Should I send it?

May 8, 2010

Dear Dr. Hoag,

This morning my husband Jose Aguilar, your patient, told me that he had been able to clear his work schedule for the weekend, allowing him to take our 3 year old son on his first Father/Son Campout. He asked me to prepare the necessary items, as they would be leaving town at 4:30 pm.

At about one in the afternoon, I remembered that Jose’s EpiPen had expired and that he needed a new one to attend the campout. We know that Jose went into anaphylactic shock as the result of some kind of insect bite, and so being out of doors at a campout poses a threat to his life to some degree, although I am not sure how significant.

I called your office to have the prescription sent to the Walmart pharmacy where I prefer to fill our prescriptions due to the fact that we pay for them out of pocket and Walmart is less expensive. I was told that my request would take from 24 to 48 hours. I politely asked if they could please make an exception and explained our circumstances. The receptionist seemed put out that she even had to take my call, much less help me take the necessary steps to get my husband’s prescription filled.

When the prescription was not called in to the Walmart pharmacy as requested, I called your office again to ask whether or not I could go to the Walgreen’s where the prescription was on file and get it filled there. The receptionist did not know, but she did call me back a couple of hours later (past the departure time) to let me know that the prescription could not be filled and that Jose needed to schedule a time to come in to be re-evaluated and that maybe then he could get another EpiPen prescription.

I must say that I find this to be completely unreasonable and absolutely ridiculous. Jose has not been bitten by whatever caused his allergic reaction since the time he was hospitalized, which initially resulted in his coming to you for an EpiPen prescription. I hope he is NEVER bitten again. What is the point of being re-evaluated, besides the fact that we will have to pay for another office visit, if he has been asymptomatic since the first visit?

Luckily, Jose had a refill left on his last prescription and so I was able to fill it today within 20 minutes, thanks to the efficient and friendly staff at Walgreen’s. They didn’t mind expediting the refill at all. In fact, it was their pleasure to do so, especially considering the circumstances.

Now, to be fair, I did know that Jose’s EpiPen was past its expiration date. But after having talked with a pharmacist and a physicians assistant, and having read this article, http://www.ncbi.nlm.nih.gov/pubmed/10808186, we decided that as long as Jose’s EpiPen was clear, we would use it while he was around town and within a couple miles of any number of hospitals, even though the bioavailability of the epinephrine may be reduced.

But in this case, he was not going to be in town, and when it takes hours to get to a hospital, he needs to take more precaution.

If there is a reason that Jose needs to be seen again, please enlighten me. And I mean that in the most sincere terms. I would like to be on the same page as you are.

But if, however, you have read my letter and agree that he may forego the office visit, please have his new prescription sent to the Walmart pharmacy on 2501 South Market Street in Gilbert. Their phone number is 480-224-6911.

Regardless of whether or not Jose needs to come in for a new evaluation, I hope to expect a little more kindness and professional courtesy from your staff—the kind of respect that you have always shown us when we have come to your office. I’m sure it was just an off day.

Thank you for your time and attention.

Very sincerely,



Kim Aguilar