Vasectomies

[Lily Dalke]

Does anyone know where to refer partners who are interested in finding out more about vasectomy? Do you just have them make an appointment with adult med or is there a more direct way of getting them a consult?

[Lily Dalke]

Great info from Mimi:

hi Lily,

I honestly don't know how to post this to the group from work so please feel free to do so...

In my humble opinion, the main issue for vasectomies - is ... INSURANCE.

If they have insurance...they should seek out a private medical doctor (why come to WH?!!? and wait 2-3 months for appt??)

If they are determined to come to WH - you could refer to urology or surgery.

the cost is between 600-1500 dollars (That's an educated guess)

IF they have HHC Options (which is what most of our migrant women qualify for) - the services that they can apply for have to be considered 'essential medical services' - whether  vasectomy is considered 'essential' is arguable.  Most of partners of our women rarely have insurance or HHC Options.

Insurance is a topic that many of us don't learn about - yet it is so important to the care we can offer our ladies, since it sets the boundaries on what we can offer (unless the woman is willing to pay out of pocket). You can always check micromedex for prices if you are not sure and you are prescribing something that is NOT formulary.

There have been a few incidents at MIC were prescriptions have been written for women with HHC options that cannot be filled by our pharmacy.  HHC options gives them access to Formulary MEds ONLY.  if you want to prescribe Non-formulary - that's fine - but let them know they will probably have to pay a large out of pocket expense and have it filled at a private pharmacy.  So sometimes, what is written on up to date - is not always available to them.  We don't generally have access to the most up to date, treatment and services, as I am sure you are learning, we make do with what we have.

At MIC (I have been working there for close to 3 years ) we did give out contraception and vitamins.  It was part of a large grant that was administered to the clinic by the independent public health services organization called Public Health Solutions.

I never did TCA in the clinic (maybe Martha or Liz??) but that may have been from the prior Wycoff OB service.

I do not offer routine HepB vaccine to all patients - only high risk or health caregivers (we have many home attendants who should be offered this) - so I cannot offer you a rationale for offering it everyone.

We can administer only what is available parstock - meaning what is in the cabinet. 

For the reasons mentioned above, we don't have access to non-formulary medication. It is just not an option. Where would you order it from? And who would pay for it?  I always ask myself that question - can they pay for this? can they afford this? I ask them that question if it is anything that is outside of the WH frame of reference.

 

for EPT - you may print out another prescription - you can hit renew.  despite what Salikram says - a pregnant woman - should be treated before she leaves our clinic.  That is also suggested by the DOH.  Dont let her boss you - she is not looking out for the best interest of our women - most of the times and is just wielding some imaginary sense of power.  Afterall - why is she guarding the medications?? If we need more meds - Ellison is the one to inform - so she can order more.

 

Or use your personal RX pad - you dont need to know the partners name or DOB - 

on the RX (under her name) you write EPT or "Expedited Partner Therapy as per DOH".  

Should be no problem.  Don't always believe women who say "he couldnt get it filled" or "they said it was under my name so they wouldnt fill it".  In NYS, we are strongly encouraged to give EPT in the interest of the protecting the greater good and it is considered the standard of care. It is not required by law, but what the law does is exempt us from any liability for prescribing for someone who we are not providing direct patient care to.

 

Here is the DOH link to information regarding this service.

http://www.nyc.gov/html/doh/html/living/ept.shtml

I am sure that doesn't answer all your questions. but it is a long learning process - I am still figuring things out and am happy to share it with anyone else. Public healthcare options are minimal - that is essentially what ACA/Obamacare will do.. to some extent, for legal documented persons --- doesn't really change things much for our migrant women and families... they are still stuck in the same crappy situation ;)