Magnificent Nine

A story in the USA Today about nine Texans who had gone to the ER almost 2700 times would have blown me away if I hadn't been a physician myself for the last 15 years. We call these people "frequent fliers" because they come so often and everyone knows who they are. Anyway, these patients were located in Austin and cost the taxpayers more than $3 million over a five year period. Here is what is known about them:

• Eight of the nine patients have drug abuse problems


• Seven were diagnosed with mental health issues


• Three were homeless


• Five are women whose average age is 40


• Four are men whose average age is 50

Let me be the first to say that Austin is not isolated in this issue. "Frequent Fliers" are everywhere! The article talks about answers which include:

• referring to mental health programs


• referring to primary care doctors for future care

Here's a little problem to that solution: I guarantee they have been through every mental health program and primary care doc in the community. It probably is not about access but more about the inability to commit these patients to a psychiatric facility/rehab or it is about their lack of compliance to any prescribed regimen of medication. Here is the bigger question - when will the ER be allowed to turn them away? You would have to believe that after, say, the first thousand visits of finding nothing wrong that the staff at the ER probably figured they weren't helping anymore. Either the ER docs are gouging the system for cash or they are afraid of getting sued if they turn these people away. My hunch is that it is the latter. In the future when we may have to RATION care, don't you think it would be wiser to stop one of these visits and save $1000 and use that money to vaccinate 20 kids or get two or three mammograms on an uninsured worker? I do.