• Joey Lee winces when he thinks about the future •
• so does the doctor who manages his pain •
He leaves his South Scranton apartment just once a month, to visit Pain Management Consultants, P.C., at Allied Services on the Morgan Highway, where Dr. Debra DeAngelo, D.O., maintains the intrathecal pump that frees Mr. Lee from the agony that once chained him to his bed.
Implanted in his abdomen, the pump delivers morphine and clonidine, an anti-spasm drug, directly into Mr. Lee's spinal fluid. It must be filled every 22 days, and Pain Management Consultants is the only practice in Scranton that offers the service.
Faced with a potential 100 percent increase in her malpractice insurance in February, Dr. DeAngelo, 36, says she doesn't know how much longer she can hold on.
"I'll never forget when she told me my next appointment could be my last," Mr. Lee says. "It sent a chill down my spine. I thought, 'What am I going to do?' I can't even think about it. I can't deal with it." In February 1992, Mr. Lee was a counselor at the East Mountain campus of Friendship House, a family services center where he specialized in helping troubled youths. A fight broke out and he got caught in the middle.
Crippled in both knees, he was treated with a steroid he says led to the development of vascular necrosis. The same condition that killed the career of baseball and football great Bo Jackson, the disease cuts off blood flow to the bone marrow, choking it to death.
An attempt to replace the dead bone with grafts resulted in years of painful rehabilitation, a long string of dead-end examinations by baffled and frustrated doctors and, finally, a diagnosis of RSD.
The disease is progressive, and has invaded every corner of Mr. Lee's body. Even the slightest stimuli can cause him excruciating pain. A summer breeze rakes his skin with talons of heat. Raindrops feel like red-hot rivets.
Initially, Mr. Lee took his pain medication orally, but because it had to travel through his digestive system to work, he was required to take massive doses that left him barely conscious much of the time.
He eventually moved to an external pump that fed medication through a shunt in his chest, but a staph infection took away that option last year. His intrathecal pump was implanted soon after.
"It changed everything," Mr. Lee says. "This is the best I've ever felt." All of that will change, he says, if Dr. DeAngelo packs up her shingle and leaves the state. There are a few doctors in the Wilkes-Barre area that work with intrathecal pumps, but Mr. Lee isn't sure he could handle the travel.
Even if he could, Dr. DeAngelo says there's no guarantee another physician would accept Mr. Lee or the dozen other intrathecal patients Pain Management Consultants treats.
"The problem with pumps is that doctors don't like to take on other people's pumps," Dr. DeAngelo says, explaining that such patients are often taking highly addictive medications that can be abused. Doctors who haven't been with the patients from the beginning have a hard time trusting them.
"We don't accept outside pumps," Dr. DeAngelo adds.
And Pain Management Consultants recently stopped accepting new patients.
"There's no sense taking on chronic pain patients if you're not sure you're going to be around to treat them," Dr. DeAngelo says with a shrug.
Dr. DeAngelo says she and her husband, Dr. Nicholas A. DeAngelo, D.O., pay more than $50,000 a year for malpractice insurance. The practice has taken in roughly $800,000 so far this year, she says, but it pays about $810,000 on payroll and medical supplies annually, she says.
When the policy expires early next year, Dr. DeAngelo says she and her husband face as much as a 100 percent premium increase. If the malpractice insurance premium doubles, it would make the practice unprofitable, she says.
"There's just no way we can pay that," she says, pointing to former colleague Brian Holmes, a neurosurgeon who left Scranton for Hagerstown, Md., where he now pays $14,000 a year for his insurance.
She and her husband are thinking about following Dr. Holmes to Maryland, Dr. DeAngelo says, "but I don't want to read another story about doctors, doctors, doctors. I want to see a story about the patients who won't be able to get treatment and the staff people who are going to lose their jobs." Dr. DeAngelo fights back tears when she talks about the people who work for her.
Office manager Beth Ebersol has been with the practice since it opened in February 2000. So has nurse Lee Gonzalez. Her mother, Judy McDonald, has been a nurse at the practice for two years.
Another nurse, Margie Morris, came on board a year and a half ago.
Debbie Brzozowski, who handles billing, joined the team in March 2001. Kim Mecca was added to the office staff last July. Staffer Laura Keiper, transcriptionist Judy Dombrowski and X-ray technician Nancy Nash have been with the practice just three months.
"This is my family," Dr. DeAngelo says. "If I leave, they're coming with me." But Joey Lee, and more than 1,000 other Pain Management Consultants patients, will be left behind. If he can't find another doctor to maintain his intrathecal pump, he will have to go back to taking oral medication. For every milligram of morphine he gets from the pump, he will have to take 300 milligrams orally.
"I'll be a zombie," he says, shaking his head. "I'm not going back to a bedridden state. I can't live like that. I just can't."
http://www.joeylee.com