Opinion ID: 1033708
Heading Depth: 4
Heading Rank: 1

Heading: Medical Providers

Text: Wiedeman suffered from chronic pain associated with rheumatoid arthritis and spinal fusions performed in 2004 and Nebraska Advance Sheets STATE v. WIEDEMAN 197 Cite as 286 Neb. 193 2009. In August 2009, Wiedeman saw neurologist Dr. Betty Ball for her neck issues. Wiedeman continued to see Ball until August 2010. Separately, beginning sometime in 2009 and continuing until July 2010, Wiedeman was a patient of nurse practitioner Cheryl Laux at the Chimney Rock Medical Center in Bayard, Nebraska (Chimney Rock). On January 12, 2009, Wiedeman signed a pain contract with Chimney Rock, apparently in conjunction with pain management issues resulting from her 2009 spinal fusion surgery. In the contract, Wiedeman agreed to receive opioid medication only from Chimney Rock and not from any other source. Wiedeman further agreed to fill her prescriptions for opioid medications at only one pharmacy of her choosing, not at multiple pharmacies. Laux testified that she did not know Wiedeman had any other medical providers. During this period, Wiedeman also went to Quick Care Medical Services from time to time. There, she saw nurse practitioner Jodene Burkhart and also, as can be surmised from the record, a “Dr. Harkins.” In December 2009, Burkhart ran blood tests that indicated Wiedeman had rheumatoid arthritis. Burkhart prescribed hydrocodone and recommended Wiedeman see a rheumatologist. The nearest rheumatologists are located in Colorado. Many of those were not accepting new patients, and the evidence was that Wiedeman has still not been able to see one. Dr. Michelle Cheloha became Wiedeman’s treating family practice physician in April 2010. Cheloha explained that Wiedeman needed to see a rheumatologist for a more definitive diagnosis and better treatment of her arthritis, but Cheloha tried to address the issues relating to Wiedeman’s condition until a rheumatologist could do so. Cheloha was aware of urgent care visits to the clinic where Cheloha worked and explained that it looked like Wiedeman needed to establish routine medical care. Cheloha was also aware of Wiedeman’s past treatment with Ball and of the arthritis test results. It does not appear, however, that Cheloha knew Wiedeman was still regularly seeing Ball when Cheloha accepted Wiedeman as a patient. Nebraska Advance Sheets 198 286 NEBRASKA REPORTS Nor, apparently, was Cheloha aware of Wiedeman’s treatment by Laux at Chimney Rock, or of the visits to Quick Care Medical Services. Cheloha admitted she did not specifically ask Wiedeman if she was seeing other physicians. But Cheloha did specifically recall discussing with Wiedeman what medications she had previously tried. Cheloha mistakenly concluded from that conversation, and from reviewing her records, that Wiedeman had last been prescribed a narcotic in 2008. Wiedeman told Cheloha that she had been taking tremendous amounts of over-the-counter ibuprofen for her pain. Wiedeman also told Cheloha that she had “tried” her mother’s narcotic medications relating to rheumatoid arthritis. Wiedeman did not disclose any other past or present prescriptions relating to her chronic pain issues. Wiedeman saw Cheloha monthly. Cheloha began prescribing hydrocodone. She stated that the maximum dosage was 6 pills per day, or 180 pills per month. Cheloha started with a plan of 90 pills per month. By May 3, 2010, Cheloha increased the prescription to the maximum dosage of 180 pills per month. Cheloha eventually switched Wiedeman to oxycodone when the maximum dosage of hydrocodone was still failing to address Wiedeman’s pain issues. Cheloha told Wiedeman not to mix hydrocodone with oxycodone. The maximum monthly dosage of oxycodone is also 180 pills. On April 14, 2010, Cheloha represcribed 90 pills of hydrocodone after Wiedeman told Cheloha that her husband had accidentally taken her pills out of town. On June 1, Wiedeman told Cheloha that she had an allergic reaction to the oxycodone and that she had flushed the pills down the toilet. Cheloha rewrote a prescription for 180 hydrocodone pills, with one permitted refill. This was the only prescription written by Cheloha that allowed a refill, and the record is unclear whether this was intentional.