for small businesses. Wonder what it was? /SPIT)
Why didn’t mom just buy the meds and try to get reimbursed? I’d do whatever I had to do to keep my child alive. There are parts of this story that don’t make any sense.
I’m on Symbicort, which is about $100 a month before insurance. My lovely insurance company insists that I order a 3 month supply at once. So now we’re at $300 before, around $125 after. Of course, that’s not considering that I’m on 5 such maintenance meds per month. Even after insurance, 5 x $125 is a good bit of change to pay all at once.
Amen. This story stinks from every angle. Too many lawyers, too many government boobs and too many agendas to figure out where the truth lies.
I agree, I’d sell everything I owned for Rx for my son.
Nobody denied the boy this medicine. They just didn’t pay for it. Big difference.
Of course, it may still be a problem.
“This woman just sat around waiting for the government to do something.”
Yup, just as she’s been taught she was entitled to do by the govt run schools, the media, our culture, and now these lawyers.
Socialism kills, first the spirit and eventually the bodies. Death is the inevitable result. Lots of death. The sadest thing? Socialism is often self-inflicted suicide-by-government...
She got samples. Just not in time. My two had to take Advair along with a nebulizer when the inhaler wasn’t doing enough.
The story doesn’t tell enough to determine just how many ways this child was failed by adults. Not being able to get a human on the phone but once...she should have gone in person.
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