911 taxi service

Recently an 18 year-old girl was brought to the ER by ambulance stating her left arm hurt and that she was feeling quite anxious. The patient was assessed by our triage nurse and since there were already about 5 patients in waiting to be seen, this patient, who did not have a life or limb threatening condition, was appropriately sent to our waiting room until a bed was available for further assessment by a doctor. Within several minutes of sitting in the waiting room the patient’s father showed up, became quite angry, and started yelling at the front desk staff. The father demanded to know why the patient was not already in an exam room. “She came in an ambulance!” He had a point, the patient did indeed arrive in an ambulance, but the paramedics revealed that the patient had actually driven to within 1 block of the hospital and then pulled over and called 911 to take her the final block. Instead of driving 90 more seconds she had waited 6 minutes for medics to arrive and transport her the final distance. As I reviewed the patient’s electronic medical record I found that the patient had been seen in the ER the day before for a skin rash. The patient had waited in the waiting room and then had received a medical screening exam by a physician’s assistant. At that time the examining physician determined that shedid not have a condition requiring emergent treatment, and he advised the patient to use an over-the-counter lotion and follow up with her primary care provider. Apparently the patient decided that another screening exam would be inadequate so this time she decided to arrive in the ER by ambulance so that she would be seen quickly and not have to wait in the waiting room. The patient and her father were furious that her ploy had failed and now she would have to wait - just like everyone else. Apparently dissatisfied with his daughter’s care the patient’s father went outside and called 911 to transport the patient to another ER for assessment. Boy was he pissed off when medics informed him that their responsibility was to transport patients to the nearest available ER capable of treating the patient, and they were not a free taxi service that could drive patients around while they shopped for an ER where they would not have to wait. Since the nearest ER was the one where the patient was currently located the medics stated they would not transport the patien. Obviously the patient and her father were not planning on paying for the patient’s medical care or transportation, so they felt comfortable completely abusing a system that is designed to initiate stabilizing care for critical patients and transport them quickly to a location where they could receive definitive care. Abusing this system and these care providers by using them as a personal taxi service in an attempt to move in front of other patients who had arrived at the ER by private vehicles is not an uncommon occurrence. It occurs several times each shift that I work. Patients are never responsible for the costs, either because they have medicare, private insurance, or veteran’s benefits, or because they simply do not plan on paying when they are billed. It’s amazing how many people aren’t intimidated by the threat of collection agencies. Instead of visiting their primary care physician or a community clinic which would be more appropriate for their complaints they come to an emergency room to receive treatment. If they do receive care it is going to cost them(or at least be billed to them) many times the amount they would pay for the same care at a clinic simply because the cost of operating an emergency room is much higher than operating an outpatient clinic. However, since they are not responsible or will not be taking responsibility for the bill they show up anyway demanding immediate attention and treatment -- often in an ambulance, thereby wasting money and resources without any regard to the crisis in medical costs and resources that exists today.