Medicaid Patient Harrased by Nurse for not vaccinating in Eugene, Oregon

[orvis]

I live in  Oregon.  I up until my daughter was 14 months old, took her to a local clinic where my decision to not vaccinate was not looked down on (at least openly) and I simply filled out a form stating I was declining to vaccinate.  She is now 21 months old.   She has not been sick, so I have not needed to take her to a doctor.   She recently came down with the flu. 

We had placed her in OHP which is the Oregon Health Plan.  I had to choose a doctor as her primary care physician (outside of the clinic she normally goes to) whom she has not yet seen.

I called the Medicaid office first to see if I was allowed to bring my child to the emergency room with out the doctors pre -approval as she has been throwing up and had diarrhea as well.  I was told that I would have to speak to the doctors office, and that if they decided the situation called for the emergency room then I would need a referral, unless it was life threating.  To me my child vomiting and diarrhea is an emergency situation.  So I took issue with the fact that I couldn't just bring her to an emergency room with out approval. 

Well, I called the doctors office and spoke with a nurse about the flu like symptoms.  She said I was not a patient since I had never been in, even though the doctors name is on my child's card as the PCP.  She said I would have to first come in to the office to fill out forms before I could even think of making an appointment.  I asked when I could do that and she said I might have to make an appointment to do that.    She also said my medical records had to be transferred to them.  She gave me advice about giving my child "pedylite"  but inferred it would be too expensive for me to afford.  She also said to cut out all milk and juice for then next 48 hours (my child is 21 months old) and she is only tolerating cheerios so for me to feed her only water and cheerios I would rather give her the milk even if I have to water it down for nutrition even if she will get diarrhea from it, its better then cheerios and water.  Well so my request to either make an appointment with the doctor, or to go to the emergency room was denied. 

Now on to the vaccination part: 

The nurse then demanded to know if my child had had an 18 month check up, when I replayed her last check up was at 14 months She asked if my child has had her vaccinations up to date.  I told her no my child hasn't had any vaccinations, to which she said 'none of them?" I explained to her she had been seeing a doctor and  that that doctor had said it was ok and that I had signed the 'refusal to vaccinate form", the nurse laughed and said ' we know they never say its ok" , she then said that this doctor my daughters PP, would not take patients who did not vaccinate.  I let her know that it was my choice, and she said that it was the doctors choice whether to take me as a patient or not.  She let me know that the doctor might call me back to let me know if she would decide to accept me as a patient..  I asked so the doctor or you will call me back then?  And she answered 'yes' I have not surprisingly, received any call back. 

This really concerns me as I can now no longer 'establish' my child as a patient there.  They apparently do not want Medicaid patients there, and definitely not ones who do not want to vaccinate their child.  Here I was a concerned mother for my child being sick and instead of the nurse being concerned about the diarrhea and vomiting storms.  I was given a lecture on vaccinations and made to feel like I'm putting my child in danger, when its the complete opposite. I understand they could not see my daughter unless her flu symptoms turned into dehydration.  I also understand I did not need more fear put into me about having to get my daughter vaccinated, and the nurse acting as if she's going to let OHP know that I am not getting my child vaccinated. 

When its my choice, OHP already knows I sighed a religious exemption form!,  Now I am worried about what is going to happen, with the way the nurse was acting,  and why the nurse had the right to act like this to me.  Anyone else with a similar story and what did you do?

[emmy526]

i changed drs when i had one that treated me as less than the mother i am, and you should find someone else...and there is no reason you cannot take your child to the ER if you feel there is something life threatening going on...suppose your child was turning blue? wait for the dr to okay going to the ER?  i dont think so...and an office thats going to treat you like that over the phone, will be even worse in person... keep your child out of the drs office as you have been doing, and only take her to a walk-in clinic if its warranted or the ER.. there are choices in this. and its against the law for the dr to harass you about not vaxing if you signed a waiver.  You should call the insurance commissioner and report via filing a complaint about that drs office for harrassment and bad judgement of medical advice. 

and in my experience, nurses are the WORST ones to give advice on the phone about illness.  as a matter of fact, i have had several nurses put me in the ER due to their idiocy, acting like they are drs when they are not.  And pedi nurses in the drs office are some of the worst out there too..

[orvis]

Well my child had severe diarrhea and throwing up, the OHP customer service told me I had to get an emergency room visit referral;l from my child's PP first.  That is what I was attempting to do.  Hopefully, for like an accident or something severe, I wouldn't need to get a refer ell first.

I should call the medical board to file a complaint about the nurse you think?  I'll have to look into it.

The nurse was very condescending and definitely acted as if my not giving vaccinations was a major evil.

I did sign a waiver, she seemed to ignorant to know about the decline to consent form.  She acted like it was illegal or something.

[miriam]

.  

Edited by miriam - 5/29/12 at 8:13am

[orvis]

Helen Miller was the doctors office my daughter is assignhed to.  I spoke with a nurse, I don't know her name, this was in Eugene. 

[craft_media_hero]

I'm sorry your child is ill and you are dealingnwith the stress of being treated badly by the nurse on the phone that's horrible!

I want to reassure you on some things and just give my opinion that may or may not help you out.

1. Puking and diarrhea can be pretty bad, but not necessarily emergent, in my book. They are pretty common in childhood illnesses so take a deep breath and try not to panic. Get thee pedialyte stat, though. The "mother to mother" or something like that kind is generic and plain, doesnt have all the dyes and flavorings. My kid did have emergent dehydration in the emrgency rooom, and she was treated with super-pedialyte, which worked; they will treat your dd the same as you can at home unless she is dehydrated to the point of needing IV fluid. Give a Tb every 15 minutes even if she pukes it up. If it gets worse or no improvement in 48 hrs then go to the emergency room even with no referral.

Also, feed the BRAT diet, bnanas rice apples toast or any other food that could be switched out for those, ie cheerios for toast, pears for apples, rice cake for cooked rice, etc. Those are " binding" foods and will hopefully slow down the runs I would not give dairy milk, only breastmilk if you have access to some or soy/nut/rice milk. Pedialite popsicles a good or you can make banana ice cream wich is just frozen mashed banana if you think she ould eat a "treat" food over smth else. Dairy is hard to digest and feeds the mucus--we always avoid dairy when sick. I also find salty foods helpful with a dehydrating illness, so salty rice cakes are a good one in my family.

Thats what I would do in your shoes but I am not a doctor yadayada if your mama gut truly feels its lifethrearening then of course get medical care asap.

2. In mybstate, medicaid will cover emergnecy visits even if there is no referral. Just my experience, but if you have that card, they will bill Medicaid. It may vary in your state, tho, but hopefully your dd will be better ithin 48 hrs and this will not be an issue. Chevk around to see if there is an urgent care or after hours clinic in your area as an alterntive to the hosp or the pp office you spoke to. They usually take medicaid and cant really comment too much on your nonvax decision since you will only see them once.

3. Check out the mdc tribal areas or IRL crunchy groups n your area and get referrals for. Doc who may be more supportive or at least less nasty abt your decision to not vax. I would just not pursue any action with the othe pp since they are obviously not a good fit for your family. It took us YEARS but we finally have a ped who is in sync with us and tho she is pro vax is also open minded enough to respect and not pressure us and realize that not all folks have the same need/risk factors for every vax.

Good luck! Try to relax! Skin to skn is still good for you and babe.

[Paigekitten]

My personal experience with OHP is that you do not need a doctor's referral to take your child to the ER.  

[craft_media_hero]

How are you and the little one faring, Orvis?

[orvis]

I was told I did need a referral when I called the LIPA help line's # listed on the back of the health care card.  Asking about what coverage was provided for emergency room visits for my child under the CHIP plan.  Unless it was a 'life threatening situation', I was told only then if it was could I bring her in to the emergency room with out a referral from my PP or nurse.

As I said before, my child throwing up, for no apparent cause, repeatedly, if left  up to me as a mother was considered by me to be  an emergency room situation.  Where as to others it may be simply a moderate case of the flu.  That is why I called them to find out if I could bring her in under those circumstances.  They told me to call my PP first before I brought her in.

I should not have to determine that myself, as a mother if it is a "life threatening situation" or not I should be able to go to the emergency room for health care.

I think that I should be able to bring my child in for something as small as a stubbed toe if it seems serious to me. 

So, are you saying you brought your child in to the emergency room, and it was not a 'life threatening situation' and you were not later on billed for it? 

Edited by orvis - 11/4/11 at 10:52pm

[orvis]

Originally Posted by craft_media_hero 

How are you and the little one faring, Orvis?

We are both no longer ill, thank you for asking.

Fed her the brat diet, and she stopped throwing up after another 2 days.  Though I did not stop her bottles of milk, as the nurse told me to do. She had been self-weaned completely at 18 months, but she still has 2 bottles of milk a day.  I stopped giving her apple juice, and as for the milk, I watered it down more, as I did not feel comfortable not feeding her anything when she would not eat and was throwing up. 

She started to eat normal after 4 or so days. 

I don't know why its like that in this state, in the last state we lived in you did not need any refereel and you could see absolutley any doctor as well.  I don't know why its like that here.

Edited by orvis - 11/6/11 at 2:26am

[Paigekitten]

Oh, maybe CHIP is different the OHP?  It was after office hours though, so maybe that makes a difference?  She had fallen and bumped her head, we just went in as a precaution. 

[orvis]

This is just copied ver batem from the website:

So I don't know but they sure like to use a bunch of useless acronyms:

 

"OHP Plus includes the Children's Health Insurance program (CHIP), the no-cost public assistance option of the Healthy Kids Program."

 

It was probably because it was after regular doctor office hours, and you didn't call first to see if it was ok?  I don't know.  If I had gone I'm sure they would have accepted us at the emergency room its just I am not sure if OHP would have decided to bill me afterwords.

Edited by orvis - 11/6/11 at 2:43am

[Paigekitten]

The OHP benefits manual says in a couple places that 24 hour emergency care is covered but you have to get a referral to see a specialist, but then it does say if you can be charged if you go for emergency care that isn't an emergency you can be billed.

https://apps.state.or.us/Forms/Served/he9035.pdf

It just never occurred to me to call before hand since I knew emergency services were covered and an after hours possible head injury seemed pretty clear cut. 

The way the nurse treated you seems pretty horrific.  I would certainly complain if it were me.

[orvis]

Well that is basically what I was told when I called them too. I've not read it before so I will check out your link. Its nice to see that it is an actual rule and that I wasn't told the wrong thing.  Thanks for letting me know.  I understand why you would have gone for an injury like that after hours, my daughter 'just' had the flu but to me it was pretty serious.  Yah I don't think my not giving my daughter vaccinations should have been discussed or questioned by the nurse, it had nothing to do with why I was calling her.  I've never had any vaccinations and its never been questioned by anyone as an adult when I go to see a doctor when I'm sick.