Cesar had one of Fresno's more expensive habits. He liked to abuse alcohol, and then when he didn't feel well, he called 911 for ambulances — sometimes multiple times a day — to taxi him to a hospital of his choice. He was such a regular that he became partial to the turkey sandwiches served at one hospital every Tuesday.
Each of his ambulance trips cost hundreds of dollars and a basic hospital checkup around $400. So that adds up to your basic $1,000 turkey sammy. In one year, he called for an ambulance 710 times. It was draining the system, and more importantly, his underlying problem — the alcoholism — was not being addressed.
When confronted, his attitude was defiant: "I can use the ambulance whenever I want."
He was not alone. Word spread that this was a good way to get free transportation, food and health care. In 2012, The Bee's Marc Benjamin wrote about others abusing the county's emergency ambulance services to the tune of millions of dollars wasted each year.
Finally, after his story, there was a big wake-up call. Now, almost two years later, he reports success from Daniel Lynch, emergency medical services director for Fresno County. The EMS has devised a unique policy and procedure to cut abuse drastically. The program has saved more than $3.9 million its first 18 months. People suspected of abusing the system are given three warnings, and a list of resources, then they will not be taken to a hospital unless an emergency professional deems it necessary.
Makes sense. How much more money could be saved around the county if other departments tackled their challenges in the same way?
How did they do it?
The overarching policy issue is giving respect to the social services safety net and mental health treatment. The vast majority of frequent fliers were mentally ill, substance abusers or homeless. Getting help for the underlying causes of the calls was critical.
Sadly, the stigma and ignorance surrounding mental health and homelessness causes us to repeatedly underfund those services, which only winds up costing us triple the money, time and suffering when the problems emerge bigger and meaner.
In this case, litigation paralysis also set in. What if someone sued? There are ways to write good public policy that is fair and works within the legal system. The intention behind this plan is to help people out of the system, not to shut them out of the system, Lynch says.
Cooperation was key. They gathered all the people who could help: emergency personnel, mental health experts, social services, homeless services, hospital social services and law enforcement to the table. They engaged the abusers, stayed consistent and communicated.
This is not the end. Patients enter the system daily. It takes constant vigilance. But it is worth it. We hope other agencies will look and learn.