I’m going to weigh in on the trial of Michael Jackson’s doctor even though I have not been watching  it.

My opinion is pretty simple: Doctors who prescribe benzodiazapenes or opiates without at least ASKING a patient about their drug an alcohol use are reckless. Doctors who prescribe benzodiazapenes or opiates to a patient whom they KNOW to be an addict or alcoholic are not only breaking their “First, do no harm,” vow but are also criminally negligent (unless they have set up a medication treatment protocol that involves very strict monitoring).

This is a phenomenon that really torques me. I write and talk about it whenever I can. If I had a buck for all the alcoholics and addicts who got a ‘script for a benzo’ or a doctor who either didn’t bother to ask about their drug/alcohol use or wrote the script knowing they were addicts or alcoholics, I would be a very, very wealthy woman.

Here is one of my favorite stories: I know a woman who was in a treatment center. During some very intense therapy she began having a severe anxiety attack. She was taken to the emergency room. After she was stabilized the doctor began writing her a prescription for Xanax – knowing that she had come directly from a treatment center and that she was a newly recovered alcoholic.

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“Brace yourself,” she said.

It seemed like any other Friday morning. I went to the gym, took Dog to the park, made lunch and drove to work. I parked in the same spot. Swiped my security card at the same door and said “Mornin’” like I do every morning.

My co-worker, Carol looked like she had been crying.

“Layoffs.”

Three in my department – 24 overall.

The layoffs and buyouts began at my company about three years ago. The company has offered generous severance packages and had always let us know when layoffs were looming. Not this time. Although they still offered generous severance packages, we had no warning.

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Vacation.

I have been on vacation.  A vacation without cellphones, wifi or even my watch. The kind of vacation where time stands still and you forget what day it is. I slept until my body told me to wake up. I fell asleep when it got dark because at 39-degrees and 10,000 feet, up in the mountains where the mountain lions roam, there is not a lot to do after dark but talk, sleep and pray that the mountain lions and bears have full tummies.

I did not read a newspaper or listen to any news. I stopped to say “hello” to every dog that crossed my path and ate jerky. I stomped around in streams, up to my thighs in clean, cold water attempting to fly-fish.

I paid attention to my mood. Uptight at the airport – trying to figure out what I had forgotten. Negotiating for an upgrade on the rental car, trip to WalMart for camping supplies and provisions.

Finally, we fished.

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I subscribe to some really strange electronic newsletters. I don’t know why, except they are free and usually on topics that have absolutely nothing to do with my life – like one on military immunizations I subscribed to after the anthrax scare.

My latest is a newsletter from the Federal Firearms Licensee Information Service, a division of the federal Bureau of Alcohol, Tobacco, Firearms and Explosive at the U.S. Justice Department.

I find the bureau’s activities fascinating. It’s like the folks in Washington decided to create one agency to regulate the most dangerous and controversial substances on the planet! Alcohol, tobacco, firearms and explosives. One-stop shopping for true crime television producers!

Anyway, the lead article in the September issue of the FFLIS newsletter is called,”Adjudicated Mentally Defective” and it’s all about the federal laws governing possession of firearms by the “mentally defective” and how to get your gun rights restored if you are ever declared “mentally defective.” I’m not a big fans of firearms but you put the words “mentally defective” and “firearms” in the same sentence and I’m interested.

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Way back in the 1970′s, when I was a teenager, the only depression we knew about was the one in 1929 that made our parents and grandparents tightwads. Back then, teenagers with depression either hid it (like I did), self-medicated (like I did) or were loners – kids who did not fit in.

So when I heard a local couple who had lost their son to bipolar was underwriting Johns Hopkins’ ADAP program at local schools, I had to ask…”What if this had been around when I was in high school?”

The Adolescent Depression Awareness Program is brilliantly simple. It’s common sense at its finest. ADAP provides teachers with a curriculum to use on on how to teach their students about depression.“Through education we will increase awareness about depression and the need for evaluation and treatment.”

• Interactive lectures and discussions
• Video of teenagers describing their experiences with depression and bipolar disorder
• Homework and video assignments to reinforce key points
• Group interactive activities to teach the key message that depression is a common, treatable, medical illness.

This should not be controversial but teaching teens anything about their health can be absurdly controversial. Just say the word”condom” in in some parts of the country and you’re just asking for an inquisition by the PTA.

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There are some truly annoying people in the world. Among the biggest jerks are those who refuse to believe that mental illnesses are real. I know one of these folks. He’s a control freak. He’s right. Always right. It’s his way or the highway. There is no telling him – or even suggesting to him – anything. I think the reason I find him so annoying is that is used to be a lot like him. A lot.

Then I fell into a deep depression. One of the few – maybe the only thing about hitting bottom – is that it gives you an open mind. You can no longer hang onto your humongous ego. The harder you try, the more it hurts. As you are holding on with a death grip, you become even more annoying and controlling. You’re not just right about everything, you win every argument and then spike your opponent’s opinion in the end zone while doing a little happy dance.

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I know it’s only September but I think it’s safe to say that Blue Cross and Blue Shield is the undisputed winner of the 2011 If-At-First-You-Don’t-Succeed  Award.

After losing the decades-old mental health parity battle with the passage of the Mental Health Parity and Addiction Equity Act in 2008, Blue Cross and Blue Shield has orchestrated a very clever end run around the new law.

Here in Florida, it will work like this: As of Nov. 30, BCBSF will cancel is contracts with mental health care providers and switch to a new managed care vendor – New Directions Behavioral Health of Kansas City, Missouri. Providers – psychologists and mental health counselors – will have to decide if they want to sign a contract with New Directions in order to continue treating their Blue-Cross insured patients.

This may look like nothing more than common-sense corporate housekeeping but it is shaping up to become a devious scheme to deny mentally ill patients the treatment they are legally entitled to under the new parity law.  Here’s the rub: in some cases New Directions is paying counselors 30 percent less than Blue Cross for the same services.

Here’s what puzzles me: How can New Directions claim its reimbursement rates are “usual and customary” when BCBSF was paying mental health providers 30 percent more for the same services? Whose “usual and customary” rates are we supposed to believe? New Directions or BCBSF?

You could argue that New Directions’ “usual and customary” data are more accurate because the company specializes in mental health case management. I might even believe that except for one little problem: Blue Cross and Blue Shield and New Directions are partners.

This seems a little sketchy, doesn’t it? Especially when you consider that BCBSF sent out notification letters earlier this summer and gave providers between 15-30 days to sign on with New Directions. What’s the rush? Connie Galietti, executive director of the Florida Psychological Association, expressed the same concern, along with five other disturbing requirements in the contract, in her Aug. 10 letter to Kevin McCarty, Florida’s insurance commissioner, and Jeff Atwater, the state’s Chief Financial Officer.

“We are concerned that this short time frame is designed to scare psychologists into jumping quickly to accept the unfavorable new ND contract before they have had time to consider its significant implications. The contract, with attachments, is 28 pages long.”

The FPA asked the the regulators to order BCBSF and New Directions to give Florida psychologists 30 more days to make their decisions. The FPA also suggested that BCBSF’s new mental health claims process violates the Mental Health Parity Law “because these substantive and/or unusual changes are being applied to BCBS’ mental health services but not its medical or surgical services.”

In response, the insurance commission’s office had a discussion with BCBSF. The insurance company said it did not intend to enforce the 15-day deadline. However, a new deadline was not given, leaving providers up in the air.

As for reimbursements rates and assurance that there will enough providers in a given area, BCBSF “has robust standards to ensure that reimbursement rates and numbers of participating providers will be adequate,” according to the commissioner’s office.

Finally, the commission passed the buck on the alleged parity violation: “BCBSF states it is reviewing the matter with its outside counsel to ensure compliance with federal law. I will note that the office of insurance regulation has no jurisdiction with respect to enforcement of federal law.”

True, but the commissioner certainly could have referred the matter to the Justice Department. Of course that would be asking a lot of a politician. We should know by now that politics and insurance don’t mix.

Photo by Hannaford, available under a Creative Commons attribution license.

I think the people who set the prices for my medications are the same folks who decided Michael Vick should be paid $100 million for playing football.

I took a look at the actual price of my antidepressants and mood stabilizer yesterday and about passed out. Over $1,000 for a  3-month supply of my medications. You’re probably wondering how that amount of money could have slipped by a coupon-clipping, single-mom with a kid in college. Well, I am one of the most blessed people on the planet. I have medical insurance. Really good medical insurance with prescription drug coverage (God bless my employer).

I have this amazing prescription program for maintenance drugs – everything from birth control pills to Lipitor and, yes, antidepressants, anti-psychotics and mood stabilizers. I get a 3-month supply of generics for $30 and brand-name drugs for $60. Doesn’t matter which drug. They are all $30 for 3-months of generics and $60 for 3 months of brand name.

I know. It is an obscenely good deal and I am blessed – truly blessed – to have this benefit. I will be the first to tell you that until the other day, when I looked at the actual receipt, I took this benefit for granted. I’ve been getting this deal for so long that I just open the package when it comes in the mail and toss the paperwork in a folder in my files.

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Last Saturday I celebrated 13 years of sobriety. Whodathot? Thirteen years. It sounds strange coming out of my mouth. Thirteen years.

I don’t miss alcohol or drugs. I don’t even think about alcohol or drugs anymore. I don’t miss the taste. I don’t miss cooking without it. And I definitely don’t miss the hangovers. Just conjuring up the memory of a hangover is enough to keep me sober.

I drank a lot. I drank wine, beer, vodka gimlets, Long Island iced teas and anything with a little paper umbrella in it. I loved to drink. I even trained my dog to jump up and grab a lime from my lime tree when I popped open a Corona. She was a great dog – the best drinking buddy ever. If only she had been able to drive…

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My mother was not a particularly happy person. She worked very, very hard. She was a devoted mother, dutiful wife and she fulfilled her responsibilities in a state of resignation.

I am not a doctor but I believe she suffered from dysthymia – chronic, low-grade depression. Just before she died, during one of our many conversations in her room at hospice she said something that guides my life: “I just wanted for you kids to be happy.”

Happy.

I thought about this yesterday after my conversation with a woman who has been verbally abused by her husband for years. She is not happy. She has been so unhappy for so long that she has come to believe that happiness is not important.  Happiness is not a goal for her. She values discipline, commitment, hard work, responsibility and respect above happiness.

“I don’t believe in my heart that happiness is necessary,” she said.

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