Ray Duckler: ‘A long battle’ for treatment
Katherine Drouin gets anxious recently as she waits at the admissions office for the Walden Behavioral Care in Waltham, Mass.
Don plants a kiss on Katherine's forehead before heading out to Walden Behavioral Care in Waltham, Mass. on August 13, 2014.
Katherine Drouin leaves her apartment in Plymouth with her father, Don, on Aug.13, 2014, to head down to Walden Behavioral Care in Waltham, Mass.
Katherine Drouin walks through the pouring rain to go into the Walden Behavioral Care in Waltham, Mass.
Katherine Drouin sits on her dad's lap while waiting for the paperwork to get processed at the admissions office at the Walden Behavioral Care in Waltham, Mass.
To Katherine Drouin and her supporters, none of this makes sense.
Forget the drawn-out process of getting lab work and a psychiatric evaluation, tests needed before Drouin could receive treatment for her eating disorder. Forget the lack of resources in New Hampshire.
And forget the miscommunication between agencies, and the lack of guidelines needed to navigate the health care system.
Just look at Drouin. She weighs 60 pounds.
“I’ve spent hours in the ER,” says Drouin, who lives in seclusion in Plymouth. “They ask, ‘What’s your problem?’
“You can’t see? I’m a bag of bones.”
Drouin, 36, graduated from Winnisquam Regional High School in 1996 and has had an eating disorder for 20 years. The Monitor profiled her last Sunday, detailing her nightly need to binge and then purge in a ritual that she says she can’t control.
Hope surfaced earlier this month, when Drouin entered Walden Behavioral Care in Waltham, Mass., for the third time. But after one week, she was discharged for hiding oxycodone in her cheeks. She was stockpiling the drug, she said, so she could sell it later to two family members.
The staff had no choice but to kick her out and open a bed, considered precious real estate, for someone willing to follow the program. But Drouin continues to insist that she wants help, and her fight to get it illustrates the bureaucracy and miscommunication within the mental health system that, along with Drouin’s own inability to stay focused, have put her life in danger.
“She is slowly dying,” said Dee Cahoon, a registered nurse and health coach who has emerged as a major ally for Drouin. “We felt like she will die if she does not get the treatment. It’s just as simple as that. It’s a real illness, no less than alcoholism or diabetes. She needed treatment, but she’s received a lot of false promises.”
Since the late 1990s, Drouin has sought help from different clinics throughout the country while also spending time locked up for shoplifting at grocery stores to feed her addiction.
Nothing has worked.
“I’d go back to my little home,” Drouin said, shortly before leaving for her most recent stay at Walden. “I knew I could hide here, and I never asked for help. Now I look in the mirror, and I have no control over this. I didn’t want to go through this process of begging people for help, but if my voice is loud enough, maybe someone will hear me.”
This year, as Drouin reached out for help yet again, the tone of her pleas grew more desperate. In a letter she sent to the Monitor earlier this summer, she revealed a broken spirit, almost surrendering to her illness while hoping her honesty might still save her life.
“My issue is far too complex for any doctor or hospital facility or any other treatment program to address,” she wrote. “Never mind whether it be paid for or not. There is just no one willing, or capable, to help me.”
There is another side here, the one about Drouin’s failure to see various programs through to the end. Her recent discharge is merely the latest example.
According to Drouin and her father, Don Drouin of Nashua, she’s spent time in facilities in New York, New Orleans, North Carolina and Massachusetts, as well as a yearlong stay at New Hampshire Hospital.
Each time, Drouin was told to leave for fasting, sneaking food into her room, then binging and purging. Or she left voluntarily, with the misguided thought that she had conquered her problem.
But that doesn’t change the roadblocks she’s encountered this year.
“Asinine,” was how Cahoon described the arduous process of getting Drouin into Walden. “There was so much resistance from so many places, different policies. We would call and get different answers from different people, so it was really frustrating.”
Cahoon and Deb Stevens are registered nurses at Mid-State Health Center, a primary care facility in Plymouth. They say they worked late nights and made hundreds of phone calls to ensure that Drouin received the help she needs.
They’re both relative newcomers to the profession, each with four years of experience, and that helped them maintain the high-octane energy level needed to get the job done.
“We did not turn a cheek to this,” Cahoon said, “and people in the field for a long time might have given up long before because we were blocked over and over and had to make all those phone calls.”
Before they came aboard, Drouin got lost in the system. First, her health insurance, Meridian Health Plan, said she didn’t qualify for inpatient treatment.
“The clinical information provided by your provider does not establish weight instability, cardiac or metabolic condition associated with medical need for acute inpatient care,” a memo to Drouin, dated Feb. 20, said.
Next, Drouin tried to enter Genesis Behavioral Health, which offers outpatient care in Laconia.
“Katherine’s case was closed at Genesis Behavioral Health due to not having an eating disorder specialist on board,” a letter from Genesis read. “It has been our recommendation that Katherine go into an inpatient eating disorder facility . . . prior to obtaining treatment at this agency.”
Stevens says the process to get Drouin into treatment was far more difficult than it should have been. She says she received conflicting and inaccurate information, time and again, from all directions.
“It was absolutely ridiculous,” Stevens said. “I got really frustrated through the situation, and there were times I was really angry at the insurance companies. But looking at the big picture, no one is really the bad guy. It’s just the fragmentation of the system.”
As an example, Stevens says she received a specific billing code from Walden that Drouin’s insurance company knew nothing about. “Part of the gridlock,” Stevens said.
Another time, Stevens says, Drouin’s secondary insurance coverage, Beacon Insurance, sought proof that Drouin was a candidate for inpatient care before agreeing to pay a $1,200 deductible.
“They wanted to make sure she meets certain criteria,” Stevens said. “Like she needed to have a particular percentage of weight loss in a certain time.”
Beacon told Stevens to take Drouin to a hospital emergency ward for testing. But Beacon, Stevens says, was unable or unwilling to provide an exact checklist of what sort of testing Drouin needed, and only after Stevens looked it up using Google did she learn the answer.
“They just rattled off a bunch of stuff, and they could not give us a written list,” Stevens said.
Drouin went to the emergency ward at Speare Memorial Hospital in Plymouth, as Beacon had suggested, for blood work and a psychiatric evaluation.
They were told that Speare did not have a psychiatric practitioner on staff 24/7, and Drouin would need to be looked at by its contracted outlet, Genesis Behavioral Health.
Genesis determined it could not evaluate Drouin, Stevens says, because she was not in acute distress, meaning she was neither homicidal nor suicidal.
Later, Stevens learned that her own primary care facility, Mid-State, could have used one of its licensed psychologists to administer the psych portion. And so they did.
“This was the perfect example to show all the little pieces where things got hung up, and that was just another case where one hand wasn’t talking to another,” Stevens said. “It shows how confusing it is to navigate the system.”
Meanwhile, Drouin lost weight and grew depressed, often lying in bed all day.
“Katherine called us and said, ‘I’m done; I’m losing hope,’ ” Cahoon said. “We said, ‘Katherine, we are supporting you. Keep it together, and we will not let them do this.’ We did this day and night.”
Drouin was accepted into Walden earlier this month, with primary insurance coverage from Medicare for 75 inpatient days. She had her final late-night binge and purge Aug. 11.
“This is an addictive cycle that has cost me my freedom,” Drouin said. “It came down to just telling me where to go. Tell me what to do.”
Don Drouin and his wife, Goya, drove Drouin to Waltham on Aug. 13. They felt hope, mixed with doubt.
Back to Walden
Katherine’s red duffel bag is packed for the hour drive to Waltham. It’s raining, sometimes hard.
On the way down, with the windshield wipers thumping a rhythmic beat, Drouin’s public defender, Jeremiah Newhall, calls Don to make sure his daughter will appear in court to answer to the latest of her shoplifting charges.
Don explains he has received permission to bypass the hearing because Katherine was accepted into a treatment program.
Then he looks into the rear-view mirror, to Katherine in the back seat, and doesn’t mince words, as though the opportunity Katherine has been handed, the one allowing her to avoid a judge, needs to be hammered home.
“This time you have to think life and death,” Don says. “You’re on your way out, Katherine. Everyone seems to know it but you.”
The car stops at Walden’s main entrance, with rainwater rushing off the overhang. Katherine steps out of the car wearing white sweatpants and pink running shoes, and those moving in and out of the facility can’t help but notice how skinny she is.
We move through the main lobby and take an elevator up. Don speaks into an intercom in front of a locked door, thinking we’ve arrived at admissions.
In a muffled voice we’re told to cross an indoor bridge, to Suite 310, where there’s a small lobby, with a coffee machine, a magazine rack and a water cooler.
Don pats his knee twice, signaling his daughter to sit on his lap, which she did, a 36-year-old woman looking like a grade-school girl listening to a bedtime story.
But the story at this moment comes from Katherine, the one about the last time she tried to get help from Walden, five years ago.
“I was stealing food,” Drouin says. “I hit this wall. I thought I was better than I was. Any sign of my disorder this time, and I’m gone.”
Could this time be different? Might Drouin stick with the program, obey the rules, do what’s needed to break the cycle?
Soon, we’re escorted to a waiting room while Katherine stays behind. Don is grateful that Katherine has already had lab work done, earlier in the week. He assumes this means the registration process will be a formality, and he mutters a few choice words when told all her blood work needs to be redone.
He’s given no reason. He calls Cahoon, his shock absorber through this process, who’s stunned as well. Her voice spreads across the waiting room.
“What? We gave them all that stuff.”
“How many times do they have to poke me?” Katherine asks.
After two hours, the person we’re told can provide some information, vice president of clinical operations Paula Vass, comes in and cites confidentiality policies.
She won’t reveal anything about treatment or why the lab work had to be redone, even to Don.
She does, however, respond to a statement that Katherine couldn’t find help closer to home.
“There is no place in New Hampshire,” she says. “There’s no question about that.”
Later, four hours after her arrival, Katherine is given a bed. “There was suspense right up to the end,” Don says.
‘Cheeking,’ then discharged
“Did you hear what happened?” Don asks on the phone. “Katherine was discharged. They found prescription medicine in her room.”
Oxycodone, Katherine later claims, was prescribed to her to alleviate pain in her hip caused by a car crash last spring. She got caught “cheeking” the pills: hiding them in her mouth, then spitting them out when the nurse left her room.
A friend drove her back to Plymouth, leaving Don wondering where she’d gone. Earlier this week, a different friend drove Katherine to Don’s in Nashua for a cookout and some emotional support.
There, shortly before the mosquitoes forced a move inside, Katherine relayed what happened at Walden. She says she was caught with about 40 pills, storing two every four hours in her mouth before hiding them. She said she planned on selling them to family members because she needed the money.
After one week, a staff member found the pills in a sock, placed in the garbage.
“I don’t like rules,” Katherine says. “They searched my room, and I was putting them away. They found them. I’m ashamed.”
Before leaving the facility, Katherine had been eating three meals a day, not the one gigantic meal suitable for at least five people.
She says she never purged at Walden. She’d have a hardboiled egg, an orange and oatmeal for breakfast. She ate snacks, like Fig Newtons and granola bars. She had salmon for dinner, with a piece of whole wheat bread and a salad with Italian dressing.
The Walden staff counted her calories and weighed her each morning, making sure she faced the opposite way from the reading so she wouldn’t know how much weight she’d gained.
There were also meetings with a dietitian and a group discussion in which participants laid out their goals. Then Katherine got caught breaking the rules, saying she and the nurse engaged in a tug-of-war with the sock before Katherine let go and faced her punishment.
On their way to Plymouth, Katherine says she and her friend stopped at a Manchester restaurant, where Drouin binged on a buffet, then purged in the bathroom.
Katherine spent the next few days in bed, depressed. She says she binged and purged once and drank four Ensure shakes.
“The monster inside me doesn’t want me to get better,” Drouin said while sitting in her father’s backyard in Nashua.
Don cooks hamburgers and serves one to his daughter, with a slice of tomato and onion. She cuts her meal into little pieces and eats everything with a fork.
She says a doctor at Walden told her to get her mind right, accept the rules, and she could be readmitted two weeks from the day she left.
Meanwhile, there are insurance matters to figure out, plus lab work and a psych evaluation, steps that had taken so long to figure out not too long ago.
“I want to make it right,” Katherine says. “I want to go back and make it right.”