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
At Walgreens, pro’ly about $275
Sad. RIP.
I just explained this in a post and totally agree. When you are on Medicare your Doctor, pharmacy and you are all under very strict rules which have severe limitations and real risks if anyone goes outside the system.
If you are on Medicaid you cannot purchase the medicine out of your own pocket. It is not like having private insurance and deciding, out of expediency, to pay for it your self and deal with the insurance company later.
Under Medicare the Dr., Pharmacy and you become part of their system and rules.
Is Primatene OTC? If it is, I am going to add it to my first aid kit. I have several friends who are asthmatic and it may be their hope, in a pinch.
Agree, sad and unavoidable. Do have to wonder how much the Dr. knew?
sorry, AVOIDABLE is what I meant.
>I’m 51, almost died from my asthma a couple of times in my youth. I survived and managed before Advair was even invented.
I say this, because I think there’s a lot more to this story than is being reported.<
You said it. This just doesn’t add up, not to mention I believe I’d have personally done without to buy my child’s meds if necessary. There are cheaper steroid inhalers out there. Prednisone tablets aren’t all that expensive for that matter. Advair and Symbicort are amazingly effective and the drugs of choice.
I wonder if this kid was a preemie and had damaged lungs from neonatal care, as opposed to a typical case of asthma?
Odd... I love Symbicort.
FTA
“Andrew Lieber was Zumante’s physician since birth.”
I agree with you re the doctor, they get all kinds of freebies. Some is screwed up in the story.
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.
That means he was on permanent disability through social security. Since his mother didn’t make alot of money it would be SSI/SSP. They should have also been receiving a cash payment for him.
My mother was medi/medi here in California and they NEVER pd for her Advair, either she did or if she didn’t have the $ I did.
>The Symbicort I just started is almost as bad, though. lol
Odd... I love Symbicort. <
Symbicort is great stuff. I originally got put on plain Foradil with a steroid inhaler. I HATE that stuff. Those stupid capsules get stuck in the inhaler and it takes up too much room in the refrigerator. Symbicort is just so much simpler.
Now that is just not true. My mother was medicare/medicaid here in California. She was prescribed Advair which was never covered. When I went to pick up her meds every mnth they would tell me the Advair isn’t covered and I would shell out the dollars. They would ring it up and I would walk off with the scrip.....every mnth.....til she died.
I take care of a 99 year old every day and have for three years. My experience has been her procidures are stopped at a certain point and her drugs are controlled under medicare.
She was in a procedure and the nurse told the doctor he had reached the limit. I asked what limit and the doctor explained Medicare regulations.
My immediate response was “So I will pay for the rest of the procedure”.
He said he can’t.
Twice I tried to pick up meds and there was some sort of issue and I offered to just pay for it. I was told can’t, as there are Medicaid restrictions. They assured me the problem would be ironed out the next day and I could pick up the prescriptions.
The pharmacist explanation similar to the Doctor explanation.
You may have had different experiences but, that is my experience.
Oh, thus far I really love what Symbicort is doing for me. It’s that awful taste! lol, that’s to what I was referring. I’ve only been on it 1 month.
They originally put me on Pulmicort until I began having one of the side effects — psychosis. Symbicort is MUCH better.
one puff twice a day is a lot easier than two inhalers four times a day (two puffs Albuterol, two to four puffs Azmacort is what I take during Asthma season...)
But I know from experience the salbutamol in Advir gives a steady relief of wheezing, while the twice daily dosages allows both relief from asthma and a good dose of local steroids is also in the inhaler to stop the wheezing. You can forget you have asthma most of the time.
Indeed, steroids alone will work, with "as needed" Albuterol...but you get lazy and forget to take all those doses.
I believe the drug company has programs to help you pay for the medicine, however...LINK
the bad news is that there is a lot of paper work.
As for getting money for the medicine: Lots of folks can't afford it, but when you get dependent on the government, doing things like asking relatives for money, or asking your church to help you pay the bill, or the Salvation army, or using the money for medicine instead of karate lessons, all these ideas disappear, and only BIG GOVERNMENT (meaning a clerk makes the decision) is left.
Yep, all I had to do was mention to the assistant at the pulmonologist’s office that my meds were really costing a chunk and she gave me several full size samples. Came out to a couple hundred dollars worth of meds.
Tragic asthma ping.
Oh, don’t EVEN get me started on that! I KNOW that my rescue inhaler is nowhere near as effective as my old ones. I used that last of the albuterols I’d squirreled away just last week. Now I’m on the stupid new ventolin. If I traveled out of the country, you bet your sweet bippy I’d stock up on the old formula inhalers.
No information about the child’s father, though.
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