9 patients made nearly 2,700 ER visits in Texas

[WI_DEM]

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."

http://enews.earthlink.net/article/top?guid=20090401/49d2f4d0_3421_13345200904011233676770

[endarkenment]

1. Best Healthcare System on the Planet!

The only question is which planet, as it certainly isn't this one.

[WriteDown]

6. There is a puzzle here though....

Could even UHC handle 300 doctor visits per year per person?

[Horse with no Name]

7. There would be primary docs available for these people

at the present time, only ER docs are present for a significantly large portion of people in poverty.

[WriteDown]

9. How many primary docs would be needed for

300 million(low est) seeing doctor's 300 times per year? Even 60 times a year is a lot. As a poster pointed out downthread, these are probably drug addicts.

[Horse with no Name]

12. I think you fail to see the causal relationship of these visits

With GOOD primary care to meet their needs, whether those needs deal with chronic pain, addiction, or any other myriad of problems, those visits would be drastically reduced.
ER's MIGHT on a good day give you 10 pain pills to get you through until you can see another physician--however, if you don't have ANOTHER physician to go to, it will do nothing except tide you over until the NEXT ER visit.
There are many factors at work here--the number of ER visits is actually not the MOST important factor in this equation.

[WriteDown]

15. I agree...

I think the ultimate solution is to require bi-annual visits though. Required checkups twice a year will make a huge dent in chronic conditions and catch so many conditions early.

[Horse with no Name]

17. I think given the opportunity

that most people would do what was right for their own health situations--whether it was 2 visits a year or 20.
I wouldn't regulate that.

[WriteDown]

18. I don't have your confidence...

Many people hate doctors and just won't go as a rule of thumb. If you require 2 visits, you can spot the early signs of cancer, heart disease, std's, etc.

[Horse with no Name]

19. Most people--in my experience as a healthcare provider

fear the costs associated with these devastating diseases. They mask their fears as denial. Given the opportunity, I think our fellow Americans would seek medical help if they knew they didn't have to pay out of the nose for it.

[WriteDown]

22. Not sure about that...

My girlfriend's grandfather is a retired postal worker with superb benefits. Had a fever and a cough, but like many refused to see a doctor. Turned into bacterial pneumonia and spent 4 days in a hospital. This is just last week. I'm glad to say he's recovering, but GEEZ.

[Obamanaut]

28. "...require 2 visits..."? Can one "require" visits to dr.? nt

[WriteDown]

29. Sure.

Why not?

[endarkenment]

13. so a sane society would have outpatient treatment

for addicts - they want their vicodin damnit, give them their damn vicodin. Stop costing the system an ER visit each time they need to re-up.

[WriteDown]

16. And if they're a school bus driver....

Do you report them to the authorities? A better solution would be to have doctors have more training in how to spot addicts and offer alternative care instead of feeding them pain pills.

[endarkenment]

30. I think that is basically what I am saying.

This group was not composed of 'school bus drivers'. It was 9 highly dysfunctional people being treated in an ER because we as a society don't give a shit about people in general and certainly not about castoffs.

[Lyric]

33. A school bus driver would be drug-tested as a matter of course.

Your argument is fundamentally flawed. You picked a highly-reactionary job (somebody who keeps children safe) and used THAT as an example, when the truth is that there are very, very, VERY few jobs involving the safety of children (if ANY) in which the adult doing the job is not drug-tested regularly.

I am of the opinion that the milder forms of physical opiate dependency are not as bad as our Drug War society makes them out to be. Our society sees little difference between someone taking pain pills in moderation and someone shooting heroin. Vicodin pills are not heroin--not even close. The effects are mild after the first day or two. Lots of people take them regularly for pain, and as physicians who fear "addiction" get more and more stingy with them, people who are suffering real, everyday, chronic pain are left with not enough (if any) relief for it.

It's disgusting and bad logic to take the worst-case scenario (a heavy addict who's taking large doses and driving around recklessly) and make laws that assume that EVERYONE is going to act like that. Low-dose narcotics like Vicodin have less effect on your brain and your judgement than alcohol does. The whole "stumbling around intoxicated" thing doesn't happen unless the dose is high or you're not used to the medicine. The only really uncomfortable "side effect" is constipation, and that can be relieved by eating enough veggies and not taking too much. Yes, they're dangerous for people with serious breathing problems and other serious health conditions, but then again, so is alcohol. We haven't made THAT illegal. The vast majority of people who are in danger from pain medication are not stupid enough to take it if they've been warned away by their doctor.

I will never understand why alcohol is legal to buy in a store, but low doses of hydrocodone are not. It makes no sense to me at all. So many people suffer unnecessary pain because they cannot get the pain medication that they need.

Oh--and by the way, there's a HUGE difference between being physically dependent on opiates and being addicted. Physical dependency just means that you're going to have withdrawal symptoms if you suddenly stop. People who are physically-dependent usually take just enough to help the pain, and not more. "Addicts" are people who take it to get high, and when they can't get high from the low doses anymore, they start taking more, and more, and more, and end up taking doses that would kill any normal person. I've known addicts who got their medicine 100% legally from a doctor, and people who were physically-dependent who had to buy it on the black market because their doctor refused to believe them about the pain.

Fibromyalgia patients are especially prone to being in the latter category, as many doctors don't even believe that this horribly-painful condition EXISTS. It's almost impossible to find a doctor who's willing to treat fibromyalgia pain with actual pain medication--most of them keep trying to shove anti-depressants, new kinds of NSAIDs, and lots of other crap at us because they are so leery of prescribing pain meds. Life is HELL when your doctor doesn't believe you. It's so humiliating to sit in the doctor's office, telling him how much agony you're in, and wondering how you're going to broach the subject of pain medication, because you know damned well that HE isn't going to offer anything on his own. It's even worse when you ask and are told NO. They couldn't make it more obvious that they don't believe you.

I am a chronic pain patient, and I want to see GREATER access to effective low-dose pain medications--not more restrictions. It's bad enough as it is.

[endarkenment]

8. 60 - read the fine print - 5/years not one.

[WriteDown]

10. Even that is a ton.

I have a chronic condition and I'm lucky if I go twice a month. Just came from a spinal tap about 2 weeks ago. I think these are drug addicts as pointed out down thread.

[endarkenment]

14. homeless, addicts, derilicts - of course

that is the point. We let our total losers fall into the single most expensive treatment outside of critical care wards that there is. All because we cannot figure out that as a society we should provide proper healthcare to everyone.

[redqueen]

23. Precisely why we need a single-payer option.

I hope everyone has signed Dean's petition, and passed it on to others as well.

http://standwithdrdean.com/

[DJ13]

2. That many visits could only mean someone was paying for patients

Its not uncommon for some doctors group or hospital to get busted in the past for bringing in phony patients so they can rack up huge Medicare reimbursements.

[endarkenment]

4. The headline is hugely misleading

2700 visits over 5 years by 9 people works out to 60 visits/year. Each of these people had major chronic physical or mental health issues and should have, as the article notes, been in some more regular treatment program. They basically ended up in the ER once a week as they had nowhere else to go.

The problem here is that we do not have a system that is attempting to provide healthcare for our population, we have a system that is attempting to extract profit from people's need for healthcare.

[progdonkey]

21. 6 years, FYI... n/t

[Obamanaut]

3. So if these 2,678 visits by nine people is typical, perhaps the actual

number of uninsured is significantly less than the reported 40+ million.

[Horse with no Name]

5. I can only speak of the significant problem we have in our area

Our "frequent fliers" fit the same profiles, almost to a tee.
The majority of these are hooked on Vicodin. Many folks talk about the scourge of Meth (and I will not disagree with that), however, Vicodin is given like candy in many settings. It is considered one of the drugs of choice in our area.
Personally, I would not be happy until they make Vicodin a Schedule II and require physicians to monitor how much of that shit they give out.
The cycle is there. The docs have a patient that is in chronic pain, they prescribe Vicodin like candy, then they get tired of the patient, turf them out, and then the patient that not only has undertreated chronic pain, now has a drug addiction.
The ONLY place for them to go is the ER...and trust me when I say, if the ER doc does NOT give them the Vicodin on the first or second visit, there will be subsequent 3rd and 4th visits UNTIL they get what they need.
This is my life. I see it everyday at work. It sucks.

[eilen]

25. Well, it could also be 9 patients ER hopping

We had a few that did that and they got busted by Medicaid.

One example: a patient with sickle cell, she is chronic. She receives a script for oxycontin SR plus shows up at the clinic three times a day for an IM demerol shot, five days a week, often which children in tow (who should be at school). She refuses hydration because then she'd have to sit in the infusion room for a couple hours.

Come to find out she's hit every ED in the city every week and has been selling her oxycontin. She goes and gets more so she can sell more-- she isn't taking it. She also has forged a few scripts, going to different pharmacies.

How do I know this? After she gets busted, she is required to give a urine sample at every visit. First day she tries to pass over her daughter's urine. Now we have to send her in the bathroom alone and stand outside the door.

Another case, similar dx, comes in demanding a new script. Her previous one didn't end yet, it's the middle of the month. She claims it was stolen-- no problem, submit the police report and we will write a new one. No police report. Then admits she "shared" her pills with her neighbor. The Doc says no, I'm not losing my license for this kind of nonsense. She stages a major scene in the lobby and we have to call security. Then she shows up at the ED. The ED will give her something but not what she wants, another scene ensues. They call us, we tell them, call security or admit her for uncontrolled pain then hydrate her and place her on a PCA -- if indeed she is in crisis (which she is not). But she doesn't want to be admitted, she has plans for the weekend.

These scripts are for high doses of pain medicine. They are not toys, or entertainment. They are medicine. They can be dangerous for people who are not being treated for chronic pain.

[WriteDown]

27. Those stories are nuts...

I have a friend who is an ER doctor outside of New Orleans. He tells very similar stories. He has some really wild ones too.

[w8liftinglady]

31. we see the same things in Ellis County-we've created a nation of junkies.

Vicodin addicts...admit for chest pain,wake up every 1 1/2 hours for something-vicodin,phenergan,morphine-call the doctor,call the doctor.It is a shame.

[ddeclue]

11. Were they really the same nine people or was it John Smith and Mary White?

I would like to see these visits clustered on color coded maps to get an idea of what is really going on.

[progdonkey]

20. that seems much more likely...

2700/9=300 visits per person /6 years=50 visits per person per year or once a week. Does anyone who isn't a hypochondriac go to the doctor once a week?

[redqueen]

24. Sloppy, shoddy, corporate-agenda-driven journalism.

Don't you just love it?

[Bugenhagen]

26. I believe

I believe it is the same people. My mother works in a hospital and observes exactly this sort of thing. The small population of persons who regularly enter the ER were pretty well known to the hospital staff. As far as I knew they knew the names of all of them; most people can at least tell you their names.

As an example, one patient with diabetes used to come in very regularly in shock from failure to treat him or herself. I can only surmise why that would be, but it was so. I always sort of put it down to either mentally incapable of self-care or else so lost in despair of the situation that the person was borderline suicidal (possibly subconsciously). I have seen similar, but much less drastic despair behavior in a very close friend that I know and love. In any event the patient returned to the ER very often with insanely high blood sugar. The ER could stabilize the patient and so forth, but there wasn't any way to get the person to take care of themselves once they were discharged. The ER can't do follow ups in any meaningful way. I love the ER. Those guys will save your life, but they are only leg on what should be a tripod, because we also need preventive care for everyone as well as some sort of follow up system of home care or asylums or something.

To me this is indicative of a system whose motto is, "you are on your own". For having access to the best health care in the world, we also have got to be one of the worst societies in the developed world (if that is a figure of speech that still has meaning) in terms of actual population-wide health care.

Stories like the OP need to be promulgated so that widespread awareness of this phenomenon sinks in with the voting public. I have had health insurance off and on throughout my life. Sometimes good insurance, sometimes virtually unusable because of high deductables. If you have a $5,000 deductable and you are working a low wage job, you tend to put off worrying about that funny looking mole or chronic headaches or whatever. Many young people observe that you can always go to the ER, even without insurance. This is true and it helps with the broken leg, but it doesn't help at all with that mole. If the mole is melanoma and it spreads, well, the ER can't do much for you.

Sorry for the rambling.

[xchrom]

32. shrug -- the poor have a whole HOST of problems that manifest themselves like this.

with out single payer, mdicare for all, nationalized health care -- watever you want to call it -- incidents like these will always go on.

i work very closely with the aids community -- and i can tell you that this is not uncommon.

these are not pretty peple with pretty lives.

they have complex issues -- and the system as it is now is overwhelmed.

at clinics -- social wokers have client lists well above 600 individuals.

and that's before this current economic crisis.

we are in trouble -- we have been in trouble -- and as long as we don't see these highly dysfunctional people as relevant parts of society -- then this will continue.