The Prescription Scam Investigation

by

02/17/2003

W 50th St & 6th Ave, New York, NY 10020

Neighborhood: Midtown

One of the sayings where I work is that we see them all. Creaky old dope fiends with nine lives and wrecked veins, skinny young Africans with silky French accents, and lots of distracted crack smokers with rattling lungs. We also see the occasional sweet matronly mami from Puerto Rico or a doe-eyed young innocent from Harlem. But for the most part, I’ve found that running a transitional residence for 65 homeless people with AIDS in midtown Manhattan is like speed-reading a bunch of Raymond Carver short stories set in a bus terminal with mainly black and Latino characters whose alternately abject and comical lives are real: most of the time.

Last fall a health program that works with homeless people was scheduled to come in and offer free, low-threshold chlamydia tests for all the men and women under our roof. Luckily for our folks, the new test they had bypasses the traditional pipe-cleaner-up-the-urethra technique and just requires an ounce or two of urine. Even though most of our people are beyond the age range where chlamydia is epidemic, they’re still likely candidates for any and all sexually transmitted diseases. Plus it would introduce the health program to our folks, and vice versa. We put up a few notices about the tests around the building to try and encourage people to come down and at least talk with the docs.

On the night of the tests two women from the health program set up shop in the dining room, sat down with a dozen or so of our folks to do their paperwork, and then sent them off to the loo, one-by-one, specimen containers in hand. Everything was going smoothly and by the time I went back to check on them an hour or so later, business had been so good that they’d run out of specimen containers and had resorted to using small Styrofoam cups with plastic lids, some of which still held fruit cocktail from that evening’s dinner. I saw a few people spooning down the syrupy sweet peaches and pineapple chunks on their way to the bathroom and wondered if they’d rinse out the cups before depositing their samples.

When everyone’s pee was collected and the health workers were starting to gather their papers, one of them walked over to where I was sitting, pointed at one of their forms and asked me, “Is that a really common name?” I focused on the name for a while and told her “No. I don’t think so. But why do you ask?”

Myra H. was a thirty-something Latina who’d been staying with us for the past couple of months and had developed a reputation among the staff as a whining manipulator with overdeveloped ass-kissing tendencies. Fat around the edges, Myra, had once suffered from an unknown dermatological problem that had left her covered with scores of small brownish splotches, head to toe. The second or third day she was here she brought her mother in from Queens to show mom what a beautiful place, with such a nice staff, that she’d finally been placed in. This was the one setting that would enable her to steer clear of the crack pipe and wayward types she’d always had so much trouble avoiding, she told dear old mom and me. Hers was a claim that had been heard countless times since the transitional residence opened about seven years ago. But uttering such words is close to a kiss of death, similar to the old jock jinx about appearing on the cover of Sports Illustrated and then striking out tw! enty times in the World Series or failing to even make the Olympic team, let alone bring home the gold. We would of course try to help Myra stay clean, but at that point we didn’t know yet if she could walk the walk.

In many ways Myra fit our new profile. As recently as the mid-‘90s you’d still see the occasional middle class gay white man transition through the AIDS welfare system after getting sick and losing everything. Today about the only one-time middle class folks we see here are those who’ve taken a decades-long, steep slide down the Big Rock Candy Mountain, helped along by the weight of a huge monkey on their back. With a few exceptions the people now needing government help and a bed in a program like ours due to HIV have grown up on welfare, been victims of physical or sexual abuse, started using drugs and having sex by thirteen or earlier, and have had to eat the institutional gruel of reform schools, jails, and charity hospitals. They’re seriously undereducated, have scuffled on the streets, and see the virus as just one more piece of the scrambled puzzle that makes up their life. Some don’t change and sooner or later end up dead before their time. Others, the miraculous few, will undergo a resurrection and begin to picture themselves in a house with a white picket fence—and actually get there.

Myra H. seemed much too oily to make the big turnaround, and what the health worker was telling me did nothing to change my opinion.

“We had a patient last year and I think her name was Myra H.,” the worker told me. “We started wondering if she was really HIV positive, so much so we told her we couldn’t treat her any more unless she brought us a current HIV test. I think it’s the same person. We told her to get tested and bring back the results but we never saw her again.”

And then there was another angle. The health worker also thought she remembered Myra living at the time in a fleabag hotel with her boyfriend, who was also getting medical treatment from the program. The worker and others had begun to suspect that the boyfriend, who was definitely HIV positive, had been stealing blank prescriptions from the program’s doctors. Several forged prescriptions for expensive drugs had turned up at the state Medicaid fraud office, and they all came from doctors that either Myra or the boyfriend had seen.

The state Attorney General’s investigators had been around asking questions and it was looking as though the boyfriend and Myra were working with a crooked pharmacy that would fill their forged prescriptions, bill Medicaid, and then buy back the drugs from them at well below market value. The pharmacy would then be able to fill another prescription, forged or otherwise, with the returned drugs and bill Medicaid twice or maybe more for the same bottle of pills. In return the boyfriend and Myra would have cash from the pharmacy to buy crack or heroin. As far as scams went it wasn’t the most foolproof or original. Some HIV positive addicts have always been known to get their prescriptions filled and then sell the unopened bottles on the black market, even if the drugs they’re selling might save their lives. Or if the drugs are in any way pleasantly psychoactive, they might sell some and keep the rest for their own enjoyment. If Myra could adequately feign mental illness and at least temporarily pass as someone with HIV, she could get lots of prescriptions for all sorts of drugs, all of them marketable. Medicaid, cash benefits and free housing also go to indigent, homeless New Yorkers with HIV.

The prescription scam investigation was out of my hands and would take care of itself. But Myra was in my care, so to speak, and I had a responsibility to the program. Every night there are hundreds of truly sick people who would give anything to occupy Myra’s room. And I was very eager to see how she would react.

“Why are you hassling me?” she said with a sneer of indignation. “You think I don’t wish I didn’t have the virus? Are you crazy? I’ve been tested plenty of times. But right now my t-cells are high and my viral load is nearly undetectable.”

Myra was fluctuating between throwing rage at me and trying to come across as the teacher’s pet. I asked her where she was first diagnosed and she gave me the name of a small hospital in Queens. I then called a local clinic and made an appointment for her to get tested the next week. “I hope for your sake that it comes back negative,” I told her.

“You and me both,” she said with a question mark in her voice. Myra then made herself scarce. I didn’t see her again for two weeks. She missed the appointment for the HIV test and when she finally surface she was agitated and all over the place. I offered a seat in my office but she refused and stayed in motion.

“Look,” she yelled, “I made an appointment at the hospital I go to for a test. That’s where I want to go.” I told her that I was going to make another appointment for her at the local clinic and that she would have to go there with one of the staff. “And if you don’t make that appointment you’re outta here and I’ll let people know what happened,” I told her.

Again she disappeared, but a week or so later Myra’s on the phone, saying she’s hospitalized and asking me if we could hold her clothes and the rest of the stuff in her room.

A couple of days later Myra called again and said she wouldn’t be coming back. And like the health program, we never saw her again. She’s off to who knows where. Locked up, maybe, or still trying to avoid the cops. Oh, and in case you’re reading this Myra, no need to worry, your chlamydia test came back negative.

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