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9 people visited Emergency Room 2700 Times


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http://news.yahoo.com/s/ap/20090402/ap_on_...ent_er_patients

 

Guess who is going to be using up the free health care that taxpayers will pay for....more people like this. This is fucking why the two times in my life I have needed the Emergency Room...I had to wait for 4 hours to be seen the first time and 3 hours the second time. No matter that once was a broken collar bone and dislocated should that was swelling by the minute....and second time my wife was having chest pains and shortness of breath.....but hey the 6 snotty nozed kids and their fat moms on cell phones with 100 dollar hairdos and freshly done nails needed Motrin and Tylenol for their fucking runny noses. :angry: :angry:

 

Luckily I have a high pain threshold and ended up leaving and going to another hospital on other side of town and was seen immediately....and wife was having anxiety attacks as it was two days after her father died from 18mos fight with cancer while she was holding his hand.

 

Fucking leeches...

 

 

9 patients made nearly 2,700 ER visits in Texas

Wed Apr 1, 9:19 pm ET AUSTIN, Texas – Just nine people accounted for nearly 2,700 of the emergency room visits in the Austin area during the past six years at a cost of $3 million to taxpayers and others, according to a report. The patients went to hospital emergency rooms 2,678 times from 2003 through 2008, said the report from the nonprofit Integrated Care Collaboration, a group of health care providers who care for low-income and uninsured patients.

 

"What we're really trying to do is find out who's using our emergency rooms ... and find solutions," said Ann Kitchen, executive director of the group, which presented the report last week to the Travis County Healthcare District board.

 

The average emergency room visit costs $1,000. Hospitals and taxpayers paid the bill through government programs such as Medicare and Medicaid, Kitchen said.

 

Eight of the nine patients have drug abuse problems, seven were diagnosed with mental health issues and three were homeless. Five are women whose average age is 40, and four are men whose average age is 50, the report said, the Austin American-Statesman reported Wednesday.

 

"It's a pretty significant issue," said Dr. Christopher Ziebell, chief of the emergency department at University Medical Center at Brackenridge, which has the busiest ERs in the area.

 

Solutions include referring some frequent users to mental health programs or primary care doctors for future care, Ziebell said.

 

"They have a variety of complaints," he said. With mental illness, "a lot of anxiety manifests as chest pain."

Edited by Brock
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Well, let's see...

 

Of the 20 or so people I have seen today...

 

How many actually NEEDED to be in the ER, as opposed to how many could have gone to their doctor, or simply taken OTC medications?

 

Two.

 

That's right.

 

Two.

 

One out of 10. (I know stu won't believe that, but hey...).

 

We routinely have people come in with, say, a backache or a headache, and I'll ask them two questions:

 

1. "Have you taken anything for this? Motrin, Tylenol, anything?"

 

2. "Have you called your doctor about this problem that has been going on for (2 days, 3 weeks, a month and a half, etc.)?"

 

Would you care to guess how many times the answers are "No." to both questions?

 

Almost. Every. Single. Time.

 

And when I ask them why not, you know what the answer usually is? "I don't have any."

They come to the ER to get dispensed pain medication, and run up a 3 or 4 hundred dollar charge, that they have no intention of paying, rather than go to Fred's or Walmart and buy a 4 dollar bottle of generic Motrin or Tylenol. Because if they go to the store they will have to actually buy it. I actually had a woman tell me, "why should I go buy some when I can just come here, and y'all have to give me some."

No, I am not kidding.

Now another sad thing is, a lot of people are now wise to the trick of saying "I have chest pain" to get taken to the back fast...then when they get back there, they suddenly develop a bladder infection, or a sore throat, or insomnia, or whatever.

 

Our ER's have become the catchall. We are now the doctors office, the pharmacy, the work excuse place, and the therapist, in addition to being, once in a blue moon, the actual Emergency Room.

 

And Brock is right. Guess who is paying for all these people?

 

Yup. :angry:

 

-Doc

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:o:mellow:;)

 

no, i think it was her father dying in her arms two day earlier but thanks for the diagnosis you offered....I think she would gladly swap mental illness for her fathers life and not having to go through that again.

Edited by Brock
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no, i think it was her father dying in her arms two day earlier but thanks for the diagnosis you offered....I think she would gladly swap mental illness for her fathers life and not having to go through that again.

 

Sorry that happened to you guys, Brock.

 

Chest pain and SOB should be going to the head of the line immediately, as should obvious fractures.

 

Unfortunately, like I said, our population of 'frequent fliers' has now figured out that "Chest pain! Shortness of breath!" get then in quicker....which results in some jackass occupying a bed that would otherwise have someone in it that really WAS having chest pain.

 

THese people now treat the ER like the big, free, 24 hour, walk-in clinic.

 

We have now tried to triage more diligently, and when we find someone who abuses the system chronically, they tend to get a couple of hours of FLT.

What's that, you ask? "Fluorescent Light Therapy."

 

Of course that has risks as well... as evidenced by the woman who died in that ER waiting room. However, I have to say, I don't think I've EVER had anyone wait for more than 8 hours. She was there for, what, two days?

 

Well, I gotta run. My nursing staff tells me I have to go see 4 or 5 emergency colds now. <_<

 

Oh, and the drunk who fell in a local chain store, and is already on the phone with a lawyer. :bomb:

 

-Doc

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no, i think it was her father dying in her arms two day earlier but thanks for the diagnosis you offered....I think she would gladly swap mental illness for her fathers life and not having to go through that again.

I was just pointing out the irony of two items I quoted from your post, not offering any diagnosis.

Didn't mean to offend. I am sure most of us would rather have our parents back too.

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not sure how you meant it...she had chest pains and shortness of breath and after 2 hours of tests they said it was likely anxiety attack from all the stress of her fathers illness and prescribed some drugs.

can assure you it is not mental with her...she never goes to doctor and never complains. good southern girl.

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Yeah we definitely have our share of frequent flyers, but the Dr.'s are now telling them all to stop abusing the ER because most of them have some type of "mental Illness" and are sponging up the SSI from the people who really need it. Thank God I only have to work ER every other weekend. Shortlegs

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I supervise (and fill a slot on the rotation) a Crisis Response Team. We are 24/7 and respond to law enforcement,EMS and the local ER. There are four fulltime staff whose primary purpose is to assess these folks and take a "safety first" but divert whenever possible approach.The goal is to keep resources available for those who are truly in need and save tax dollars.

 

Were these patients in our county we would have been called to do an urgent/emergent mental health/substance abuse evaluation and recommendations w/referrals would be made to the appropriate treatment providers.This may occur at their residence,police agency,back of the bus,on the street,school,in the ER...

 

Recommendations may include out-pt substance or mental health treatment. Other times they may need in-pt psych stabilization. Some may need a medically assisted detox (you can die from certain types of w/drawal including alcohol,benzos) or rehab for substance issues.

 

If they appear to be drug seeking for real or imagined pain they are referred to PCP or Pain Management doc.

The ER doctors then flag these pts in the system so the other docs will be aware of what their issues are and what other options have been offered to these pts. The pts are advised that they have been flagged and that the expectation is that they follow up with appropriate treatment. They are given appointments/referrals upon their discharge. The ER docs rarely prescribe pain meds to anyone with a hx of addiction or serious mental health issue with no validity to source of pain.The pts are NOT told that they can't return (is illegal/unethical?) but they are told by the ER staff that their notes would indicate that pt's issues were chronic,not emergent,and that the pt has been provided with appointments to appropriate treatment providers. There are some diehards who will try to come back a time or two but they soon get the message and stop abusing that ER. Some of these pts will then go to the hospital in the next county not realizing that the same group of docs and nurses also work there.

 

Our program is quite successful in that our stats reflect that we do what we are paid to do. The ER staff love us. We have a great working relationship with law enforcement and EMS.We save them time (road cops love this) and money (fewer EP trips amd overtime due to babysitting in ER, Chiefs love this).

 

We see a cross section of society and there are all types of folks who have "issues". Not all of these people are like the ones in the article. Some are desperate and come to our attention because of that and not because they are trying to abuse the EMS system.Many do have moderate to severe mental health issues which goes untreated for many reasons (no insurance,psych meds can have harsh side effects and are expensive,stigma,symptoms themselves can interfere with pursuing treatement such as depression can be immobilizing,anxiety causes avoidance,paranoia speaks for itself). Often times these folks develop substance issues as they try to self medicate with the wrong type of drug.

 

I probably have written what is a long and boring post about a topic most won't care much about. Dr Mark.,if you made it this far,you would love to have me and my crew in your ER. We help the ones who want and need help and we use the "chicken wing" approach on the rest.

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I agree with MsZoom and Brock. Believe it or not, 7 out of 10 Americans suffer from some kind of mental health issue. The majority never seek treatment due to the stigma involved with obtaining help, and the attitudes that exsist towards those who are SICK, yes I said SICK. Thing is, a person with a bi-polar disorder usually convinces themselves that they don't need their meds. When that happens on a full moon, Doc & Alisa rue the day they ever studied for their respective fields. And yes, certain mental health disorders begat full 100% disability, hence government assistance, albiet the patient may appear to be in training for the olympics physically, and at quick glance one can not understand why the individual does not work. Could be that voices are screaming at them every waking second telling them how fucked up they are. My first day in graduate school, the professor gave me a tape recorder (walkman), and a set of instructions to complete. I was told to leave campus with this tape playing and board a bus cross town, change buses, go into a bakery and ask about ordering a birthday cake, and report back to the professor my findings. Well I clicked the tape on, and all these ghost-like voices telling me I was dirty, everyone was laughing at me, and I was queer and various and sundry other wonderful things. Hell, when I got back to class women were crying, guys looked shocked. WHen I was asked to report on my experiences, I told them it sounded like a cross between my darling ex-wife and my drill instructure. Seriously though it was a demonstration with powerful results. I cannot imagine life like that.

 

Being a right wing Republican, I also understand the scumbag, leach, baby factory, lazy, piece of shit fuckers who have never had a family member in 3-4 generations hold a steady job. I quit taking Medicaid/Medicare in my private practice due to you have to have advanced degrees in linguistics to understand how to capture funds. You fuck up one little thing, you have to pay them back, even if they audit you in 5 years time.One of the stupidest things I saw in the new guidelines was that mental health providers had to had a dedicated "ombudsman" telephone that can only be utilized for consumers to complain about how badly you treated them. I can say this, things go much smoother now that I take cash and real health insurance for renumeration.

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If those stats are correct, and split somewhat evenly amongst each patient, that is one trip per patient per week every week for six years. Looks like the ER staff would have recognized each and everyone after a few visits and treated each(or not) accordingly.

 

'Course not knowing protocol and rules for treating or refusing to treat malingering patients or addicts, maybe ER staff's hand's are tied.

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If those stats are correct, and split somewhat evenly amongst each patient, that is one trip per patient per week every week for six years. Looks like the ER staff would have recognized each and everyone after a few visits and treated each(or not) accordingly.

 

'Course not knowing protocol and rules for treating or refusing to treat malingering patients or addicts, maybe ER staff's hand's are tied.

I questioned this myself...what the hell happened that they kept coming back. My guess is that these patients were getting what they wanted and not what they needed.

 

State laws/Practioner regs can differ from state to state. Our county happens to be a proactive and progressive county and the local ER has benefited from a law enforcement initiated and implemented mental health program.

Had those patients been in San Antonio instead of Austin they would have had an approach similar to what we do here. Our model is based on the San Antonio-Bexar County model (on a much smaller scale due to the size and rural status of our county) which has been nationally recognized for Hospital/Jail Diversion of mentally ill patients.

 

I think that common sense has to kick in at some point. It may be that based upon the regs in their location/facility they cannot refuse to treat reported symptoms,including pain.

 

Our Team can also assess at the request of paramedics for pts who are medically cleared/have a pattern of abusing ambulance/hospital services. If we do not feel that there is an imminent risk of danger (suicide/homicide or dangerous symptoms present such as delusions/hallucinations/mania) then they can refuse to transport. The rationale is that we are a rural county and it is expensive to run an ambulance 30-4o miles one way for a non-urgent/emergent matter.

 

In addition some of the outlying areas have one crew/one bus. If they are transporting unnecessarily then their territory must rely on mutual aid (another unit in another town on standby). This means if there is an accident or heart attack,etc. there will be a longer response time. It is cheaper and safer for one of us to respond to the scene,assess and make disposition. If we need to write an Emergency Petition and there is no medical need then a police officer can transport, the bus goes back to the barn and we coordinate the patients admission/aftercare plan. If they are not a danger to self or others we link them to appropriate out-pt care and the officers return to service instead of taking a trip to the ER.

 

We get some comical reactions from patients who migrate here from other areas. This is due to the very large resort beach on our coast. Many are absolutely floored when the medics refuse to transport them to the ED for "pain" and then they up the ante with a suicidal threat which gets them...ME or one of my crew...instead of a free ride to the hospital to get free pain meds for them to abuse.

 

The medics favorite line is "You HAVE to take me,it's the law". This is where the medics usually make the suggestion that they return to where ever they came from. One medic tells them "You're not in Kansas anymore". If they have medical problems or there is a gray area they will err on the side of caution and transport to protect liability and patient.

 

I typed the long version as I want folks to know that there are pockets of the country that are addressing this issue of wasted resources and wasted tax dollars.Given these issues coupled with the waiting room full of non-emergent colds,blisters,etc. I can see why the ER staff gets burned out and struggles with their bedside attitude.

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I think a lot of places are scared to do the RIGHT THING for fear of lawsuit if by chance ONE TIME something happens and they file a suit saying medical care could have prevented it...

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Alisa, I would LOVE to have a crisis team. You have no idea. That idea is the best thing for ER docs since penicillin.

Unfortunately, I'm in Mississippi, and we are about 47th in mental health care.

NAMI has given us an 'F' in this state since the ratings began.

 

The sad thing is, the malingerers and the other bottom-of-the-barrel types that we have to deal with, eat the resources that are truly needed by the truly ill, both physical and mental.

 

Unfortunately, we also live in a society that is so litigiously-oriented that we have to order tests that we know we probably don't need... like godawful expensive CAT scans for example...because there is that half a percent chance that the junkie-looking person with the headache has a tumor or a bleed from falling down...and God forbid you miss it, because then their family (who threw them out of the house years ago) will sue you for 50 million dollars. And win.

 

This is my world.

 

-Doc

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I think six of those folks live in Euless, we have so many frequent fliers that I know their medical histories by heart. EMS is used as a Taxi service by alot of folks, seems some one once told them if they went to the hospital by ambulanc they could bypass the waiting room. Not the case, I often start my pt report on the phone with "I have a candidate for triage". Meaning you should see anyone with a problem greater than the one I'm reporting first.

 

Doc, I feel your pain. First call of the year was at 3am with a pt who had a cough, she's had the cough for 5 days, and decided that the ER would not be full at 3am on New Years day and she could get right in. The level of ignorance is amazing, I can't tell you how many children I've run on that were having seizures cause Mom and Dad didn't have the sense to give them them some thing for their fevers, or they were not smart enough to realize that one dose won't last 24 hours.

 

Hospitals and EMS are going to be continuely overused, simply because we do not ask for money up front, and we won't turn anyone away. With that being said, I will add that I would rather tote a dozen GOMERS (get out of my ER) then miss out on responding to the one pt that truely needs help, due to monetary considerations.

 

I would also like to say that "mental illness" is no different than being a Diabetic, in both cases the body is not making or responding to a substance that those with out the illness make and respond to. In both cases a life long commitment to managing health is required, often times drug thearpy that once worked will cease to work, and a new regiment is sought. With both illnesses folks often quit taking their meds (for a number of reasons) and bizzare behavior becomes evident.

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