Frequent fliers

Frequent flyers are the bane of EMS systems nationwide. A woman in South Caroliina was just charged with abusing 911 after calling them with bogus medical complaints more than 100 times since 2005, according to deputies. That sounds extreme until you think that this case is not even the average for abusers.

In my first due area, I had a patient (let's call him Jimmy) that used to call 911 4 or 5 times a week. I once ran on him 5 times in one day. (That is the record for my system: 5 in a day for one patient. The previous record of 4, to a patient we called Miss Cleo because she looked like the celebrity, was also mine.) The reasons for this vary.

In Jimmy's case, he would call to get a ride to his sister's house when he was out of money after having spent it all drinking, or he would call 911 to be taken to the ER, where they would give him a sandwich and a Gatorade, and he would walk out.

Miss Cleo was a different story. She had psychiatric problems. The first time I ran a call on her, she was lying on her back trying to do CPR on herself because she couldn't find her own pulse.

There is Kevin, the homeless guy that just needs a place to sleep. There is Eric, who knows the ED staff will feed him. The list goes on.

The problem is multiplied nationwide. Indianapolis. Also in Washington, DC. In Louisville.

Some measures, like the one in DC help, others won't. For example, in Houston they are charging a $13 per mile fee. The problem is that this won't stop the abusers: Medicare and Medicaid won't pay that rate, and neither will the abusers who won't pay the ER, either.

EMTALA and legal liability are at the heart of this issue. EMTALA says that everyone has to receive treatment, even if they can't pay. Legal liability is the fear of being sued of you refuse to transport a person and they turn out to actually be ill. The frequent flyers know how to play the game: feign chest pain, go to the head of the line.

This is a problem that has no easy answers.