I have a feeding tube and a medical prescription for real food because my body can’t tolerate the usual enteral formulas. I have been carried by Lincare.   A few weeks ago, I was advised by Lincare that they were no longer going to carry the product as it was not profitable. It was suggested that I could use Liquid Hope which is a vegan certified organic product. I ordered a sample and had no problems with it. When I tried to obtain it a host of problems surfaced. First, getting an appointment to get a new prescription. The producer of the product told me it would take 60-90 days to process my insurance because they use volunteers. I am totally dependent on the use of the feeding tube and access to a product I can consume. I could not accept starving for that length of time. I was told, “It’s a first come first serve basis.” I could order the product and pay out of pocket. It would cost me a good $1000/mo.   I am on social security and can’t afford that price. I then tried to find a supplier who could bill insurance earlier. I ended up calling around to everyone I could only to discover that I live in a Competitive bid area and the supplier could not send me the product because of my zip code. I called Medicare trying to get help and a staff person there called around to find someone who might have the product only to discover they did not have it or they could not provide because of the zip code. I did find Option 1 who wanted to help but could not because of the Competitive bid. I called Colorado State Infusion             who told me they lose $60 on a 24 packet box and can’t afford to carry the product.  Insurance reimbursement is so low. In short, the one supplier who was willing to help me couldn’t because of my zip code. Lincare does not want to carry the product nor does any of the others seeking high profit. I realize I along with others are in the minority in terms of product need because of physical/ medical intolerance of the usual formulas. The question is will Liquid Hope and REALFOOD be able to survive as providers and be shut out of supplying to people in need because of a Competitive bid designation by zip code. This is one of the most absurd things I have experienced in the health care arena where people are leaving out the word CARE simply for profit making. I had starved six weeks waiting for surgery. Then after surgery, my food was backing up into my esophagus and I had to be referred to a specialist to determine if I should have another surgery. Another eight weeks for another surgery and eight more weeks for healing. I am tired of starving. Wouldn’t you and anyone else be? I wanted to take Liquid Hope because it has more calories and protein.   How can you help deal with this overwhelming problem that patients in need confront?

I understand there is a Medicare guideline governing suppliers. “If the contract supplier does not ordinarily furnish the specific brand or mode of delivery and cannot obtain a revised prescription or locate another contract supplier that will furnish the needed item, the contract supplier must furnish the item as prescribed” (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/DME_Ref_Agt_Factsheet_ICN900927.pdf

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For years I struggled difficulty swallowing. After consulting a GI it was suggested that I have a feeding tube. I was told “you can do this and get on with your life.” It wasn’t the life I wanted so I decided to try acupuncture. I had been throwing up repeatedly and getting dehydrated. No one could tell me how to overcome this. My thought was there is one man on the planet who might help. That man was Kharta Purta Singh. I got on the internet and found him in Oregon. I did a telephone consultation with him and he told me which herbs to purchase. I did and the throwing up ceased. Amazing! I started acupuncture and managed to eat for about eight years. This was an expensive route to take, because insurance does not cover this type of treatment. It worked up until about a year ago when I began having severe choking episodes, blurred vision, elevated blood pressure etc. I had to succumb to having a feeding tube. As it turned out, I starved for about six weeks waiting for surgery. Feeding tube in and more hurdles to jump. I had to prove I needed real food as my body would not tolerate the formulas that are promoted by Western medicine and suppliers are willing to provide because they are profit makers. Finally proved I needed real food. Someone was willing to be a supplier until recently when they decided it was not profitable and took up warehouse space. Even having REALFOOD, it was not working for me because the food would back up into my esophagus— more choking. All of this meant I would have to be tested for motility. Finally got the motility test which demonstrated I had severe acid reflux and could benefit from another surgery. The doc involved took off to Hawaii for a vacation failing to make the referral. Finally got the referral. Wait for an appointment, then wait for a date when the surgery could be done. More starving. What a dreadful journey. When I hear someone say, “I’m starved.” I can only reflect — you don’t know what you’re talking about.

There is a positive in all of this and that is the discovery of Liquid Hope, a vegan certified organic product. This company was started by a woman whose father had a swallow problem. It is good to discover people who are guided to do good in the world by providing real nutrition. It’s not all about the money. For anyone out there with this dilemma, there is Liquid Hope.

A medical helicopter can be dispatched to a scene that is in no way designed for safe landing.     Most helicopter accidents seem to occur between 10 p.m. and 6 a.m. in low visibility conditions and at a time when fatigue can certainly play a significant role. These variables definitely combine to create a deadly combination. So a pilot most likely needs specialized equipment to assist in the navigation process. Night goggles, terrain sensing equipment, radar altimeters can definitely help. The big obstacle has been expense and availability.   The military has first priority for night goggles.   Pilot training is expensive as well. With the new rules mandate, how are hospitals going to finance an already expensive operation? Accidents are costly. How will the industry cope with the new demands?

The FAA would like to see the culture of the industry changed. It has proposed changing the terminology of “helicopter EMS” to “helicopter air ambulance” to try to eliminate the reference to “emergency.” I really don’t see how this would make a difference. The word “ambulance” is definitely associated with the concept of “emergency.” Pilots, nurses, hospital administrators and the public know well that this is a vehicle that has been dispatched to an emergency. It is the same as denying the sirens of the fire trucks are not signaling an emergency as they race down the street.  Care to comment?