This blog is posted on behalf of AADE Advocacy Committee Member Lisa Laird. Lisa serves as the Inpatient Diabetes Care Coordinator at the Lankenau Medical Center in Wynnewood Pennsylvania. She is active in state and federal advocacy. Lisa and her husband have three adult children with type 1 diabetes and a fourth child with the genetic predisposition to possibly get type 1. Empathy and advocacy are a natural extension of life with diabetes.
Kevin Houdeshell of Sheffield Lake Ohio, died at age 36 on January 8, 2014. The details of his last days are not complete. His parents, Dan and Judy Houdeshell, work through their grief tirelessly helping prevent this tragedy from happening in any other family affected by diabetes.
Kevin ran out of insulin on December 31, 2013 for the first time as his father Dan recalls. Kevin approached the pharmacy for a refill, but the prescription had expired. Because of the holidays, and through repeated attempts, Kevin could not contact his primary care physician who managed his diabetes since diagnosis nine years before. It is thought that Kevin had Latent Autoimmune Diabetes (LADA). This autoimmune disease leaves the patient dependent on insulin for life. Kevin’s A1C ranged from 7-9%. His father wanted him to see an endocrinologist, but Kevin wanted to stay where he was for care.
Like Pennsylvania, Ohio had provision to dispense 72 hours of medication in some situations, but the authority to dispense drugs on an expired prescription was not explicitly part of Ohio law. Kevin was left without any insulin and died nine days later.
Kevin was a bar manager of a TGI Fridays and was employed there 18 years. He was a graduate of the University of Cincinnati and an avid Cleveland sports fan. When he presented at work with flu-like symptoms, he was sent home. He refused visits from friends fearing he would give them the flu. How many of us in practice see Diabetic Ketoacidosis (DKA) on a daily basis? How many of us endlessly teach signs and symptoms to patients, families and friends? @Beyondtype1 has a national campaign underway to increase awareness. The problem arises when cognitive impairment occurs during sickness. At this time, no one is expected to make the right or best decision in his or her care. We know children and adults die in DKA when left untreated or treatment arrives too late to reverse the severe acidosis.
We don’t know why Kevin didn’t seek emergency medical help, both after the denial of prescription refill and when he presented with symptoms. We don’t know what education he received regarding his chronic disease. What we do know is we can work to remove the threat of an expired prescription from the potential demise of anyone with diabetes.
Empowering Pharmacists
Pharmacists have an oath: ‘To consider the welfare of humanity and relief of human suffering my primary concern.”
Improving access to insulin has become a priority to the Houdeshell family to honor their son and brother. Their push for legislative changes heralded House Bill 188, signed by Ohio Gov. John Kasich in December 2015, effective March 2016. The bill was crafted by State Senator Gayle Manning and State Senator David Burke, a pharmacist. The law allows for certain medications related to diabetes, asthma and heart disease to be filled by a pharmacist if a customer has made reasonable attempts to contact their physician without success. Florida has joined this movement with HB 941 signed into law April 14, 2016.
Pennsylvania Action
In 2017, State Senator Patrick Browne and State Rep Ryan Mackenzie introduced emergency prescription refill legislation in the Pennsylvania state senate and house respectively. Members of the diabetes community, including many diabetes educators, worked to build support for this legislation by meeting with legislators, sending letters, and making phone calls. This legislation passed in February 2018 and was signed into law by Governor Patrick Wolf. Click here to learn more about this bill, including the advocacy efforts surrounding its passage.
In addition to OH and PA, a number of other states have taken action to pass some version of Kevin’s law:
- Ohio
- Florida
- Arkansas
- Arizona
- Wisconsin
- Washington State
- Illinois
- Idaho
- Michigan
- California
- Tennessee
- Montana
- Pennsylvania
Other states, like Colorado, Oklahoma, Kentucky, and South Carolina, are working to follow suit. If your state is not on the list, this may provide an opportunity to take at look at your state laws and speak to other stakeholders in your state like legislators, patient advocacy groups, and other diabetes organizations to bring about a change in the law.
Photo: Kevin Houdeshell
Kevin wrote this in a high school English class saved by his mother:
“Live your life in the present like every day is your last. This is all about leaving your mark. To leave this world knowing we’ve made a difference, knowing that we will be remembered.”
With respect and deepest sympathy to the Houdeshell family,
Lisa Laird RN, BSN, CDE, FAADE
AADE National Advocacy Committee Member
PA AADE Coordinating Body
Laird.lisa@gmail.com