Heal Thyself

Rapid detox leaves a nurse suffering unforeseen side effects

Karen Augustine, as an addict whose medical insurance didn't cover participation in the study, enlisted Channel 13 crusader Marvin Zindler to intervene on her behalf with Methodist, which agreed to let Augustine pay for the procedure on a monthly plan based on her income at Cypress Creek, and dependent on an understanding that she would return to that work after her detoxification.

In fact, it's here that Augustine may have made her gravest error, at least from an administrative standpoint, on the road to recovery. Her HMO coverage includes an employee assistance program (EAP) called Plan 21, putatively designed to provide assistance -- including counseling and treatment programs -- to employees who approach the EAP with their problems. Augustine declined to avail herself of these services because, she says, her experience led her to believe that word of her addiction would filter back to her supervisors and result in her firing.

"I was terrified. I lost sleep over it. I saw it as, if they found out, I'm finished."

The irony of this particular fear wouldn't become apparent until later.
Augustine underwent ultra-rapid detox, under the direct care of Dr. Silverman, on May 15. She came out of the anesthesia stunned by its effectiveness.

"I remember telling him [Silverman] that I couldn't believe how I felt as opposed to normal detox, and I wished that I could go to work and tell them [about the treatment]. And his exact words, and I'll never forget this, were, 'I wouldn't be apt to do that. I would tell them you met someone who had it done.' "

Silverman backed his advised discretion with a note, dated May 18, on Baylor College of Medicine letterhead, faxed to Augustine's Cypress Creek nurse manager Teisha York (who has since moved to West Oaks Hospital). The letter read: "Please be advised that Ms. Karen Augustine was under my care at the Methodist Hospital last week. She was discharged home on Saturday, May 16, 1998. Due to pulmonary complications secondary to intubation it is my recommendation that she remain off work until Monday, May 25, 1998."

The doctor's excuse was accurate, but incomplete, apparently reflecting his knowledge that Augustine's employers might not lend a wholly sympathetic ear to her attempts to kick her habit. That's all well and good; the excuse, Augustine says, was discussed prior to the procedure.

What confuses her is why, then, on the same date, on the same letterhead, yet another doctor's note was faxed to the same supervisor, this one stating: "Ms. Karen Augustine underwent ultra-rapid drug detoxification under anesthesia by Dr. Richard Silverman on May 15, 1998. She will need one week off work to recover from this treatment and to participate in ongoing support." This second note was signed by an Assistant Professor Peter H. Norman, MD -- a man Augustine says she's never met, had never heard of, and has since spoken to only once, when Norman returned Augustine's call to Silverman, who has since departed to Florida for a teaching sabbatical.

It might have been little more than a paperwork mix-up (and, since Augustine insists she never signed any release forms, a violation of patient confidentiality laws).

It might have been, except it was more than that, because when Augustine arrived at a June 2 "return-to-work meeting" at Cypress Creek, she found herself facing human resources director Adrienne Livingston, director of nurses Brenda Schiavone, program director of CD Services Robert "Dr. Bob" Eller, nurse manager York and copies of the two conflicting statements faxed from Methodist, which, sans prelude, they shoved across the table toward Augustine for explanation.

"They started hacking at me," says Augustine. "They didn't even question it, they just blindly broadsided me. Boom. I didn't know what to say. Adrienne asked for my keys and my badge and I was told that I would be suspended without pay pending an employee assistance program assessment."

By July 1, Augustine had received notification that her insurance had been canceled. On July 15, she called her employee assistance program, only to be told that they had never heard of her case (as of press deadline, Augustine has yet to hear from them). And on July 30 she was contacted by the Texas Peer Assistance Program for Nurses, which informed her that she had been "referred to TPAPN because there is a concern regarding your nursing practice," and had ten days to respond to their letter or the organization would be "obligated to refer your case to the Board of Vocational Nurses Examiners for their action," which could include suspension of Augustine's license. All the while, Augustine had been fending off requests for a meeting with her supervisors at Cypress Creek, who, she says, would not agree to her request to have an attorney present.

Augustine contacted her Peer Assistance Program (an advocacy group out of Austin that tries to help get nurses back on their feet), but even that has added to the confusion. Augustine says TPAPN case manager Cathy Dell informed her she'd been fired from Cypress Creek. Augustine, meanwhile, has received no such notification, and an August 26 meeting with Schiavone and Livingston failed to clear up the employment question, with Augustine's supervisors recommending that she contact her insurance company's employee assistance program for an "assessment" -- even though the EAP has failed for over a month to contact her, and her insurance coverage has been dropped.

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