Don’t allow abuse of ambulances

When Hawaii Medical Centers closed down in January, one of the most acutely felt gaps in medical care was felt in the emergency services arena — two fewer emergency rooms to supply the services needed by a rapidly growing area.

And now it comes to light that the demand side of the equation has been adding to the strain, too, even more than necessary. The city Department of Emergency Services reviewed its log of 911 calls and found a top 10 list of patients, most of them served by EMS dozens of times in a year — 527 help calls in all. Topping that list was a single individual for whom the ambulance was summoned 142 times in 2010.

Something needs to be done to find ways of treating these patients more effectively and with less cost to the taxpayer. For some people, the ambulance has become the health-care plan of last resort, and it simply wasn’t intended — or budgeted — to perform that way. Many are among Honolulu’s homeless population, which complicates the challenge of solving this problem.

All of them have medical problems, sometimes including alcoholism, mental illness or other conditions. These are people who need help, but certainly the ambulance and other emergency services is not the way to deliver it. The cost is roughly $800 per trip, and it ends up on the taxpayers’ tab, with many of the most frequent users receiving government benefits under Medicare or Medicaid programs. And this doesn’t even count the emergency-room costs for those who get hospital treatment as well.

That is not the way to deliver care. The failure is clear in the numbers: Someone who calls 911 91, 75, 50 or 40 times in a year — the tally for those rounding out the Top 5 in the list — is not finding a solution on this path.

The emergency department, fortunately, is moving to take the problem in hand. Dr. James Ireland, the agency’s director, told Star-Advertiser writer Susan Essoyan that his staff is working on an outreach program, which, he said, "will not only help them but also save a lot of money."

A pilot program has a target start date of the end of October, in which critical information is collected on the top users. A working group of the state Interagency Council on Homelessness will be joining in with the outreach. Collaboration of this sort is exactly what is needed.

Further, this effort seems to align with a worthwhile project under way at the John A. Burns School of Medicine, where teams of trained providers and doctors in residence are forming teams to meet some of those needing mental health services where they live: on the streets.

Perhaps there’s a wider network to be formed by combining efforts of EMS and the medical school to get a handle on the repeat patients’ health needs, and find social services that can take these people under their wing.

There certainly seems to be potential for community involvement, too. An initiative geared for helping house the homeless drew thousands of interested volunteers last weekend, and some synergy could be possible there, said Colin Kippen, state homelessness coordinator.

The aim should be to get more people treated in a primary-care setting, added state Sen. Josh Green, an emergency medicine physician himself. It’s not only the homeless who overuse the emergency room, and he called for a program to divert people to primary-care providers with extended hours and to urgent-care clinics, which seems an entirely sensible objective.

The EMS finding that its 911 emergency service is being overused, even abused, by a small but persistent set of patients is alarming. It’s one of a myriad problems linked with the homelessness crisis that certainly will worsen if they’re ignored. And that’s an outcome with a financial and human cost that nobody wants to see.