Re: Guest Post - frequent 911 callers.

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My father's expertise is aircraft noise and annoyance. He says that upwards of 90% of an airport's aircraft noise complaints will come from one neighbor. He says it would often be cheapest for the airport just to insulate the one sensitive person's house.


Posted by: Megan | Link to this comment | 11-12-13 1:06 PM
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60% of 226 calls is 136 calls due to her fainting in public. I suppose maybe if you faint, sometimes two people will call, but still, that's a great deal of medical problems.


Posted by: Moby Hick | Link to this comment | 11-12-13 1:15 PM
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I so told you so.


Posted by: Opinionated Flavor Flav | Link to this comment | 11-12-13 1:22 PM
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The article doesn't have much of her perspective. I mean, it sounds as if she's really fainting, but also as if she's got some condition where the continual fainting isn't doing her any damage. You would think, if she were behaving reasonably, that after consultation with a doctor she'd come up with some kind of Medic-Alert bracelet she could wear that would say "I'll be fine in a moment, no need for an ambulance." or whatever the situation actually is.


Posted by: LizardBreath | Link to this comment | 11-12-13 1:32 PM
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Medic-Alert bracelet she could wear

"Ask me about my extremely low blood pressure."


Posted by: Moby Hick | Link to this comment | 11-12-13 1:45 PM
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We had a neighbor, years ago, who called 911 pretty regularly for things like fainting spells. Also, she was a terrible person.


Posted by: Sifu Tweety | Link to this comment | 11-12-13 1:48 PM
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it sounds as if she's really fainting, but also as if she's got some condition where the continual fainting isn't doing her any damage

leaves a lot of bruises, though.


Posted by: E. Messily | Link to this comment | 11-12-13 1:49 PM
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That did sound callous, didn't it. Or, to be precise, that was callous, wasn't it.

What I meant is, if something happens to you hundreds of times, you develop some sort of routine way of managing it, usually. It doesn't sound as if the ambulance to the emergency room is necessary, but I'd like to hear her perspective on what she thinks is the issue and how she's managing the situation -- if it makes sense from her angle, it makes sense.


Posted by: LizardBreath | Link to this comment | 11-12-13 1:59 PM
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I think it's likely she is doing herself lasting damage and just hasn't noticed it.


Posted by: Moby Hick | Link to this comment | 11-12-13 2:04 PM
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Maybe it was callous, but that wasn't my intended implication.

I pass out roughly every 2-3 weeks these days, but it has magically never happened (yet) when I was both in public and alone, so nobody's called an ambulance for me so far.

I did spend the day in the ER again today, anyway, though. Don't worry, I'm not any less fine than usual, probably!

Anyway I understand the frustration of the city bosses not wanting to waste money, but I also am pretty sympathetic to sick/disabled people maintaining as much independence as possible. Seems like there's probably some sort of middle-ground solution, although I'm not sure people would check for a bracelet before calling. Maybe a t-shirt or a hat?


Posted by: E. Messily | Link to this comment | 11-12-13 2:06 PM
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That sounds pretty creepy. Couldn't they just tax everyone an extra, like, $1 a year and take her to the ER when she asks? The ER isn't that fun; it seems unlikely that treating a few outlier people like this is going to lead to lots more like her. I would much rather have a society with a few anxiety-disordered malingerers than a society in which the city seeks conservatorship if they decide your need for services isn't legit.


Posted by: Frowner | Link to this comment | 11-12-13 4:18 PM
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She's one more reason why I keep applying to be on a death panel. The ERs are overloaded as is, even a hospital you usually hear about when some celebrity fucks up has patients on gurneys in the hallways.


Posted by: biohazard | Link to this comment | 11-12-13 4:34 PM
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Precisely the "high-utilizers" that a lot of groups are staking their hopes on for medical and social cost control. It makes sense in general, but guardianship (denial of legal agency) seems a step too far.


Posted by: Minivet | Link to this comment | 11-12-13 5:33 PM
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Having an escort just follow her around when she's out of the house might be cheaper than 115 ER visits. There's a lot of skill and equipment mobilized for those, overbooked as they are. Still a nasty autonomy issue in tailing her, even if her actions aren't restricted.

Seattle has a similar distribution of calls, according to an EMT friend of mine; probably most cities do. A nonprofit managed to open a SRO in which drinking (and now, I imagine, marijuana) are legal but misbehavior isn't, and is reported as having vastly improved most of its inhabitants lives on all sorts of measures -- they sit about in quiet hazes rather than binging when they can.


Posted by: clew | Link to this comment | 11-12-13 6:09 PM
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Having an escort just follow her around when she's out of the house might be cheaper than 115 ER visits.

This is something like the typical M.O. for high utilizers, I think. Lots and lots of individual attention outside the hospital.


Posted by: Sifu Tweety | Link to this comment | 11-12-13 6:12 PM
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they sit about in quiet hazes rather than binging when they can.

Making fun based on typos is the lowest form of humor but picturing a room full of sad alcoholics where every once in a while somebody goes "bing!" is cracking me up.


Posted by: Sifu Tweety | Link to this comment | 11-12-13 6:13 PM
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Maybe they're all just sitting around using an internet search engine.


Posted by: Blume | Link to this comment | 11-12-13 6:17 PM
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Redmond reaches into Seattle, true.

Parp.


Posted by: clew | Link to this comment | 11-12-13 7:26 PM
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It doesn't sound as though she actually has a physical condition that would cause seizures or fainting. The medic says that her symptoms are reported "under the claim of 'seizures' or 'narcolepsy,' which have never been correlated with medical findings."
And of course if you call 911 and report "shortness of breath" they are going to go all out. That's what they're trained to do, because it's a symptom of cardiac problems. Ambos in the UK get lots of callouts to idiots with colds who report "difficulty breathing".
But it's irrelevant, really, whether she has a physical condition or not. Either she has something so physically serious that she has to visit the emergency department once every three days, or she's not responsible for her actions and is making lots of unnecessary 911 calls. Either way, this conservatorship sounds good. If she's having to be hospitalised once every three days, her independence is being seriously limited anyway!


Posted by: ajay | Link to this comment | 11-13-13 2:45 AM
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Except that other people are calling in about half the time, which sounds like she's got convincingly apparent symptoms. "Never been correlated with medical findings" could mean there's nothing there, or could mean that she has no access to care other than the ER, and they've never done anything to diagnose her -- they just get her on her feet and shoo her out the door.

She sounds as if she's handling the issue badly, but I wouldn't think there's nothing physically wrong with her.


Posted by: LizardBreath | Link to this comment | 11-13-13 5:38 AM
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they've never done anything to diagnose her -- they just get her on her feet and shoo her out the door

That would be pretty fucking unconscionable if they were trying to put her into custodianship before ever trying to diagnose her. It is a little hard for me to picture that the doctors who (presumably) are involved in the decision-making would go for that.


Posted by: Sifu Tweety | Link to this comment | 11-13-13 5:52 AM
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20: I think what it means is that she's claiming she has seizures and/or narcolepsy, but she doesn't. Doesn't mean there isn't some sort of physical cause, but it's not the one she says it is.

could mean that she has no access to care other than the ER

The article says she's "had various medical insurance plans throughout the years" which is shocking writing because a) they mean "through" not "throughout" and b) it doesn't elucidate whether she has one now, or indeed has had one any time recently.

This is shocking: "she has an outstanding balance of $61,366.33 owed to the D.C. Fire and EMS for ambulance transports".


Posted by: ajay | Link to this comment | 11-13-13 6:13 AM
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21: Unconscionable, sure, but not terribly surprising. Of course, you can't tell anything about the facts from reading a story like this -- everything it says or implies could be way off.


Posted by: LizardBreath | Link to this comment | 11-13-13 7:12 AM
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Of course, you can't tell anything about the facts from reading a story like this -- everything it says or implies could be way off.

Don't talk about our child, Martha!@#


Posted by: Sifu Tweety | Link to this comment | 11-13-13 7:14 AM
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My uneducated guess is that she has an anxiety disorder which causes her to hyperventilate and eventually pass out. Lots of folks describe anxiety attacks in entirely physical terms. Then, perhaps she's refusing follow-up appointments with specialists, since I bet the ER is making sure she's not having a heart attack or small stroke and then referring her for follow up. I bet the docs have a decent guess of what's going on physically (after 30 years) but can't get her to be compliant.

22: Insurance often only covers a small amount of transport cost, and that total probably accrued at $400 per trip or something. They're not allowed to refuse you, so the amount can go unpaid without an immediate penalty unless the city wants to take measures to collect.


Posted by: ydnew | Link to this comment | 11-13-13 8:13 AM
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25.1: That seems more a more likely explanation than any other option I can think of.


Posted by: Moby Hick | Link to this comment | 11-13-13 8:17 AM
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25.1: That's the most plausible explanation I can come up with, certainly. I do think there's room there, though, for the hospital to be assuming that's what's going on, despite never having gone through a full diagnostic workup to rule out other possibilities. I had a friend sent home from the Peace Corps because she was having panic attacks; it took her doctors at home months to figure out that they weren't panic attacks, it was a drug interaction between (IIRC) something she was taking for bronchitis and something she was taking for giardia.


Posted by: LizardBreath | Link to this comment | 11-13-13 8:56 AM
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She was taking things for the Irish police?


Posted by: Moby Hick | Link to this comment | 11-13-13 8:59 AM
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An Irish policewoman is known as a giardiniera.


Posted by: ajay | Link to this comment | 11-13-13 9:12 AM
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27, Agreed it could be something else, but either way, medical mystery stuff requires persistence and follow-up on the patient's part (and an ability to navigate our messed-up system). I don't think the ER is the right place for doing it, which is why they'd like to get her to a neuropsychiatrist for a full evaluation. I'm guessing, though, that they referred her to a mental health professional, and she took it as an insult and refused. Her records aren't public but I'd guess (with no evidence) that she's been scanned and evaluated by neurologists who can't find a cause.


Posted by: ydnew | Link to this comment | 11-13-13 9:15 AM
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This sounds like the case for a patient advocate/social worker - someone who could figure out why she's not getting follow up. Does she lack cash and/or insurance? Does she have little access to transport and the recommended follow-up is far away? Is she so anxious that even going to a non-ER medical appointment is too much? Is she so lonely and messed up that she is - consciously or unconsciously - reluctant to give up on the attention she gets at the ER?

All of this just runs right up against capitalism. That woman definitely needs something, it probably will be cheaper than ER visits but may not be especially cheap (what if what she needs is a totally new supportive housing environment? the kind that generally doesn't even exist in the US?) and of course, they're going to seek conservatorship because the cheapest option of all is just to take over her life and then do the most expedient thing.

I mean seriously, people are so stingy. What would it cost to provide really good care for the handful of really messed up and needy? A hundred thousand a year each? That's peanuts. I'd gladly pay an extra...well, I don't even make that much, but they could take an extra five bucks a pay period out of my pay to provide more medical services and I wouldn't whine. What if everyone just chipped in so we weren't always needing to go on about cost control? No one would even notice after the first couple of paychecks.


Posted by: Frowner | Link to this comment | 11-13-13 9:20 AM
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I think your cost estimate is off by a factor of five or ten, depending. And the handful of really needy is probably off by even more, depending on the definitions of those terms.


Posted by: Moby Hick | Link to this comment | 11-13-13 9:24 AM
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An Irish policewoman is known as a giardiniera.

They're found in ponds and cause intestinal distress?


Posted by: essear | Link to this comment | 11-13-13 9:27 AM
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Strange women lying in ponds distributing summonses is no basis for a system of law enforcement and maintenance of public order.


Posted by: ajay | Link to this comment | 11-13-13 9:33 AM
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31: I'm supportive of your idea, but I think the costs are more likely a bit higher for truly needy people. A hundred grand ought to be enough to provide a single full time social worker, but when you start throwing in doctors visits and intensive care for the hard cases it might add up to quite a bit more.

We (the US as a whole) can easily afford it, even at the higher rates. We don't do it because a significant fraction of the population likes to see the weak suffer, and considers that suffering to be just recompense for being a bad person in some way.


Posted by: togolosh | Link to this comment | 11-13-13 9:36 AM
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a significant fraction of the population likes to see the weak suffer

That explains much of the resistance to cycling also. "How dare you ask me to respect something that I could run over?"


Posted by: Moby Hick | Link to this comment | 11-13-13 9:39 AM
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The other problem is that it's not just about providing services, it's about wooing people into using them, if you're not going to put them into guardianship and compel them. One possibility in this situation is that the woman doesn't see what's going on as a problem -- she faints, gets an ambulance to the ER, gets the immediate treatment she needs, and everything's fine. The impetus for change here seems to be all from the hospital, which (if that's accurate) means that any resolution of the underlying problem is going to require that she be either persuaded or compelled into getting on board with diagnosis and treatment or support.


Posted by: LizardBreath | Link to this comment | 11-13-13 9:52 AM
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There was a good New Yorker article a few years back about I think Philadelphia targeting frequent ER users with, um, intensive wraparound services, for lack of a better catchphrase, and the success and challenges they had. This strikes me as a bad case for guardianship, but I have an extra strong squick factor about guardianships because of having had to serve on a jury deciding them and how stressful it felt to take away someone's legal autonomy.


Posted by: Thorn | Link to this comment | 11-13-13 9:56 AM
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Possibly by Malcolm Gladwell and possibly blogged here. Let me go look.


Posted by: LizardBreath | Link to this comment | 11-13-13 9:57 AM
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This is the one I was thinking of.


Posted by: LizardBreath | Link to this comment | 11-13-13 10:01 AM
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I have an extra strong squick factor about guardianships because of having had to serve on a jury deciding them and how stressful it felt to take away someone's legal autonomy.

As I said, though, if she has to be hospitalised every three days, her autonomy is being fairly diminished as it is.


Posted by: ajay | Link to this comment | 11-13-13 10:03 AM
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42: Oh, sure, there's definitely something going on. I'd just want to see better documentation than what's in the article before signing away her rights. (And we did agree to give guardianship to the state for someone with a persistent mental illness who didn't consent to that, so it's not that I think it should never happen or that I'm not complicit.) It just seems like there should be middle ground here and I'd want to be clear other options had been tried already.


Posted by: Thorn | Link to this comment | 11-13-13 10:07 AM
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her autonomy is being fairly diminished as it is
So we should finish the job?


Posted by: Eggplant | Link to this comment | 11-13-13 10:08 AM
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I hadn't read the article linked in 40. It's good stuff.


Posted by: LizardBreath | Link to this comment | 11-13-13 10:11 AM
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44: I think the idea is more that someone being hospitalized every three days may have more nominal autonomy but less practical autonomy than someone who's been compelled into treatment that makes the frequent hospitalizations necessary -- a much smaller percentage of the second person's time is spent actually under compulsion.


Posted by: LizardBreath | Link to this comment | 11-13-13 10:19 AM
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46: exactly. Except that "makes the frequent hospitalizations necessary" s/b "unnecessary" I assume.


Posted by: ajay | Link to this comment | 11-13-13 10:21 AM
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The article in 40 is interesting (I haven't finished it yet) but this

He persuaded Camden's three main hospitals to let him have access to their medical billing records.

seems totally bizarre. Isn't that illegal? How did he "persuade" them to violate confidentiality laws?


Posted by: E. Messily | Link to this comment | 11-13-13 1:27 PM
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If he went through a medical school IRB, I think it would fly with proper safeguards.


Posted by: Moby Hick | Link to this comment | 11-13-13 1:34 PM
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48: It becomes clear later on that they were anonymized.


Posted by: Natilo Paennim | Link to this comment | 11-13-13 2:11 PM
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For things that this, you can only get so far with anonymization. They talk about how he matched billing records to addresses (by block) and finding the guy with 300 admissions in a year. Lots of people wouldn't really be de-identified.


Posted by: Moby Hick | Link to this comment | 11-13-13 2:19 PM
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