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City ends free Rx benefit for elderly

Cutoff leaves hundreds seeking help

(Published December 2, 2002)

By JOHN DeVAULT

Staff Writer

A senior D.C. official said last week that pressures arising from Greater Southeast Community Hospital’s recent financial difficulties were to blame for the recent cancellation of a longstanding city-funded prescription drug benefit that served hundreds of chronically ill senior citizens.

According to doctors and others working in the city’s primary care clinics, the program’s Oct. 1 cutoff threatens the health of an estimated 600 elderly patients, and faces them with sudden, unexpected and skyrocketing medication costs.

One 71-year-old man being treated at the Walker-Jones clinic in Northwest Washington suffered a disabling stroke Oct. 4 when he ran out of critical blood pressure medications he could no longer afford after being dropped from the program, according to his doctor.

Dr. Leah Wolfe, medical director at the Hunt Place clinic in Northeast Washington, another city-funded clinic, sharply criticized the decision to economize by ending the prescription drug program for seniors.

"The elderly are the most vulnerable population," Wolfe said. "As a group they have the greatest dependence on medications, and if they lose them, the consequences are more severe."

Deputy Mayor Carolyn N. Graham said the prescription drug program – an offering of the D.C. Healthcare Alliance, the District’s privatized primary care program for poor and uninsured residents – fell victim to the monetary morass that has increasingly enveloped Greater Southeast Community Hospital over the past year.

Graham’s Office of the Deputy Mayor for Children, Youth and Families oversees the alliance’s operations.

"This program got caught up in all of the other financing issues that Greater Southeast is going through," Graham told The Common Denominator.

But she said that the program remains a contractually stipulated part of the alliance package of benefits to D.C. residents. She said she is working with Department of Health Director James Buford and alliance coordinator Deborah Thompson to restore funding for the program.

A Department of Health spokesman said both Buford and Thompson were unavailable for comment.

Greater Southeast Community Hospital, whose Arizona-based owner recently filed for Chapter 11 bankruptcy protection, has been the anchor institution of the alliance since its inception last year, and the hospital’s financial problems have thrown doubt onto the alliance’s future viability.

Nonetheless, Mayor Anthony A. Williams has steadily maintained that the hospital’s financial difficulties have not impaired the alliance’s services to its clients.

But last week, doctors, social workers and patients themselves said the ending of the drug benefits program – which carries an estimated annual cost of $900,000 – was already having a devastating effect on elderly, low-income residents.

Thomas Spell, speaking from his bed at Howard University Hospital, where he is being treated for the effects of an Oct. 4 stroke that paralyzed the right side of his body, said he learned his drug benefits would end when he visited the Walker-Jones clinic on Sept. 27 to refill prescriptions for 14 different drugs he takes to treat high blood pressure, heart disease and diabetes.

Spell said he had earlier suffered three heart attacks and several minor strokes.

But at the clinic, he said, a social worker told him that his drug benefits had been abruptly ended after almost 20 years: He couldn’t refill even his current, almost depleted prescriptions at the clinic pharmacy. And, he was told, he now bore the responsibility for finding a way to pay for his more than $400-a-month’s worth of medications himself.

The social worker was able to fill some of Spell’s prescriptions through special free and discount offers from some drug companies – a stopgap strategy some clinics are now pursuing – but couldn’t immediately supply at least three medications.

Spell’s physician, Dr. Diana Lapp, said those included important high blood pressure medications Spell needed to ward off further strokes. One week after his frustrating visit to the clinic, Spell was felled by a major stroke.

"I worked, worked, worked for everything I got," said Spell, a retired air conditioning mechanic, his voice slurred from the stroke. "And now I’m on Social Security.

"This wasn’t done right," he said. "They tell you right when you go to get your medicines – ‘You’re off the list.’"

Said Dr. Lapp, "Not having those medications was a major factor in his having a stroke. I don’t have much doubt about that."

She said that before the cutoff, Spell had been responding to his drug regimen. "Things were going well for him," she said.

"I was quite shocked [at his stroke]. I didn’t predict this from the blood pressure I’d seen in him," she said.

She added, "I also think the stress [from losing the drug benefit] was a factor. I definitely think there was a cause and effect between not having the meds and the stress."

Lapp also cited the case of another Walker-Jones patient, a man with diabetes who wasn’t able to pay for insulin. The man recently had to be rushed to a local hospital emergency room, suffering from diabetic shock.

Lapp and others said the city also did a poor job at giving clients warning of the impending cutoff. Many former alliance clients now face monthly drug bills totaling $200 to $400 for medications they need to stave off life-threatening medical conditions.

Jean Ruffin, a 67-year-old former hospital worker with high blood pressure and heart disease who wears a defibrillator implant in her chest, said she got the news about the cancellation of her benefits not from an alliance official or a social worker, but from a security guard at Walker-Jones. Ruffin said he noticed the alliance card in her hand as she waited in line in mid-October to refill her prescriptions at the Walker-Jones pharmacy.

"He said those cards are no good anymore," she remembered. "‘You’ve been cancelled,’ he said."

She said she tried to re-apply to the alliance for benefits, but was rebuffed. "They didn’t say, ‘We can help you this time, but not next.’ There was none of that. You were just cut off," she said. "I’m poorer than I’ve ever been, and I’m 67 years old. I had to borrow money from my daughter to pay for my prescriptions."

She said she was considering canceling an upcoming doctor’s appointment set up to test her for an apparent thyroid condition, because she couldn’t bear more medical expenses. "I know they’re going to prescribe something," she said.

Suzanne Jackson, director of the Health Insurance Counseling Center, a George Washington University-based resource center that tries to help consumers with health insurance difficulties, said phone calls to the center have "sharply increased" since the alliance shut down its prescription drug program.

"The volume of calls to our hotline has about doubled," she said. "We’re looking for funding for more staff."

But, she said, the options available to seniors outside the alliance program are few. Most seniors receiving Social Security payments earn too much to qualify for Medicaid, she said, which in the District picks up the cost of prescription drugs.

She said that mostly, the center helps seniors navigate the piecemeal array of free and discounted offers from drug companies that is the closest thing to an affordable stopgap for most seniors. But she said that system is hard to negotiate, demands a lot of paperwork and is often only marginally helpful.

The programs, she said, typically last for only three months before they must be renewed, and usually offer deep discounts on only cheaper drugs. A supply of medication that costs $15 might be discounted by half, she said, but one costing $80 – not an unusual price for a month’s supply of hypertensive or cardiovascular medications – would likely be discounted only to about $60.

"It’s very laborious, and it’s not always a very effective approach," she said.

"The mayor has the power to do this, to get these people covered," she added.

However, Renee Wallace, deputy director of the D.C. Primary Care Association, said that while the city’s drug benefit cutoff was ill-considered, it should be put in perspective. She said that nationwide, few states or localities offer any prescription drug benefits to seniors. Overall, she said, "the alliance is the most generous in the nation for the uninsured. Most of the nation isn’t doing anything."

D.C. Department of Health official Ronald Lewis discounted the idea that doctors and clients at city clinics didn’t get enough warning that the alliance’s prescription drug benefit was ending.

Lewis said his agency told doctors "at least six to nine months ago" that a decision had been made to discontinue the program. He said that decision was made by former health department director Ivan Walks, who left the agency in May.

That assertion was affirmed by Jose Aponte, a spokesman for Unity Healthcare, the company that contracts with the city to run six of its clinics, as well as on-site pharmacies. "The decision [to shut down the program] was made several months ago. It’s been implemented in the last several weeks," Aponte said.

But Lapp and others said the city’s decision-making process was confusing, and its notifications haphazard.

She said that after hearing rumors for weeks, the Walker-Jones staff received notice on July 1 that the drug benefit would be discontinued.

"But then after two weeks they changed their mind," she said. "They sent us a list of the 450 supposedly current patients, and said we’re going to continue the program with just those," she said. "But no new enrollments."

However, she said, it quickly became clear to staff in the clinics that the alliance list was faulty. Lapp said staff at her clinic alone identified about 50 of their continuing clients not on the list. "So we sent those names off to the alliance," she said.

Finally, she said, the announcement came in early fall that the program would shut down for all participants on Oct. 1.

"The alliance didn’t give much advance notice [of the cutoff] or try to phase it in," said Dr. Wolfe. "To this day, nobody from the alliance has called to talk to me."

Wolfe, who spent several years as a health care policy analyst on Capitol Hill before becoming a doctor, added, "I think this all shows that the alliance is on pretty precarious footing."

Lapp said the notification process to her patients was also haphazard. She noted that just last week, one of her patients received a letter from the alliance reminding her that it was time to re-enroll in the program.

Health department official Lewis disagreed with Deputy Mayor Graham’s explanation of the reason for the program’s closing, arguing that a chief reason for ending the drug benefits was legal, not financial.

He said city lawyers objected to the alliance offering prescription benefits to Medicare-eligible residents because one alliance requirement is that the alliance serve uninsured residents, and Medicare is a form of insurance.

"We were informed by the corporation counsel that it had to be only uninsured folks," Lewis said.

Therefore, he said, department officials decided to end the benefits because "we wanted to ensure that we weren’t violating the law."

D.C. Primary Care Association Executive Director Sharon Baskerville also said there was a legal objection to the program – but she said it centered on the fact that the program provided drug benefits to some Medicare-eligible clients (the elderly) but not all, since many disabled persons under age 65 are eligible for Medicare benefits. Therefore, she said, some city officials feared discrimination lawsuits.

"There was a legal argument and a financial argument," she said.

But Graham said that no legal objections have been raised against the prescription benefits program.

"I know nothing about that. The corporation counsel has not weighed in on this," she asserted.

Copyright 2002, The Common Denominator