Emergency responders are being strained by such inappropriate calls to 911 and patients who want ambulance rides to hospitals when their medical ailments are less than dire, a Dayton Daily News investigation has found.
Dayton Fire Chief Herbert Redden calls them “frequent fliers. Some frequent fliers may be transmitted to the hospital — within a year’s time — 65 times,” he said. “It’s not germane just to Dayton. It’s a national trend.”
Each ambulance run costs local cities between $309 and $1,060. Dayton’s rates range from $500 to $1,050, meaning 65 trips would rack up a bill between $32,500 and $68,250, much of which would be picked up by taxpayers.
Emergency responders rushed to Dayton resident Melvin Brooks’ house 40 times between April and June, leading the city to finally charge him with 911 abuse. Recordings of his garbled calls reveal him complaining about seizures, “devil worshippers” and paramedics not taking him where he wants to go.
Uncompensated trips — including not just misuse, but legitimate care that isn’t paid for — cost Dayton alone $8 million a year, according to Redden.
Meanwhile, the city is trying to cut up to $15 million from its budget — possibly in part by refining ambulance service — and emergency response staffing has gone down in recent years while the number of calls have gone up.
“Those frequent fliers make a big indentation as to the service we can provide,” Redden said.
Dayton handed out 57 tickets last year for 911 abuse, up from 34 in 2008. They have taken eight people to court in the first six months of this year on this charge; that’s more than the last two years combined.
But in addition to the cost to taxpayers, there is a danger that medics on an errant call won’t get to a real life-or-death emergency in time. Each time EMTs transport someone to the hospital — even for minor ailments — it puts a medic out of service for about an hour, Redden said.
Some calls amount to clear-cut fraud: Someone claims to be ill, then jumps out of the ambulance at the hospital and trots down the street, just wanting a ride across town.
But more common are the calls in which someone needs some help, but less than a full lights-and-sirens ambulance run to a costly emergency room.
Jefferson Twp. resident Maggie Racz summoned paramedics 15 times in two months. She’s diabetic, and says she frequently needs medical attention. Last time she called, she was ticketed.
Racz defends her use of the 911 system. “(That’s) what it’s for, and they’ve come through every time,” she told WHIO-TV reporter Jim Otte during a recent interview.
EMS calls up as population dips
The Dayton Fire Department responded to 25,860 EMS calls in 2010, up from 20,594 in 2000. That, while the city’s population dropped nearly 15 percent in the decade.
The National Academies of Emergency Dispatch estimate that 20 percent of all 911 calls are not life-threatening, according to NAED co-founder Jeff Clawson. These calls still require some sort of response, the NAED is careful to add. About 13 percent need medical transport — for such things as burns to less than 18 percent of the body, a broken knee or maybe a seizure — but not a paramedic. Another 6 or 7 percent would be better served by a nurse help line or social service agency, Clawson said.
Calls and response
Montgomery County Regional Dispatch handles medical calls for a dozen local jurisdictions, including Dayton. Dispatchers there ask callers questions to determine what type of call it is, then send out the number of units each jurisdiction mandates for each type of call.
Montgomery County Sheriff’s Department Capt. Rob Streck, who oversees dispatch, said there is disparity in how many units each jurisdiction sends to each type of call, but less than there used to be since they moved to a priority dispatch system about a year ago. Within that system, some calls are categorized as possibly not needing an ambulance response. But local emergency officials have yet to feel comfortable not responding to them at all, Streck said. There were 259 such calls last year.
A review of Dayton’s 911 runs in the first half of this year show the most common complaints they get are chest pain, someone falling unconscious and auto accidents. Breathing problems, falling down or simply “illness” are all fourth, each accounting for 5.2 percent of calls.
Many of these calls include not just an ambulance, but also a fire truck because of the manpower and number of paramedics needed under a worst-case scenario, Redden said.
“If I’m going to err on somebody’s life, I’m going to err on the side of safety,” Redden said.
This means staffing every vehicle with at least one paramedic. The average firefighter/paramedic costs the city $103,979 in salary and benefits a year, versus $54,172 for a top step civilian EMT. EMTs, or emergency medical technicians, have considerably less training than paramedics.
The cost of rides
Dayton charges between $500 and $1,050 for an ambulance ride based on the level of life support provided, only a fraction of which is covered by insurance. Dayton only collected about $4.3 million of the $14.4 million worth of ambulance runs city paramedics went on last year. Nearly $6.2 million of this deficit is from discounted rates negotiated with insurance companies, but another $4 million simply went unpaid.
Because a Department of Justice lawsuit over minority hiring practices has frozen the hiring of firefighters, Dayton has taken on 25 nonfirefighter EMTs and 15 paramedics. A civilian paramedic is on average $22,108 a year less expensive in salary and benefits than one who’s also a trained firefighter.
Cost-saving recommendations from Dayton City Manager Tim Riordan include handing ambulance service over to local hospitals. He estimates eliminating city ambulance services could save up to $2.5 million a year. Redden and the firefighters union have expressed concerns that could reduce the quality of care provided.
Problem more urban than suburban
One way to tamp down on 911 misuse is to prosecute abusers. Dayton has stepped up its efforts in this area, handing out more than 100 tickets in the last two years.
For people who rack up five tickets in one year, the city is taking them to court on more serious charges. That effort has more than doubled this year.
But this is an arduous effort for what is, at most, a fourth-degree misdemeanor that comes with a fine of up to $250 and 30 days in jail.
In Fairborn-Beavercreek Municipal Court, three people were charged last year and one woman twice in 2008. That court hasn’t seen any 911 misuse charges this year. The Kettering Municipal Court has handled four 911 abuse cases since 2008.
Other local communities have seen similar spikes in EMS runs, but don’t cite abuse or misuse of the system as a major problem.
Kettering, the area’s second-largest city, sees only a fifth of the number of EMS calls as Dayton. The city collected about $1.4 million of the $2 million in billable ambulance costs last year, though it doesn’t attempt collection for people who live or work in the city.
Kettering officials say one program the keeps down repeat calls is a senior services coordinator who works with the fire department. “If we have somebody that does pop up (as a frequent flier), we contact her (the coordinator) and she will get involved with the patient to try to secure home help (care) or get them into the system,” said Kettering Fire Chief Bob Miles.
The Beavercreek Fire Department — which had only 3,804 EMS runs last year — also doesn’t perceive misuse of the system as a problem, according to Chief David VandenBos.
“We have the occasional person utilize our medics for minor medical conditions, but the practice is minimal compared to legitimate usage,” he said.
But older communities that, like Dayton, have concentrations of low-income people and elderly in high- rises can relate to Redden’s concerns.
“It’s a prevalent issue across the service statewide,” said Xenia Fire Chief Jeff Leaming.
Xenia receives about 4,200 EMS calls a year, Leaming said, and often has to weigh what to do with a chronic user.
“We have in the past refused services,” he said, though he added that is unusual.”
One city hopes to send cab instead
At the forefront of rethinking EMS services is Louisville, Ky., according to NAED. Instead of a $475 ride to an expensive emergency room, some 911 callers in that city get a $27 ride from a private transport company to a local urgent care clinic.
Nonemergency calls can go to a nurse who can counsel the caller on what to do and sometimes help them set up a doctor’s appointment.
Some calls are transferred to the city’s social services or government help line. Neal Richmond, chief executive officer of the Louisville EMS division, said the triage system was set up last year to save money and keep ambulances ready to respond to real life-or-death emergencies.
Dayton trying something new
Dayton is taking steps to more aggressively collect payment for what it bills for ambulance rides. The city wants to send nonpayments to a collection agency instead of the current policy of writing them off after sending three bills.
For problem 911 calls, Redden said an idea proposed last year of putting low priority callers on hold for up to hours at a time to focus on more serious calls “sort of fell to the side” in light of concern from the community.
Dayton Fire Lt. Barry Cron said paramedics this year began drawing up individual patient care plans for “chronic users.”
Cron remembers a man who lived alone and “didn’t see the world clearly” who would call 911 up to 60 times a year complaining of stomach pain.
“It was always the same thing. We took him to the hospital ... they would give him some sort of medicine and send him on his way,” Cron said.
With care plans in place, the paramedics would have that history on their ambulances and be able to first suggest he try taking the medicine they gave him last time he was at the hospital with the same symptoms.
When the system is in place in the next few months, Cron hopes to cut each frequent ride in half by at least not transporting the caller to the hospital.
Ultimately, Redden believes the best way to save money is for the public to understand what 911 is for.
A Dayton Daily News reporter rode along with a city ambulance and saw a woman with a health problem for which she was receiving treatment walk out to an ambulance for a ride to the hospital after calling 911. Her boyfriend followed in another car.
“If a person is already there with a car, and it’s a minor illness or injury, why not just take them to the hospital and leave that level of service for a true emergency,” Redden said.
Frustration to EMTs
When the emergency radio starts wailing and the printer at the station fires up with details from the call, the front-line emergency responders are calm amid the calamity.
They don’t know if the call reporting chest pains is routine angina or full cardiac arrest — or someone just trying to hitch a ride across town. And they don’t care.
“When someone calls 911, in their viewpoint it is an emergency, and we are going to respond,” said Tyler McCoy, spokesman for the Dayton firefighters union.
Jim Cox, president of the union, said they rarely get calls of cats in trees anymore.
These days, the questionable calls include a toothache, or a headache, or someone exaggerating their symptoms on the phone.
“Typically when a dispatcher receives a call, there are key phrases and words that would make these things a sense of urgency, but when you get there it may not be what was relayed on the telephone,” Cox said.
“I can remember people waiting at the front door with a suitcase, waiting for the ambulance to take them to the hospital,’ he said.
“But then again, I can remember the person who just didn’t feel good and when I got there they were having a heart attack.”
“They said they were sorry they called us,” he said.
Sitting on office chairs in the break room of Station 11 between calls — “Orange County Choppers” playing in the background — the veteran paramedics had many stories of calls to 911 that should not have been made.
There was the guy who lived on Apple Street, just blocks from Miami Valley Hospital, and said he was sick and demanded to go to Good Samaritan.
Then when they got there, he hopped out and said he felt better.
“He had a girlfriend two blocks from the hospital,” recalled firefighter/EMT Brad Monin.
Then there’s the man with a manageable seizure disorder who was transported to the hospital four times in 24 hours.
Each time, he walked right out and had another seizure down the road.
But these calls are not the butt of jokes as much as a source of frustration, and compassion.
“To me it’s not so much abuse, but it’s a misunderstanding of what it can be used for,” said Monin.
“People need to understand there’s better care out there that’s better for them.”
Contact this reporter at (937) 328-0374. Jeremy Kelley contributed to this report.
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