Intoxicated "frequent fliers" strain emergency services

Dec 12, 2012

Providence Public Safety Commissioner Steven Pare wants you to call 911 if you're having a real emergency. But he says most calls these days - more than 75 percent - aren't emergencies. And that's stretching city resources thin.

"Look, every time we send a rescue out on average to pick up a person anywhere in the city and transport them it's costing the taxpayer $550 dollars."

Par says the city eats about $10 million dollars a year in ambulance runs. And up until just a couple of weeks ago, rescue crews simply responded to every call, emergency or not, with the same urgency. They even had a punch line about it.

"You call, we haul, that's all. That's what they said here."

Not everyone who calls and they haul-needs the emergency room. That's often true of people who are intoxicated. But current state law requires emergency rescue crews to take intoxicated people to the emergency room, period.

"And the danger and risk is tying up our six rescues on all these non-emergent calls. And then we have a couple emergencies that come in. And we don't have the rescues to send. So we call on out-of-town rescues that may take a bit longer."

Those out-of-town rescues cost money, too. But Par says a new policy is allowing emergency dispatchers to prioritize calls. He says that in just a couple months they've been able to cut out-of-town rescue requests in half. Still, many of those rescue runs are for people who are drunk or high and probably don't need the emergency room.

Kevin Gomes is the kind of guy you hope is answering when you call 911. He's calm. Good natured. And he was a Providence firefighter for years. Now, he manages this place, the city's emergency call center. It's in a small brick building on the other side of the highway from downtown.

"We have one gentleman that calls every day, the same time. I no feel good. I don't feel good.' We know he's been drinking."

Every day, they send an ambulance for him. And take him to the emergency department, where he gets a sandwich and sobers up. He hasn't called yet. But Gomes says it's only a matter of time.

"Ironically, you know where we pick him up? A liquor store. Outside of a liquor store. So they're enabling him too."

Gomes says he and his colleagues answer around 50 calls every day either from passersby who see someone slumped on the curb or from the intoxicated person. That's more than half the 32,000 rescue runs every year. Gomes and his colleagues say they'd rather be putting their years of experience and room full of high tech equipment to better use. They'd rather not have to pick up that guy who calls every day--nicknamed "no feel good." Because Gomes says they know it's not doing him any good.

"They do need help and we understand that. And there's got to be some kind of system where they're getting that help. Whether it be like a comfort station, or but not where they're just getting a sandwich and when you sober up they're letting you go. They're giving you some type of counseling, or they need something."

Lots of people agree with him. And we'll get to some of the solutions. But there's even more to the problem. Gomes knows the transportation side of the equation. The emergency department visit itself can cost at least $650 dollars and that's just for basic medical attention, a turkey sandwich, and a place to sleep it off. The problem has gotten so bad for emergency responders and hospitals that Rhode Island lawmakers convened a special senate commission to study it. They asked: should we divert intoxicated people, the so-called "frequent fliers," from emergency rooms, and what do we do with them instead?

Dale Klatzker runs the Providence Center, a nonprofit that helps people with substance abuse and mental health problems. He doesn't think substance abusers are getting what they need in emergency rooms.

"The emergency room physicians want to do a good job. They care about people. But they're trained to deal with an acute episode of something. What we're talking about here is a chronic illness."

Meaning that addiction typically gets worse, can be fatal, and usually takes some kind of longer-term treatment than a night of drying out in the ER. What's more, Klatzker says alcoholics and drug addicts might not accept treatment right away.

"This is a generally treatment resistant, low motivation group of people who aren't going to . You're going to have to work 10 times harder to engage them and connect with them, than you would with somebody else."

Many are homeless, or have other mental health problems. They need more than a trip to the emergency room and a discharge back onto the streets a few hours later.

"If people have a safe place to go, and they're treated with some dignity and respect, at least some of these individuals will engage eventually and seek and receive treatment, and recover."

So Rhode Island is looking at some options. One is a sobering center. Another is a waiver of that state law requiring rescue crews to take intoxicated people to the ER---so that instead, they can take them to the sobering center. And, that wherever they're taken, patients have access to the range of services they need to recover. Klatzker says a lot of those services are already out there. The problem is that people aren't being connected to them effectively. But a sobering center could serve as a hub for those services. At the very least, Klatzker says, it could save money down from the thousands many frequent fliers cost in public dollars every day in ambulance trips and ER visits.

"We are spending the money now. We are serving these people now. It's costing a bunch of people a bit of money to provide bad care for bad outcomes."

The state has to come up with a proposal by December 31st. If approved, the plan will need funding. To succeed, Klatzker says that plan has to be about more than a shelter bed.

"What I worry about is that there's no way currently for government or any of the parties involved in this to make a big enough investment without expecting that you're going to see an immediate return on that investment, but know that in making that investment that in a year, or in two years or in three years you're going to make a significant difference."

One community not far from Providence has seen a significant difference since it opened a sobering center and began taking people there instead of to emergency departments. It's a model Rhode Island is considering if lawmakers can agree to fund it. We'll visit it tomorrow in the second part of our series.