State law in Ct.

[jnk]

Polysomning, you've made it onto my "good'uns" list

Well deserved.


And, of course, my position statement and recommendations on the whole RT-beliefs matter is already on the record:

viewtopic.php?f=1&t=39644&p=347923#p347923

More proof that I often fail to listen to myself.

[rested gal]

Polysomning, you've made it onto my "good'uns" list

Well deserved.

I was quite sure you'd think so, Jeff.

And, of course, my position statement and recommendations on the whole RT-beliefs matter is already on the record:

viewtopic.php?f=1&t=39644&p=347923#p347923

My response is the same now, as it was then...

ROTFL, jnk! You created a classic!

More proof that I often fail to listen to myself.

Love your sense of humor.

[kempo]

At some point, I can see where the technology will be so intuitive that prescriptions should only be needed for insurance coverage.
--like glucose meters.
(or insurance will simply not cover it)

If you didn't have to have a prescription for an xpap or mask you could buy them from Wally World for 1/3 of the current price.

[howkim]

When it comes to FDA, keep in mind that they really don't get involved in how people USE things. They don't care if I prescribe off-label. They don't care if you sell your OxyContin to your neighbor (The DEA sure as heck does, but not the FDA). They don't care who, if anyone, messes with your CPAP pressure. They do care what marketing claims are made for drugs or devices and they do care about the product labeling (which has much to do with the marketing claims), production processes, and evidence for safety and efficacy.

So, FDA cares if someone sells you a CPAP machine without a prescription (but not if you buy one without) but they don't care what the prescription says or even if you, after you get the machine, follow the prescription or not.

In terms of techs doing titrations or split-night studies, they already have all the applicable orders before anything gets started. Doctors are very good at writing orders that minimize the need for anyone to wake them up. The techs aren't doing anything without an order.

Hear, hear!!

[leejgbt]

I believe what a lot of DME providers get wrong is that the State Respiratory Boards do have rules about allowing patients to adjust these devices. While I am unsure if this makes it a law, a respiratory therapist could lose their license for this type of violation. I am unaware of this rule having ever been enforced but the threat is real for the RT. Many DME providers have extrapolated this into "it's against the law". I doubt it is.

[Slinky]

What has to be understood here is that whilst it may be unlawful for a "medical professional" such as a local DME provider's RRT changing the pressure on a PAP w/o a prescription from a doctor to do so it is NOT unlawful for a person to change the pressure on their own personal PAP that they use for themselves.

Some seem to have a problem grasping the difference between changing a pressure setting for someone else and changing the pressure setting for yourself.

Kapeesh????

Whilst I was raising dogs it was unlawful for me to give a shot to someone else's dog but lawful for me to give my own dogs their shots.

[Tip10]

Is it illegal to NOT use the machine? I think not.
Is it illegal to NOT take prescribed medication? Again i think not (unless perhaps the court orders the meds but that's a special case).
Is it illegal to NOT watch your diet when a doctors tells you to? I think not.
Is it illegal to NOT quit smoking when a doctors tells you to? I think not.

It's not illegal to change your pressure settings.

It IS probably illegal to change someone else's pressure settings and It very well MAY be illegal to advise someone else to change their pressure settings (in both cases you are treading very close to practicing medicine without authorization).

Short of a court order no one can force you to take a medication nor accept a treatment.

Now, that being said might there potentially be some ramifications for NOT using it or NOT using it at the prescribed settings -- I'm sure there probably are -- one of the over the road truckers might speak to this but cannot they pull your CDL on medical grounds if you are not using the machine, if prescribed, or they might also be able to do so if you are not using it in the prescribed manner.

[Spirit]

In the past, I have called my allergist or other doctors, stating I changed my med dose, and they tell me that's fine. If any drastic changes occur, call thier office or go to the ER. So, yes I have changed my dose, without prescription changes. And I'm sure many thousands of others have too. Many thyroid patients adjust meds according to how they feel.

Medical laws are created to protect medical professionals. Stating, if you change your own dose or pressure, we are not liable. Prescriptions are written, so there is no confusion as to who done it, if misfortune/tragedy occurs. Celebrities are good example.

I find that many doctors are cooperative with responsible patients. So, law's are made to protect medical professionals. That is not what I prescribed. But, that does not mean a doctor refuses to allow patients, to adjust thier own treatments. By giving a patient medication, cpap machines etc.... once a patient walks out the door, nothing a doctor can do. If patient don't use cpap, sell cpap, or change pressure, nothing any medical professional can do. How difficult is it to change doctors ? How difficult is it to find a doctor or DME, that allows a patient to change thier own pressure ?

I am an automotive business owner. Many customers, come in for diagnostics and repair vehicles on thier own. How difficult is it to get a copy of sleep study, purchase own equipment to provide self treatments ?? How difficult is it to, have a family member, friend whom is a doctor to write a prescription ??

Apparently, a patient is not suppose to access data. Just a week ago, DME clinic gave me a data print out, with thier company name on the documents.

Truth is, everything in life is about money. As long as patient stay's on treatments, regardless if they take matters into thier own hands or not. Medical professionals are being paid. That's all they care about.

You take care of yourself, we lose money.

It's against the law to change your pressure ? Well is it against the law not to use my cpap ? Is it against the law to get a second opinion ? Is it against the law, for me to seek a doctor, whom is a friend, to change pressures for me ? We are talking about my life, not yours. Thank you.

So, in reality it's all beep beep !!! So, stop worrying friends. There is no law against, making choices in life. Sorry I wrote alot

[Spirit]

Oh and one more thing, before I crash. I believe there are warnings/precautions to increasing pressure, for various reasons, but no law against patient making pressure changes. Reason being, hospitals would post up medical laws pertaining to patients, no different then businesses posting up labor laws and other various laws that pertain to business. Such as alcohol license, etc... Medical professionals would have documentation of these law's and by law present and explain to patient. having patient understand, sign documentation, then issue cpap machine. Hospitals would have laws posted for public viewing.

What does patient do prior to surgery ? Sign documents stating, I understand.

Good night everyone. Sleep well.

[LinkC]

Um...the "inverse logic" expressed in the preceding couple of posts is misleading. While the conclusion is accurate, the reasoning is not.

How about this: Is it illegal to NOT commit murder? Is it illegal to NOT rob a bank? Changing settings is apparently legal, but is very different from not using your machine.

[jmcsmomma]

Is it illegal to use outside their prescription, yes.

-Polysomning

Please show me where it is WRITTEN as a law. As to taking a pill that was prescribed b y my doctor and if I took an overdose, does what you say mean I would be charged for taking an overdose----- B....S.....!!!!!![/quote]


Actually, yes. People are also charged when they attempt suicide and fail. Something about the use of a narcotic.

[jmcsmomma]

Also, this business that sleep doctors prescribe the best pressure they can at titration is some bologna. How is it that they got as far as 12 with my husband, but PRESCRIBED 14 for him, and his AHI was in the 9-10 range still. I fixed his pressure to 15 something( i can't remember right now) and his AHI was 4.3 Thursday, and 5.6 this morning.

[rested gal]

Also, this business that sleep doctors prescribe the best pressure they can at titration is some bologna. How is it that they got as far as 12 with my husband, but PRESCRIBED 14 for him, and his AHI was in the 9-10 range still. I fixed his pressure to 15 something( i can't remember right now) and his AHI was 4.3 Thursday, and 5.6 this morning.

Just a guess on my part... perhaps they ran out of time during the titration, the doctor recognized that and prescribed a higher pressure than the titration got to. Now you and your husband are working on making his therapy even better, jmcsmomma. Looks like you two are doing a very good job at tweaking it at home. Perhaps the doctor did prescribe "the best pressure he could" as a guesstimate, given that he did prescribe more than the titrated (to that point) pressure. The doctor got it up to the chopped sirloin stage anyway. Better than bologna. You and your husband are taking it on up to the filet mignon category.

You're doing (quite successfully) much like these people did, except you have the added wonderful benefit of seeing machine data as you work on it:

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://www.tnlc.com/Lara/laura/osa/CanP ... wnCPAP.pdf

[jmcsmomma]

Also, this business that sleep doctors prescribe the best pressure they can at titration is some bologna. How is it that they got as far as 12 with my husband, but PRESCRIBED 14 for him, and his AHI was in the 9-10 range still. I fixed his pressure to 15 something( i can't remember right now) and his AHI was 4.3 Thursday, and 5.6 this morning.

Just a guess on my part... perhaps they ran out of time during the titration, the doctor recognized that and prescribed a higher pressure than the titration got to. Now you and your husband are working on making his therapy even better, jmcsmomma. Looks like you two are doing a very good job at tweaking it at home. Perhaps the doctor did prescribe "the best pressure he could" as a guesstimate, given that he did prescribe more than the titrated (to that point) pressure. The doctor got it up to the chopped sirloin stage anyway. Better than bologna. You and your husband are taking it on up to the filet mignon category.

You're doing (quite successfully) much like these people did, except you have the added wonderful benefit of seeing machine data as you work on it:

Link to a study that concluded, "yes."
"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
http://www.tnlc.com/Lara/laura/osa/CanP ... wnCPAP.pdf

I'll have to check that out later, I'm at yet ANOTHER wrestling tournament.
I got a kick out of your steak analogy:)

[Gunn]

Alright folks be gentle with me. I am a RT and I own my own DME. Is it illegal to change your pressure? I doubt it. Is it smart? I doubt it. The reasoning is, if you have CHF or COPD and are on one, you could cause serious damage. If you don't have a complete understanding of lung physiology, I wouldn't want you near my CPAP. If a auto titrate CPAP is on a setting of 5-20 cmH2O, and a patient is uncomfortable, I do the down load. I look at the report see where they rest at, and notifiy the DR. and make the necessary changes. All of MY patients put on an Auto are because they did not want to go in for the second study. If your DME is giving you fits CHANGE DME's. Most of the big chain DME's do not have an RT. They have people off the street that get a small introduction from one of the vendors. Someone asked about a Split study; the reason they can make changes and stuff is there is a protocol for that, it keeps the person from possibly dieing during the study. But again, they have to meet the standards. And yes I wear a CPAP so does my wife, brother, sister, father. OSA is very serious, and should be treated as such. If you lower your pressure, why even use the CPAP? A set pressure is set for a reason, it is where you rest the best. There maybe circumstances involved also, you could have PLM's involved with your sleep. Most primary care Drs. would not know a obstructive apnea from a central apnea. They are treated differently. I am in Oregon, but most of my patients are from different states, because they can't get the quality of care from their DME's. I can't blame them. I went into sleep medicine because of the run around I was getting. If your DME is not checking the pressure in front of you every six monthe FIRE THEM. If they don't do things the way you want FIRE THEM. Now, I WILL NOT change pressures willy nilly, I have to look at the down loads and confir with the doctor. Because the repercussions are imense. I could loose my license, I did not go to school for 4 years and practice for over 15 years to possibly loose my license over a setting. Most Drs. sleep or other wise will defir to a RT, not a tech. I encourage my patients to ask intelligent questions. We are not here to keep the people (Or I Am Not) ignorant or to hide anything from them. There are a lot of RT's and DME's out there just find one you are comfortable with. Then you don't have to make these changes. I know some of you it is not about medicine, it is about the "They Are Not Going To Tell Me I Can't Do It". If that is the case and something happens to you in the long run.... As for the cost, the charges are set by Medicare, weather you are on medicare or not. The Insurance companies go by the DMEPOS standards. If somebody wants to have a legitimate conversation about this with me, fine I am happy. But if they just want to contact me to hear your gums flap I don't have the time to take away from my patients or serious questions. The reason you are told the illegal crap is who ever you got that CPAP from is still liable. Unless you sign a release. gunn