A hospital released a drug-addicted veteran with an opioid prescription. One day later, he was dead
By ANDY MARSO | The Kansas City Star (Tribune News Service) | Published: September 24, 2017
KANSAS CITY, Mo. — Stephanie Price’s last phone conversation with her son burns in her memory.
It was Thursday, Aug. 18, 2016. Price’s son, Jeromy Bubacz, was about to be discharged from Stormont Vail Health in Topeka after a minor medical procedure.
Bubacz, 29, had been fighting prescription drug addiction for years after he was diagnosed with sarcoidosis, a lung condition that cost him his position in the U.S. Marine Corps.
Price, who lives in Olathe, Kan., had been by his side for most of it, shepherding him toward sobriety.
“I said, ‘Jeromy whatever you do, please do not leave there with prescriptions,’” Price said, recalling their last conversation. “(He said), ‘I know Mom, I know. It’s fine, Mom.’”
Bubacz left Stormont that day with prescriptions for 120 opioid pain pills and 30 tablets of alprazolam, a benzodiazepine anti-anxiety medication commonly called Xanax.
Some time late the next night, Bubacz died of a drug overdose.
Price called it an “astronomical amount of pills” and could not understand why they were prescribed. Bubacz’s VA medical records, which she assumed would transfer with him, said he had a history of “opioid dependence.” Price said she’s not received any explanations from Stormont Vail and she filed a formal complaint with the hospital last month.
In response to calls and emails from the Kansas City Star, Kara Welter, Stormont’s director of marketing and communications, said the hospital does not comment on patient care and released the following statement when asked if it was investigating Bubacz’s death:
“As a health care facility, we have a process for case review according to Kansas statutes regarding the quality of patient care delivered,” Welter said. “By law, results are protected and cannot be disclosed.”
The coroner’s report determined that Bubacz suffered an accidental overdose of oxycodone and alprazolam, with his advanced sarcoidosis a contributing factor. The report also included photos of the pill bottles that were brought in with him.
In addition to his VA medications, Bubacz had three bottles prescribed by Stormont physician Corbin McIlvain and filled at a Topeka CVS Pharmacy on Aug. 18, the day Bubacz was discharged.
The prescriptions were for 60 pills of 10-milligram OxyContin, 60 pills of 5-milligram oxycodone hydrochloride and 30 pills of 2-milligram alprazolam. After Bubacz died, only 16.5 alprazolam, 11 OxyContin and four oxycodone pills remained.
McIlvain has been licensed to practice in Kansas since 2007 with no disciplinary actions against him.
But Andrew Kolodny, a Massachusetts physician who is the executive director of Physicians for Responsible Opioid Prescribing, said Bubacz’s case raised all sorts of questions.
“There’s so much wrong here, it’s hard to know where to begin,” Kolodny said.
Kolodny said Bubacz’s addiction history should have been a red flag. But even without that history, Bubacz should have received no more than three days’ supply of opioids, if any, after such a minor surgery and should not have been given opioids and Xanax together.
“The combination of opioids and benzos is just absolutely not appropriate,” Kolodny said. “That’s a very dangerous thing to do.”
Kolodny also said that Bubacz should not have been given two opioids at once. He said some physicians prescribe OxyContin, a long-acting opioid, as a baseline for pain management and then add oxycodone to be taken as needed for “breakthrough pain.”
But it’s not good practice.
“All of that is ridiculous, it’s nonsense, it’s a practice invented by the (pharmaceutical) industry,” Kolodny said. “There should have been no OxyContin.”
Bubacz’s death was one of a record 60,000 fatal overdoses nationwide last year, according to preliminary data. Compared to most states, Kansas has had few deaths, but the state’s opioid problem is growing.
Between 2013 and 2015, Kansas’ prescription opioid overdose death rate increased by 28 percent and heroin deaths increased by 71 percent.
Still, Kolodny said Bubacz’s death stands out.
“I think this may be an extreme case,” Kolodny said. “I sure hope it is.”
Price said she doesn’t want her son’s death to become lost in a sea of opioid headlines. He was not a statistic, she said. He was a Marine. He was funny and creative. He loved music and fashion, especially Air Jordan sneakers. He was her son.
“You put so much energy and time into children who suffer from addiction, and it’s only because you want to protect them and save them,” she said. “And I couldn’t save him.”
“He never did heroin. He never did any street drugs. Because he didn’t have to. His lungs gave him the ability to get prescriptions. But no doctor that he saw — no doctor — ever gave him that amount of prescriptions. Ever.”
Price said she was thrilled when a Marine recruiter convinced Bubacz to join up after high school.
“We were just so excited for him to do it,” Price said. “He was just getting on the wrong path and he was hanging out with the wrong people and the Marine Corps definitely changed his life.”
The family moved to Kansas in 2009 and Bubacz shuttled between active duty stops in Florida and North Carolina. There were no outward symptoms of his lung condition, but one day in 2012 he took a hit to the chest while playing football on base and ended up getting an X-ray.
“That’s when they found something on his lung,” Price said.
Bubacz was sent to Walter Reed Army Medical Center for a lung biopsy that revealed sarcoidosis. The inflammatory condition can cause coughing, wheezing, shortness of breath and chest pain. By the end of 2012, Bubacz was medically retired.
He handled it well, Price said. He returned to Delaware, found a civilian job, got married and had a baby all within a year of his discharge.
But he also started abusing prescription drugs, she said. It started with Xanax and Adderall, an amphetamine. Price said he used his condition to “doctor shop” for prescriptions and found one particularly compliant physician who worked out of his home and took only cash payments.
Bubacz’s wife left him in 2014 because of the drug abuse and took their child with her. While Price was back in Delaware visiting her daughter, Bubacz got in a car wreck while under the influence of prescription medications. After a five-day detox, she decided to bring him back to Kansas with her, in the hopes she could help him get clean for good.
“He was probably out here less than five months and he was getting prescriptions again and hiding them from me,” Price said.
She got him into an Oxford House, an addiction recovery organization with several locations in Johnson County. A 90-day stay there temporarily got him back on track.
But soon after getting out he was doctor shopping again, this time for Xanax and hydrocodone, a common opioid.
“We had to start all over again,” Price said. “(I was) like, ‘You know Jeromy, this isn’t good, you’re going to kill yourself. You’re going to die.’”
But Price said Bubacz believed it was OK to take the medications because he had prescriptions.
Price took him to the Veterans Affairs hospital in Topeka, where Bubacz spent six weeks in the hospital’s Psychiatric Recovery and Wellness Program.
A July 9, 2016, Topeka Capital-Journal article about the program includes a photo of Bubacz and three other participants outside during a therapeutic gardening session. He stands with his hands on his hips, looking thin, but smiling. That was about a month before he died.
After Bubacz completed the Topeka VA program he was sent to a VA’s Domiciliary Program in Leavenworth, another treatment regimen with group therapy.
“He was agreeing, you know, ‘I need help, I need to stay clean, I need to stay away from these opioids and benzos,’” Price said. “My understanding was he was doing really well.”
Soon after that he was admitted to a VA hospital complaining of chest pains. Tests revealed fluid building up around his heart and he was transferred to Stormont for a procedure to drain it. Surgeons would insert a catheter into his chest. It would be minimally invasive and he would go home the next day.
Bubacz called his mom on the night of Monday, Aug. 15, 2016, to tell her the surgery was scheduled for Wednesday. She told him she and her husband would come see him the next day but he told her not to bother, that everything was under control.
She didn’t go.
“Do I regret that decision? Sometimes, yes I do,” Price said. “Because the last time I saw my son was Thursday the 11th. That was the last time I saw my son alive and actually physically gave him a hug.”
Everything seemed fine after he was discharged. He texted her to say he was staying with friends in Topeka and sent her pictures of the room.
“In one of those last conversations we had he did say to me that he didn’t want to be a junkie, that’s not who he is, that’s not what he wants,” Price said. “He was really excited about getting his life together and really excited about this opportunity to live with other veterans. He seemed pretty upbeat and gung-ho about it.”
One of his friends found him, lying on a couch and frothing at the mouth, just after midnight on Aug. 20, 2016. Emergency services pronounced him dead at the scene at 12:23 a.m.
Price and her husband were on their way to the airport for an early-morning flight when they got the phone call.
A police officer told Price her son had been found dead. She handed the phone to her husband, unable to process what she was hearing. When the shuttle bus stopped at the airport gates, she reached for her bags. Her husband gently told her, no, we’re not getting off the bus. We’re not getting on the flight. We have to go back.
It was real. Jeromy was dead.
“And then I just remember screaming on the shuttle,” Price said.
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