Is 9-1-1 a Joke?
For the Washington Post, Dave Jamieson profiles one Kenny Farnsworth, a homeless, chronically ill man who represents a chronic problem for hospitals and emergency medical care professionals in the District, a man who has come to be known as "the Burpin' Man" or "the Choker" for his rather chronic gastrointestinal and throat blockage problems, respectively. Or, perhaps more likely, for his chronic overuse of the emergency room.
Over the years, he has suffered from convulsive seizures; a deviated septum; pancreatitis; gastritis; two perforated ulcers; a hernia; lymphedema, which causes swelling in his legs; acid reflux disease; and irritable bowel syndrome. His problems have run literally from his head, where he once suffered a skull fracture, to his feet, which are two different sizes, thanks to some bone removal after a break in his left foot.
None of those problems is a minor one. If you, reader, developed pancreatitis, whatever-the-awful that is, or needed to have your spleen removed but-quick, you too might avail yourself of the city's public health care services. Farnsworth would be a hypochondriac, were it not for the serious medical ailments he has also endured. Nevertheless, Jamieson's character sketch summarizes the argument that you might have heard from your conservative grandfather over the Thanksgiving dinner table about the g-d leeches who ruin it for everyone else. Jamieson writes that medical care professionals even have a term for these problem-types who use the emergency room like it was their medicine cabinet.
Jamieson writes:
He viewed emergency care as a basic right, and he sought it whenever a problem arose, regardless of how his previous trip went. After so many visits, Farnsworth thought he was unfairly labeled as "very low priority" throughout the metro area. His attitude toward hospitals became a combative one: "I have to fight to get medical care."[ . . . ]
In fire departments and emergency rooms around the country, patients such as Farnsworth are known as "frequent fliers" -- people of modest means and poor health who go in and out of emergency rooms day after day, their fundamental health issues rarely resolved, at a tremendous and ever-growing cost to hospitals, municipalities and taxpayers. Though Farnsworth presents an extreme example, the burden of dealing with inveterate patients like him has been straining hospitals in all cities for years now.
Despite the fact that Farnsworth's unpaid medical bills run into the millions of dollars -- this, even though his visits are covered by Medicare, a fact that would probably double your grandpa's heart pressure -- Jamieson does not paint Farnsworth as a public enemy, exactly. Rather, he cites a program begun in San Francisco that seeks to solve the problem at the source, by treating "frequent fliers" like Farnsworth for the legitimate and largely psychological illnesses from which they suffer. Street Calls, a new and similar organization in D.C. that targets these habitual offenders, has cut back ambulance rides for the region's most notorious 9-1-1 callers by 80 percent by organizing teams of paramedics and social workers to find these characters and help them seek help for the long-term problems pushing them to dial 9-1-1.
Farnsworth's story represents a rather extreme example of an endemic health-care problem facing the nation, one now being debated by experts much better able to address these issues than this writer. As a nation and as a people, we rightly refuse to let people suffer and die in the streets -- but how do we deal with the costs of treating people whose care represents a significant burden on the public health? In the District, the problem that those those individuals represent -- or, the problem that victimizes those individuals -- expresses itself throughout the city. I believe I heard that a homeless man who has lived in my neighborhood for at least as long as I've lived in the city, a guy named Pierre, recently died -- a guy who needed care always and was very much belligerent about seeking and receiving it. A great number of the arguments in favor of selling and transforming the Martin Luther King, Jr., Memorial Library during Mayor Anthony Williams's administration read as though they were primarily motivated by the thorny issue of the homeless and how they use the library -- a crisis that was even brought before the Supreme Court early in the decade.
How should the health-care debate reflect the rights of those who abuse the public health sector? Is that the way to frame that question, even? Certainly any serious reform of the health-care system needs to address the single individuals who cost millions, not just the million individuals who hardly use the system -- and hopefully in a more serious way than my family talks about it over turkey.