Clark goes AMA

Today was a mess. I was written up in the first ten minutes of work for having accidentally brought home two pair of keys. Apparently they blamed everyone else but me until I rolled in and offered them without knowing they were being missed.

New patients were everywhere. There's something about Friday... their family tries to get them in before the weekend binge comes. It was also storming outside, so all 40 in-house patients plus 40 PHP patients over for lunch were crammed inside.

In the middle of the ruckus, my boss asked me to take Clark over to the apartments so he can get his stuff. He was completely calm and no one was fighting him, so I never suspected he was going AMA. AMA means Against Medical Advice, meaning the clinic hasn't approved the patience discharge. The patients are in on their own accord and can walk out whenever they want being that it's not a lock down facility. Going AMA, however, does put oneself at risk of having their insurance companies asking for reimbursement.

Clark was going AMA because of what I had done. I had given him the date of his daughter’s graduation (I found it online) and he was determined not to miss it. He had already been in a month, which is the average time for patients, and he was ready to go. The quiet broken man was steadfast in resolve not to do any more damage than he had already done.

His therapist approved his discharge, but it didn't make it's way up the chain of command. They disagreed. Their official stance was that his recovery was not yet complete - that if he were released at that time, he was likely to rebound. He needed to be held longer for his own good.

... another hole in the wall of secrecy at my clinic where I've seen the brilliant luster of profit outshine the dull ambience of common sense. The mere suggestion of forcing a patient to slip further away from his family, missing his daughter’s high school graduation, to spend another week at rehab awakens a deeply recessed fire inside of me. This isn't textbook political theory anymore, this is the real thing.

This is profit over people. This is the direct manipulation of insurance providers by a trusted source to milk as much money as possible at the cost of further ruining a weakened mans life. I know from my own family the anger that comes when a father misses a daughter’s graduation, even when he thinks he's unwanted. I can think of no clearer agitator to bring Clark back to the depths of addiction than having the one daughter who still talks to him turn her back.

Adding to me anger is that a week ago I watched them discharge The Kid. Every tech and patient who knew him was confident he'd be returning to addiction within an hour of getting home. He sat around and told "war stories" of past drug use all day, every day, giving other patients lessons on how the well off get high. Not everyone can afford to shoot coke, ya know. He had already been to fifteen rehab clinics. The first time I talked to him he wanted me to know that he'd be partying in Bourbon Street the night he got out. There's no way his obsession got past his therapists...

Yet The Kid was medically approved by the clinic to leave after 30 days. Clark was told to stay for five weeks. Clark talked about nothing but the loss that his drinking addiction had wrought him... his wife, his oldest daughter, his job... and how much he wanted to start over, while The Kid's eyes would glow when he talked about the taste of cocaine under the tongue during the blood rush after injection. But The Kid was ready to enter the real world, according to the professional staff, but Clark wasn't... Clark needed seven more days. Besides, his insurance would cover it.

Clark was pissed too. He knew it was about insurance. In his quiet way, he raged against the staff. He had recommended Dennis for the "scholarship" that the clinical staff brings up whenever patients cite insurance as a reason why some people stay a week and others a month and a half.

"If we feel that a patient is not ready for discharge and his insurance hasn't approved additional coverage, we'll keep the patient at no cost to him and attempt to recover insurance cost later," is what my main boss - who's never introduced herself to me - often tells patients during group sessions.

Dennis was about forty, coming in from DC with a crack habit. He was about the friendliest man I've met at the clinic. I thanked him at least once for always being positive, always saying "hey!" and patting me on the back as I walked by. He was a reliable smile in a sea of depression. His spirituality kept him afloat.

But his insurance ran out after eleven days. I didn't even get to say goodbye.

Apparently, under the strictest professional guidelines, a poor black crack addict from the hood can be cured from his addiction in a quarter the time as a middle-class white salesman from a nice suburb on Lake Michigan.

Funny how things work out like that.