Mother’s quest for dead son’s medical records could be solved if bill clears Legislature

  • Cecile Lavoie holds her son’s high school photo at her Northfield apartment. Robert Parenteau died from a heroin and fentanyl overdose at age 52 last spring. Lavoie is still seeking answers about the circumstances surrounding her son’s death. GEOFF FORESTER / Monitor staff

  • Cecile Lavoie holds her son’s high school photo at her Northfield apartment. Whenever he left the house, Robert Parenteau always made sure to turn around and say, “I love you, mom,” to his mother Cecile Lavoie.She would reply, “I love you too, more than you know.” GEOFF FORESTER—Monitor staff

  • Cecile Lavoie looks over some of the responses to her medical inquiries over her son’s death at her apartment in Northfield recently. GEOFF FORESTER / Monitor staff

Monitor staff
Published: 2/12/2017 12:04:55 AM

Whenever he left the house, Robert Parenteau always made sure to tell his mother, Cecile Lavoie, he loved her.

“I love you too, more than you know,” she would reply.

It’s been almost a year since Parenteau’s death, but Lavoie still occasionally refers to her youngest son in the present tense. She calls him “my Bobby” in her thick Quebec accent and misses the times he used to cook tacos for dinner when he lived in her cozy Northfield apartment last year.

Parenteau was born in 1963, nine years after the rest of his siblings.

“He was a good kid, gentle as they make them,” she said with a smile.

March 30 will mark one year since Parenteau died from a heroin and fentanyl overdose at age 52. His 86-year-old mother is still trying to get answers about the circumstances surrounding her son’s death.

He first became hooked on pain medication after shattering his leg in a bad motorcycle accident in 2004. Doctors put him on 80 milligram oxycodone pills at first, later changing the dose to 30 milligram pills, Lavoie said.

One of the few medical records Lavoie has of her son’s shows he was being prescribed 168 of the 30 milligram oxycodone pills in a single month, shortly before his death.

“All through the years, I don’t think he ever got out of the pain addiction,” she said. “If it was not one doctor, it’s the other one. It’s all the doctors that push these things.”

Lavoie is trying to get a clearer understanding of what drugs her son was taking – and for how long – before he died. But even though Lavoie is Parenteau’s mother, she doesn’t have the legal standing to obtain the medical records for her adult son.

A new bill working its way through the state Legislature could help Lavoie and other grieving family members across New Hampshire get those answers faster. Senate Bill 61 already has bipartisan backing from Democratic Senators Dan Feltes, Lou D’Allesandro and Republicans Jeb Bradley and John Reagan.

A long struggle

Family members said Parenteau struggled with addiction ever since he was put on painkillers after his motorcycle accident.

“It just absolutely took over his brain,” said Robert Parenteau’s daughter Haley, 25, of Tilton. “Nothing gave him happiness outside of artificial happiness.”

Haley was in eighth-grade when her father had the accident and resulting surgery that left a rod in his leg. He was never the same.

“As soon as he was prescribed the OxyContin, I can’t remember him not having them,” she said.

The doting father she knew was replaced by a man who was often looking for money or lying on the couch, undergoing withdrawals.

When she got her first job, her father would tell her he needed money for bills, food and gas. He would then leave, be gone all day and come back later at night with no food or no gas, and bills that were still unpaid.

“For me, it’s been the loss of two dads,” she said. “It’s my dad who cared for me, and it’s his body. He’s long gone. The addiction took him a long time ago.”

Parenteau lived with his mother when she returned to New Hampshire after years in Florida.

Even though Lavoie didn’t see the worst of Parenteau’s addiction, there were plenty of signs something was wrong: tinfoil with burned drug residue in her son’s room, strange phone calls in the middle of the night and unexplained trips out of the house. But whenever she pressed him on what was happening, he denied anything was wrong.

“He said it was a job,” Lavoie said. “I said, ‘What job?’ ”

For months leading up to his death, Parenteau was a patient of Dr. Joshua Greenspan at the American Pain Institute in Portsmouth – where he was being prescribed 168 oxycodone tablets in a single month.

Lavoie took it upon herself to inform Greenspan about her suspicions.

“I wrote him a letter about my son,” she said. “I said, ‘He is a drug addict because I have noticed.’ I said, ‘Stop giving the pills, maybe we can save his soul right now.’ ”

A week letter, Parenteau received a letter on American Pain Institute letterhead, signed by Greenspan. The letter was delivered to Lavoie’s address, where her son was living at the time.

“Dear Robert, this is to inform you that you are being discharged from American Pain Institute. Your medical records will be forwarded to the provider of your choice at your request.”

A few weeks later, Robert Parenteau was dead of a heroin overdose.

Haley Parenteau suspects her father was using illicit drugs like heroin in addition to prescription narcotics well before his death.

“I’m assuming he was on it before then,” she said.

Haley said she’s astounded doctors kept prescribing him pain medication throughout the years.

“My dad went to doctors for years and years,” she said. “I can tell you, I watched him deteriorate.”

Dealing with pain

Greenspan is a pain management specialist in Portsmouth – he often sees patients who have been dealing with chronic pain for years.

“A lot of people come to us on opioids,” Greenspan said, adding he sees many patients who have been prescribed narcotics by their primary care doctors and are later referred to him for specialty care.

“Our practice ... has been inundated with a tidal wave of patients,” Greenspan said. Often, patients “have not been closely monitored or counseled, so the problem has been thrown into our lap.”

Due to HIPAA laws, Greenspan could not confirm whether Parenteau was his patient or discuss any specifics about his care. However, he spoke in great length about his practice.

Greenspan specializes in a number of interventional therapies and procedures designed to steer his patients away from opioids, and said he would rather help patients deal with pain in a way that doesn’t involve narcotics.

Money and insurance are real constraints when it comes to alternative therapies, Greenspan said. Often, insurance companies don’t want to pay for plasma injections and spinal cord stimulators – preferring to pay less money for opioids instead.

“It’s a real shame,” Greenspan said, adding his staff argues with insurance companies weekly trying to get coverage for non-narcotic treatments.

“We’re shot down every time because the money is the principle,” he said. “We feel bad for our patients with chronic pain, they’re between a rock and a hard place.”

Still, in 2014, Greenspan was ranked as the fifth-highest oxycodone prescriber in the state, according to a Propublica Database of Medicare Part D data. He wrote 801 prescriptions for oxycodone that year, data shows.

Greenspan says he will often prescribe the drug when patients are requesting narcotics or insurance won’t pay for other forms of treatment; oxycodone is the least expensive drug he can prescribe, and it now comes in tamper resistant forms.

“If I am on the list, it’s because I have a large number of patients and insurance companies limit my options,” he said. “I’m not happy about that, but I have to deal with the cards I’m dealt.”

He regularly drug screens his patients, checks the state’s prescription drug monitoring program – and readily admits to discharging people who are abusing pain pills.

“We’re very stringent,” he said. “We discharge people frequently. We simply don’t want to be associated with these patients because we don’t want to be part of the problem.”

Greenspan is also a licensed suboxone doctor, and said he offers addiction treatment to every patient he discharges.

“Most patients, though, will deny having an addiction problem,” he said. “So that ends the relationship.”

Seeking answers

Trying to find out what happened to her son, Lavoie has contacted Greenspan’s office multiple times, attempting to get her son’s medical records.

“They won’t tell me anything,” she said.

Greenspan said he can’t give family members who aren’t approved by the patient access to their medical records, unless they are later designated with power of attorney.

“We would not be able to, by law, give them that information,” he said, adding, “I sympathize with the situation she has, I have children of my own. When they hit 18, we have no access to their medical records.”

Because Lavoie is not a court-appointed representative of her son’s estate, the law makes Parenteau’s medical records difficult to obtain. Health care privacy laws mean family members must go through a lengthy probate court process to get them.

“Under that current statute, parents cannot find that information,” said Manchester attorney Holly Haines, who specializes in medical malpractice. “Parents don’t know what happened.”

With the state’s heroin and fentanyl crisis, Haines is seeing more and more situations like Lavoie’s: Parents or children of an overdose victim who can’t find out if that person was in addiction treatment or was being prescribed narcotic painkillers at the time of their death.

At a state Senate hearing for a bill that aims to change the statute around medical records last month, Haines said she gets weekly phone calls from parents and family members who are seeking answers about how their loved one died.

“A parent may want to find out what happened,” Haines said. “Under the current statute, they can’t.”

A new bill in the state house would make it so that spouses, parents and children could more easily obtain a deceased family member’s medical records – by getting a medical authorization form rather than go through the courts.

But representatives from the state’s hospital association say expanding the designation would make things much more difficult for staffers, who already run into problems trying to determine whether spouses are who they say they are.

“How can the hospital confirm that the person standing before them is the next of kin?” said Kathy Bizarro-Thunberg, executive vice president of the New Hampshire Hospital Association during testimony to lawmakers in January.

Family spats and disagreements after the death of a family member can make it impossible to tell who to trust, said Jane Allesandrini, health information management and privacy director for Portsmouth Regional Hospital.

“We so often have family disagreements when patients are currently in the facility,” Allesandrini said. “When we have other family members claiming to be next of kin, we can’t tell. We’re trying to protect the patient’s information, even after they pass away.”

Lavoie sees the privacy laws differently – she thinks doctors are trying to protect themselves. She still wants answers about her son’s death, and is hoping his medical records can provide them.

“You get up in the morning thinking about it, you go to bed thinking about it,” she said. “What could you have done, why didn’t you do this, why didn’t you do that.

“What happened to my son, it’s enough to break anyone’s heart.”

(Ella Nilsen can be reached at 369-3322, or on Twitter @ella_nilsen.)

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