Pt self advocating… with a little knowledge, facts and little Chutzpah pt gets their medically necessary meds

Hello Steve,

My name is xxxxxxxx  and I am on disability for several reasons. Bulging/burst discs in my back, both knees need to be replaced and I have severe depression and anxiety.
I live in Florida and I am having an issue with a pharmacist at the Winn Dixie pharmacy. I recently changed pain management doctors so I could go from paying $175 every month to the new doc being covered by my insurance 
The new doctor could see that my pain wasn’t being managed well and changed my medication. I weigh xxx lbs and cannot have knee surgery until I lose xx lbs. I tell you this because my weight contributes to the terrible pain I feel when walking. It feels like daggers being shoved into my knees.
The pharmacist refused to fill the new prescription because, in her opinion, going from 15mg Oxycontin 4x per day to 8mg Dilaudid 3x per day was too much of a jump in dosage. My doc sent in a new script for 4mg Dilaudid 3x per day and the pharmacist filled it.
Unfortunately, this dosage is not managing my pain. The affects of the Dilaudid only last 2-3 hours so I am bedridden most of the time. My doctor prescribed 15mg morphine extended release 1x per day to give the Dilaudid a boost. The pharmacist has refused to fill this prescription.
Is the pharmacist right in using her discretion or is she violating my rights under the ADA? If it is a violation, could you give me an idea of where in the ADA the law is stated?
Thank you so much! It’s a wonderful thing you’re doing!
With thanks,


My response to this poor patient:

https://globalrph.com/medcalcs/opioid-conversions-calc-original-single-agent/

This is a MME conversion program … that – AT BEST – creates CRUDE ESTIMATES AT BEST…  you can pull up the hyperlink above and there is 6 different warning foot notes on this page…

According to this  conversion prgm the 24 mg of Dilaudid ( Hydromorphone ) was – in theory – about 6% more than the 60 mg Oxcodone/day you were taking.  So the 12 mg/day of Dilaudid ( Hydromorphone) was actually  – in theory – about 50%  of  your Oxycodone 60 mg/day you were on previously.

Personally,  IF I was presented a Rx with what you were taking  60mg Oxycodone/day and what you were prescribed to replace that 24 mg Dilaudid/day…  a 6% increase for someone routinely taking that much opiates – NO BIG DEAL – at most I would have a conversation with the pt about the timing in how they were taking this new medication.

In my opinion, your doc would have to have given you abt Morphine  45mg- 60 mg/day to get you up to where you were. Besides causing you elevated pain, that pharmacist could possible be throwing you into withdrawal – which could be considered INTENTIONAL

Here is a “new” regulation that the FL board of pharmacy implemented in Dec 2015 – basically the BOP stated that a Pharmacist was not suppose to start looking for a reason NOT TO FILL when first presented a Rx to be filled.   https://floridaspharmacy.gov/latest-news/validate-pain-medication-prescriptions/  Unfortunately, I have not heard about the BOP taking any pharmacist to task over doing what this Winn Dixie pharmacist did to you.

One of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy…  When all is said an done… this pharmacist appeared to have “bullied”  your doc to drop your pain management without any real clinical justification.

In my experience, the agency that is in charge of enforcing the ADA & Civil Rights Act is under the Presidential Cabinet Seat ( DOJ)… is also the same place where the DEA is also positioned and they have little/no interest in enforcing the ADA or Civil Rights Act.

IMO, that pharmacist is not as “smart” as she thinks she is… in regards to opiate rotation dosing.  Feel free to share this email with your prescriber or talk to the Pharmacist in charge at the pharmacy…  Your doc may want to call the pharmacy/pharmacist back up and tell them if they don’t want to honor his medication orders as written, he will file a complaint with the board of pharmacy and medical licensing board of attempting to practice medicine without a license. 

You might also wish to reach out to the VP of pharmacy services at Winn Dixie

Winn-Dixie Stores, Inc Corporate Office & Headquarters

5050 Edgewood Ct.JacksonvilleFL32254

Winn-Dixie Stores, Inc corporate phone number:

(904) 783-5000


Email I got back from the pt:

Steve, 

Thank you so much for the info! I spoke with the PIC today and she said she’d have no problem filling my prescriptions.
Reading your material gave me the courage to stand up for myself. I’m so grateful.

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