ROCHESTER - Last Wednesday Joshua finally got the Suboxone he needs to control the body numbing pain from symptoms of heroin withdrawal.
It took almost five months to get it, but it would've only taken a few days, says Dr. Terry Bennett of the Quick Care Clinic in Rochester, if Frisbie Memorial Hospital officials had only streamlined their referral process to allow him to dispense the opioid substitute.
Bennett claims that for a long, long time the Rochester hospital intentionally and systematically refused to give him Suboxone referrals even though he is on the hospital's staff, has never had a malpractice suit and is basically across the street.
He says in the past six months he's had less than 20 referrals from Frisbie.
"I am the only Suboxone provider in a high death, high addiction area," Bennett said. "These people are teetering down a razor blade. Timing is everything, and if you don't treat them you tend to lose people. It's unpardonable."
After reaching out to Frisbie Memorial Hospital a week ago, hospital officials did admit that two primary care physicians in their network had mistakenly excluded Bennett from their list of Suboxone providers.
In a statement on Monday, Frisbie Senior Vice President Joseph Shields told The Rochester Voice, "Dr. Bennett's office made us aware of two of Frisbie primary care providers who misunderstood the regulations regarding referrals to same-specialty providers. We immediately investigated the regulations and verified that Suboxone referrals are in fact, not subject to the same-specialty referral restrictions. We have clarified this in writing with all of our providers."
The long wait begins
Joshua, who didn't want his last name used for this report, said he experienced the runaround firsthand beginning when he went to see Bennett last October.
Growing up in the Worcester, Mass., area, Joshua said he became a heroin user at the age of 21, first using it recreationally on weekends before quickly being ensnared in a daily habit.
That all changed about a year ago after his closest friend died of an overdose.
"That woke me up," he said softly as he sipped on a coffee at a downtown Rochester eatery last Wednesday.
He said he moved to Rochester to live with a girlfriend he'd met online and that now - at the age of 27 - he's determined to kick the habit, but he needs Suboxone (trade name for buprenorphine) to get through the day.
He said if he doesn't get Suboxone his symptoms run the gamut from feeling lethargic and nervous to getting the sweats and tremors.
"I was desperate so I went to Dr. Bennett," he said. "He said I needed a primary care physician to refer me."
He said he then went to the Frisbie-run Rochester Hill Family Practice where he met with a primary care doctor who said he couldn't refer him to Bennett because he was a primary care physician.
Bennett is a primary care physician, but he is also a Suboxone prescriber and has two DEA licenses to write scripts for the two separate practices.
Joshua had come in to get Suboxone and was not a primary care patient of Bennett's.
The Rochester Hill Family Practice physician ultimately refused the referral but set him up with an in-office clinician, who supplied Joshua with a list of Suboxone providers like Groups in Rochester and Road to a Better Life in Somersworth, but not Bennett.
The two groups said "it'd take weeks or months to get me into a program," Joshua said.
In the meantime, Joshua stayed clean by buying Suboxone on the street where it costs about $20 a sublingual strip.
He said he needs a quarter to a half strip every day to keep from getting withdrawal symptoms, so it does take a financial toll, especially since he recently lost his job.
|Dr. Terry Bennett relaxing at his Quick Care Clinic office with his rottweiler mix, Crosley, named for a vintage car especially cherished by the primary care physician.
"There was a time I wanted to give up," he said. "I basically got the runaround since October."
The clear and present danger of buying Suboxone on the street is if one day you can't find a Suboxone supplier, but a heroin or fentanyl dealer offers you a fix for $5.
Feeling down and out and desperate, a few weeks ago Joshua went back to Bennett, told him of his plight and begged for help.
Bennett's staff then contacted the office of the primary care physician at Rochester Hill Family Practice who'd seen Joshua in October. This time the referral was approved.
"What's so frustrating is I couldn't get a referral," Joshua said. "Then I'd have nurses at doctor's offices just say to me, 'hey, just walk into Bennett's offices and they'll give it to you.' There's a lot of misinformation out there."
What happened to Joshua called typical
Bennett, who is a primary care physician and a suboxone provider, says what happened to Joshua is typical of many of his patients who need a primary care referral to obtain Suboxone treatment from him.
While Bennett is both a primary care doctor and Suboxone provider, he can't refer primary care patients for his own Suboxone treatments.
Bennett, a feisty octogenarian and Harvard alum known for his love of vintage and antique cars, freely admits that he has had issues with Frisbie Memorial Hospital over the years. He claims the hospital has been dismissive (he calls it "eyerolling") of his Suboxone clinic and his primary care practice and puts up walls rather than bridges when it comes to its primary care physicians referring their patients to him for Suboxone care.
"Something's going on. This has been happening over a long period of time," he said. "I hear my patients complain about it."
Bennett said since the recent leadership change at the hospital in which former CEO John Marzinzik was replaced with Interim CEO Dr. Jocelyn Caple, he has been on a better footing at the hospital and he hopes that continues.
However, he cannot condone the roadblocks that he says were in place, and institutionalized, that stonewalled heroin addicts seeking Suboxone, who were most vulnerable.
When a Frisbie-affiliated physician is told by a patient they're suffering from heroin addiction, they should be told, "Dr. Bennett is on staff, he's never had a malpractice suit and his office is across the street. Simple as that," Bennett said.
Bennett said he has about 2,000 patients in his primary care practice and about 175 patients in his Suboxone practice, which is regulated and overseen by the DEA.
Other local Suboxone options
There is only one other listed Suboxone clinic in Rochester, Groups in the Winter Street professional building.
At Groups' facility, one of seven offices statewide, three doctors prescribe Suboxone for about 70 patients who must attend a single hourlong therapy session each week to get their Suboxone supply.
Lori Boisvert, the office coordinator, said there is no waiting list, but patients do have to pay the $60 therapy session fee in addition to their Suboxone cost.
Boisvert said insurance sometimes covers some of the cost, but not always.
Another Suboxone clinic is located in Somersworth. ROAD to a Better Life also maintains seven offices statewide and prescribes Suboxone to patients using a network of doctors and nurse practitioners. While doctors can have up to 275 patients, nurse practitioners can have no more than 30, said Katie Bisson, a practice manager at Roads, which is affiliated with Granite State Pain Associates.
Bisson said once a patient completes all the paperwork, they can usually get them into the program within a couple of days, especially if they are willing to travel to one of their seven satellite offices where an appointment might become available sooner.
She said they do accept insurance, but if none is available, they require payment in advance.
The Rochester Voice asked for the amount of patients they supply Suboxone to, but they chose not to give that number.
Meanwhile, Bennett's practice has a sliding scale, he said, meaning those who are financially strapped are charged less.
Bennett said traveling to Somersworth is out of the question for many of those affected by drug dependence, which is why his downtown practice should be the first choice for Frisbie.
The Suboxone website (suboxone.com) lists Bennett as the only provider in Rochester.
Bennett said he's grateful that Frisbie appears to have corrected its protocols with regard to Suboxone referrals to him, which occurred about two weeks ago, just as The Rochester Voice began to collect information on Joshua and the problems Bennett was encountering.
With all the trials and tribulations regarding his Suboxone practice in the rear view mirror, Bennett said he was hopeful that he could get back to the business of making people healthy and saving lives.
"I'm happy with Frisbie's statement," he said. "Let's hope we can get along,"
As for Joshua, he said on Monday he was doing great and happy to be getting the Suboxone at no cost to him as he has insurance. He said now he's out looking to land another job.