WEST POINT — Blake Halfacre was working the job he loved, a civilian aircraft A-10 mechanic at Hill Air Force Base, when freezing rain hit the Wasatch Front in winter 2013 and turned his life upside down.
Then 39, Halfacre was walking between buildings on the base on Jan. 24, 2013, when he took a terrible spill on the ice, causing injuries to his head, neck and shoulders.
“I was ‘pile-driven’ onto the ice, and my shoulder separated,” Halfacre said. “My collar bone and every tendon in my shoulder broke away, with my collarbone almost protruding from my skin.”
The resulting complications from the injury and his recovery left Halfacre with a rare neurological disorder, leaving him to rely on a heavy cocktail of opioids to fight chronic pain. He says he doesn’t like taking the drugs, but doesn’t see any other legal option to relieve him from pain.
“Now with my right arm, I have to support my elbow just to brush my teeth,” Halfacre said during a recent interview at his home. “My right arm is severely atrophied. Being an aircraft mechanic, my days would fly by. I loved my work, I loved my coworkers. And to know that I’m probably never going to do that again with the problems I‘ve got — it sucks.”
It wasn’t until five weeks after the accident that Halfacre finally received the necessary approvals for surgery. He had surgery March 11 to repair what is termed a grade 5 acromioclavicular separation. Halfacre said he also experienced post-concussive fog due to the blow to his head when he hit the ice.
Post-surgical restrictions specified that he lift zero pounds from the waist up to allow his tissues to heal. But Halfacre said a doctor with HAFB’s Office of Medicine Services changed that restriction to five pounds and supervisors began to coerce him to come back to work in a different capacity.
Halfacre returned to work for a month during the summer of 2013, carrying out janitorial duties in the break room adjacent to the area where he formerly repaired and maintained military fighter jets.
“I felt like my job was in jeopardy. My supervisor was giving me ultimatums ... because in his opinion, I’d had plenty of time to heal,” Halfacre said. However, his surgeon speculated that he also suffered a neck injury, which was confirmed several months later by MRI.
“It took a series of denials and requests and denials and requests (to get approval for the MRI),” Halfacre said. “About a year and a half after that unwarranted return to work, it revealed I had a severely damaged neck and that all of these issues I was having from that return to work stemmed from being put to work with a damaged neck.”
For Halfacre, his premature return to work triggered Parsonage Turner Syndrome, “an uncommon neurological disorder characterized by rapid onset of severe pain in the shoulder and arm,” according to the National Organization for Rare Disorders.
“I was experiencing the acute phase of that while I’d been returned to work. And it was a nightmare — the pain was so unbearable that sometimes I would pass out,” Halfacre said. “It took me four attempts approaching my supervisor and the base doctor so that they realized the error in their recording of my restrictions.”
Fortunately, last spring a University of Utah surgeon performed a procedure called arthroplasty to replace a disk in his neck.
“The surgery was a success and it did give me some relief, but it didn’t give me everything the doctor had wanted,” Halfacre said, noting he still suffers from Parsonage Turner Syndrome and chronic pain. He’s also awaiting another surgery on his lower back due to aggravation of a previous injury by his fall on the ice.
In June 2016, Halfacre obtained a second opinion from a doctor with the Office of Workers’ Compensation Programs. Following a day-long interview with Halfacre, who arrived heavily loaded with documentation, Dr. Susan Weit concluded, “Had Mr. Halfacre been allowed to heal as initially directed by his surgeon, he may have avoided further aftermath of the initial injury, such as Parsonage Turner Syndrome, additional stress, and progressive prescriptions of pain medications.”
She also noted Halfacre raised concerns about his current pain killer dosing, saying “these medications kill people ... and they want to give me higher doses but I refuse.”
“Had he been able to heal in accordance with (his doctor’s) orders and subsequent recommendations from other providers, he likely would have healed in a relatively short amount of time,” Weit said in her written opinion to the Air Force.
In addition to dealing with chronic pain, two recent events have spiked Halfacre’s stress levels.
An Air Force memo dated Dec. 29, 2016, informed him that his base job was being terminated in January, which means a corresponding loss of health insurance. Then, on Monday, Jan. 30, a West Point pharmacist denied him a refill of two opioid painkillers — oxycodone and morphine in hefty doses — to manage his pain.
Halfacre is in the process of appealing the job termination and was able to find another pharmacy further away from home to fill his prescription.
Cole Brinkerhoff, head pharmacist at the Smith’s Marketplace in West Point, said he was doing his job when he confronted Halfacre about having an opioid-reduction plan.
“A pharmacist can deny filling any prescription if he feels it’s not appropriate. He can use his professional judgment,” Brinkerhoff said. And Halfacre’s high doses raised red flags, even though he called his doctor who confirmed the amounts.
The CDC issued recent guidelines to rein in opioid prescriptions for chronic pain, and Brinkerhoff said that “we’re working to get people toward a safe dose” by managing pain in multiple ways that include physical and cognitive therapy. “We want it to be a partnership with the doctor, but not all doctors see you that way. They see you as an interference.”
And Brinkerhoff said he wants the patient to at least exhibit a willingness to work toward reducing opioid use, but Halfacre “didn’t show any willingness to try any other things. Had he been willing to do that, I would have filled his prescription.”
For Halfacre’s part, he said he also receives nerve-block injections and carefully controls his diet and rest because, “I’m always running from the ugly monster called chronic pain,” he said.
Halfacre described how Brinkerhoff pulled him aside for a 45-minute conversation about things he felt he already knew.
“His only explanation (for denying the refill) was ‘I’m uncomfortable.’ I thought, ‘You’re uncomfortable?’” Halfacre said. “If I were to let my medications lapse, I don’t care how tough you are. I’m out of toughness.”
Halfacre related a short stint he experienced without his opiate medications a few years ago.
“I was vomiting constantly and couldn’t keep pills down orally, so I went about 12 hours without them before I realized I had to go to the emergency room,” Halfacre said. “It felt like I got shot in the stomach. It was such an unbearable pain. I just know that if I didn’t have the intravenous painkiller they gave me at the emergency room, that I might not have lived through it. So I’ve had a taste of what withdrawals are like.”
At this point, Halfacre said he’s roughly $30,000 in debt and grapples with limited options.
“In the future, I might have to move to a medical cannabis-friendly state, so I can have a plan for opioid reduction. I know there is an avenue I can go down, but not in Utah,” Halfacre said. “Everybody who has my symptoms in the support group I’m with says they have their lives back because of this miracle plant. My pharmacist asked me what I could do to reduce opioids, and I’m saying I could move.”
While Utah is surrounded by states that have legalized medical cannabis, state lawmakers are hesitant to jump on that bandwagon and patient advocates are now pushing for a 2018 ballot initiative to legalize its use for medical purposes.
But there is movement, in Utah and nationwide, to reduce the number of opioids being prescribed.
Utah lawmakers are currently considering several bills regarding opioid prescriptions.
Rep. Ray Ward, R-Bountiful, is sponsoring HB50, which would cap prescriptions at seven days for individuals who have not received an opiate medication within the past 90 days, and HB90, which deals with insurance and minimizing the risks of opioid use.
Meanwhile, Rep. Stewart Barlow, R-Fruit Heights, is sponsoring HB146 to allow partial filling of an opioid prescription.
Halfacre had a bit of advice for others who might find themselves in his shoes.
“I tell federal employees ‘don’t get hurt.’ And if you’re on pain medication in this state, keep on your toes because your pharmacist can take it away at any moment,” he said.