Would it surprise anyone to learn that drug use is widespread among hospital employees? I think not. There is even a new TV show called Nurse Jackie, whose main character played by Edie Falco, is clearly addicted to prescription drugs and trades sex for drugs with the hospital pharmacist. The creators of the show have made the Nurse Jackie character the most competent person in the show's fictional hospital. That's all well and good when it comes to creating an edgy adult TV drama, but not in the real world. Real addicts are only competent in their own minds.

Meet Nurse Melony.

According to a recent Los Angeles Times article exposing the failure of the California Nursing Board Drug Diversion Program to protect us from nurses on drugs, Nurse Melony Currier is a poster child for nurses on drugs. In one episode, Nurse Melony passed out in her car the morning of her second day on a new job at Starpoint Surgery Center in Studio City, California. Once awakened, she was escorted to a drug-testing facility to provide a urine sample. In the restroom, she injected an anesthetic she had stolen from the surgery center, according to state records and a Starpoint official. Currier had failed repeatedly -- and spectacularly -- at rehabilitation. Over 4 1/2 years, she'd been discovered high in her car at a Hollywood hospital, stolen anesthetics at a San Gabriel Valley hospital, been convicted of burglary after taking more drugs from the same hospital and flunked a drug test.

Melony Currier first landed in trouble on Nov. 8, 2001, when she was arrested for stealing Demerol from Providence St. Joseph Medical Center in Burbank, CA. (She later told board investigators that she'd stolen drugs every day for months.) Nearly two weeks after her arrest, while working at Planned Parenthood in Van Nuys, she was found collapsed in the bathroom, injecting herself with the general anesthetic propofol - the stuff that killed Michael Jackson. Two days after that, she returned to Providence St. Joseph and stole more of the drug, board documents say. She was later convicted of misdemeanor theft in the Van Nuys case and petty theft and drug possession in the Burbank case.

Currier, then known by the last name Dietrich, was allowed into the California Nursing drug diversion program in February 2002, The program finally expelled her in 2006 -- after the five relapses. A month after Currier was ejected, according to board documents, she went to Providence St. Joseph, where she'd been arrested five years earlier. Posing as an employee, she said she'd come to collect drugs for outpatient surgery. When questioned, she "fled," board records say, driving 10 miles to Verdugo Hills Hospital in Glendale. Again posing as an employee, she stole two cases of propofol, according to court and board records. Two days later, on Oct. 18, 2006, Currier was arrested when she returned to Verdugo Hills for more.

The California nursing board filed a public accusation against Currier in March 2007-- nearly 5 1/2 years after the agency first learned of her drug problems. When the board settled the case in 2008, Currier's license was suspended for one year and she was put on probation. As part of the settlement, she admitted the allegations. Currier is now free to practice nursing with restrictions.

She may stay off drugs, but it seems unlikely. How many more patients will have to suffer because of Nurse Melony and others like her?

An external insulin infusion pump is an FDA approved mechanical device used to deliver insulin to manage diabetes mellitus. The pump is about the size of a deck of cards, weighs about 3 ounces, and can be worn on a belt or in a pocket. It contains a cartridge reservoir filled with fast acting insulin. The pump connects to narrow flexible plastic tubing that ends with a needle inserted just under the skin near the abdomen. Users set the pump to give a steady trickle or "basal" amount of insulin continuously throughout the day. Pumps also release additional ("bolus") doses of insulin at meals and at times when blood sugar is too high based on user input. Frequent blood glucose monitoring is essential to determine insulin dosages and to ensure that insulin is delivered appropriately.

Private insurance companies as well as Medicare will pay for infusion pumps as medically necessary for patients with documented diabetes mellitus meeting all the following criteria:

1. Has been seen by their medical provider four times within the last year; and


2. Completed a comprehensive diabetes education program within the past two years; and


3. Follows a program of multiple daily injections of insulin; and


4. Has frequent self-adjustments of insulin doses for the past 6 months; and


5. Has documented frequency of glucose self-testing an average of at least 4 times per day during the past month; and


6. Has documentation of any of the following while on a multiple daily injection regimen:




a. lycosylated hemoglobin level (HbAlc) 7.0 percent; or
b. "Brittle" diabetes mellitus with recurrent episodes of diabetic ketoacidosis, hypoglycemia or both, resulting in recurrent and/or prolonged hospitalization; or
c. History of recurring hypoglycemia or severe glycemic excursions; or
d. Wide fluctuations in blood glucose before mealtime; or
e. "Dawn phenomenon" with fasting blood sugars frequently exceeding 200 mg/dl.
f. Pre- conception or pregnancy to reduce the incidence of fetal mortality or anomaly; or
g. The patient with diabetes mellitus successfully using a continuous insulin infusion pump prior to enrollment in a new health insurance plan has documented frequency of glucose self-testing on average of at least 4 times per day during the month prior to enrollment

Here's the insurance company's rationale:

"External subcutaneous insulin infusion pumps are considered medically necessary only for people who have demonstrated the ability and commitment to engage in a regimen of pump care, frequent self-monitoring of blood glucose and careful attention to diet and exercise.

The pump must be ordered by and follow-up care of the member must be managed by a physician with experience managing persons with insulin infusion pumps and who works closely with a team including nurses, diabetic educators and dieticians who are knowledgeable in the use of insulin infusion pumps.

Documentation of continued medical necessity of the external insulin infusion pump requires that the member be seen and evaluated by the treating physician at least every 6 months.

Some external insulin infusion pumps are able to take results of the blood glucose reading, calculate the appropriate insulin infusion rate, wirelessly transmit the results from the blood blucose monitor to the pump, and automatically adjust the insulin infusion rate, saving the member some extra steps. These insulin pump features, when present, are considered integral to the external insulin infusion pump and blood glucose monitor."

I think medical bankruptcy is more a reflection of middle-class financial immaturity than it is an indictment of our health care system. OK Calm down for a minute. Hear me out.

According to the popular media, middle-class American families, most with private health insurance, are being forced into bankruptcy because of their medical bills. For instance, a CNN.com article called, Medical bills prompt more than 60 percent of U.S. bankruptcies. makes the following points: more than 60 percent of bankruptcies are linked to medical bills, and three-quarters of people with a medically-related bankruptcy had health insurance. There have been scores of stories like this in the past month based on the Himmelstein, Harvard University study. The story alarms us because most of us consider ourselves to be middle-class and most of us have health insurance. We thought we were protected from medical catastrophe. Many supporters of a single-payer government health plan say this story supports their case for government health insurance.

The following story is fictional, but conforms to the statistical facts of the Harvard study.

A year ago John and his wife, Ronnie, earned a combined $85,000 yearly. Living in high-priced Nassau County, NY, they barely considered themselves middle-class. They pretty much lived from paycheck to paycheck. Shortly after Ronnie was diagnosed with breast cancer, she had to quit her job. The family now has to make do on John's income of $60,000 per year. He didn't want to worry her, so he used their credit cards to pay bills. Now, John is running out of money and credit. He can't pay all his bills. He has to prioritize. At the top of the list go those bills with obvious consequences for nonpayment. Paying the mortgage is obviously a high priority. Don't pay and the bank will foreclose and take away the family home. He's seen it happen to a neighbor. Likewise, his car can be repossessed. The utilities can be turned off. The consequences of not paying his medical bills are not so obvious, so those bills go to the bottom of the list. He can rationalize not paying. He tells himself, "Doctors are rich. Why should I give them my last dollar? Besides, my insurance company has already paid most of the bill anyway. Can't they let me off the hook for the balance?" But John is surprised by how aggressive the doctors and hospitals are at collecting what he owes. His daughter's pediatrician has even filed in Small Claims Court to recover a lousy $210. Even so, John can't pay, so he goes into survival mode - paying the essentials and everything else will have to wait. Finally, the pressure from the constant phone calls and collection notices becomes overwhelming and John and Ronnie file for bankruptcy to get protection from their creditors and to try to save their home.

If John and Ronnie had been part of the sample group in the Harvard study, they would have been categorized as a "major" medical bankruptcy case. Major meaning that medical debt was the primary cause of the personal bankruptcy filing. John's total debt excluding his mortgage was just over $75,000 at the time of filing for bankruptcy. Yet, his medical debt was less than $10,000, (typical of the Harvard study), only 13% of his total debt. His health insurance covered over $80,000 in medical expenses and prescription drug claims for his wife and daughter in the year previous to his filing for bankruptcy.

The biggest cause of John and Ronnie's financial troubles was the loss of income from Ronnie's job because of her illness. There is state disability insurance. New York State made short-term disability payments of $170 per week for 26 weeks (total benefit of $4,420) and that helped, but not enough. While Ronnie has recovered from surgery and radiation treatments, it will be some time before she is ready to work again.

What if John and Ronnie had been covered by a single-payer government health insurance plan like Medicare? Would they have been better off? Yes, a little better. As Medicare patients, they would have had less out of pocket medical costs due to a smaller deductible than their private plan. But it would not have made a significant difference. It would not have saved them from medical bankruptcy. In fact, a large percentage of those listing medical debt as the reason for their bankruptcy are over 65. These people are already on a single-payer government health insurance plan called Medicare.

The message of the cautionary tale of John and Ronnie is not about health insurance but about personal responsibility. Nobody wants to hear it, but here it is. The government is not going to save us from financial ruin, even if it's caused by illness. It is our responsibility to spend less than we make and save for a rainy day. Sorry. No government bailout for us