Albuquerque ERs Spend $11.9 Million Yearly Treating Drunks

Jul. 2--At least 500 times a month, an ambulance unloads a drunk at an Albuquerque emergency room.

Drunks make tough patients, said Diane Cassell, director of emergency services at Presbyterian Hospital.

"They can't talk, can't walk -- often they can't sit up," she said. They sometimes have trouble breathing and need help from a respiration device. "And they are usually here quite a bit of time, often 12 to 18 hours."

They take up beds needed by other patients. And they are expensive.

Presbyterian's cost for treating a single drunk in the emergency room typically runs about $1,850, Cassell said. That figure does not include the cost of diagnostic tests.

A 2004 analysis by Bernalillo County found that Albuquerque's three major hospitals spent a total of $11.9 million a year treating inebriated people at their emergency rooms.

Albuquerque Ambulance Service transported an average 553 intoxicated patients per month to hospital emergency rooms from June 2003 to May 2004.

Bernalillo County officials want to lighten the load for hospital ERs. That was the intention when the county bought a former Charter Hospital for $2.5 million and opened the Metropolitan Assessment and Treatment Services center, or MATS, in 2005.

But paramedics still take down-and-out drunks to the ER.

"There has been no decrease in the number of inebriates that are hitting the emergency rooms," said Dr. Philip Froman, medical director of Albuquerque Ambulance, the city's contract ambulance service.

The county's 50-bed MATS facility near San Mateo and Zuni SE is a "social-model" detox center that lacks the medically supervised care required to accept the most serious cases, Froman said.

Paramedics can transport someone to MATS only if the patient can walk and does not require medical care, he said. The patient must also agree to be taken to MATS.

"If they can't walk, they go to the ER to sober up," Froman said.

County officials say MATS is taking pressure off hospitals by giving them a place to send drunks once they are medically stable.

Cassell agreed that MATS offers a destination for drunks but only after ER personnel perform costly and time-consuming work.

MATS "doesn't give us those initial treatment options," she said.

'Huge problem'

Dr. Sam Slishman, an Albuquerque physician who specializes in emergency medicine, said drunks pose a "huge problem" for ER personnel and contribute to the long waits and crowding in ER waiting rooms.

"It's difficult on everyone when patients who are intoxicated are treated in the ER," said Slishman, who recently stepped down as a University of New Mexico physician.

Slishman agrees that MATS provides an alternative for drunken patients once they are stabilized.

MATS "is the only entity I can send a drunk to in the middle of the night," Slishman said. "It would be great if (MATS) could care for inebriates earlier in their intoxication, but they're just not at that point yet."

County officials acknowledge that MATS has fallen short of their original expectations.

"Unfortunately, we've had way more delays with this than we envisioned," County Commissioner Deanna Archuleta said.

The cost of providing medical care at MATS and paying for medicalmalpractice insurance proved unrealistic for the county, Archuleta said.

Instead, the county turned to the state Department of Health to provide a medically supervised detox center.

By appointment

In March, the health department opened Turquoise Lodge under the same roof as MATS. The 34-bed detox center offers medically supervised care for up to 28 days. The statefunded center has a $4.3 million annual budget.

But Turquoise Lodge admits patients only by appointment from 7:30 a.m. to 5 p.m., Monday through Friday. The center lacks the staff and capacity to accept drunken patients on an emergency basis, said director Bob Galligan.

Deputy County Manager John Dantis said the county is negotiating with state officials to expand the size and services of Turquoise Lodge.

The county, in partnership with area hospitals, is offering to pay the Department of Health about $1.2 million a year to expand Turquoise Lodge to 72 beds and accept emergencies, Dantis said.

Dantis and Department of Health officials shared few details about the negotiations.

"We're exploring how this would work and the possibilities of expansion," said Katrina Hotrum, deputy health secretary. The discussions are in the "beginning stages."

"We have not done the calculations to assess whether that money is enough to do what the county wants to do," Hotrum said.

Hospitals pay

She acknowledged that Bernalillo County is offering to pay $1.2 million a year for expanded services.

Most of that money -- $900,000 a year -- would come from Albuquerque's three major hospitals.

Bernalillo County negotiated agreements in September 2006 that called for Presbyterian, Lovelace Hospital and University of New Mexico Hospital each to pay the county $300,000 the first year to operate a medically monitored detox center.

Lovelace has paid the county $100,000 under that agreement. It is the only one of the three hospitals that has paid anything, although Dantis said the county doesn't expect payment until the expanded services are in place.

"The intent is to reduce crowding in the ERs and get patients more appropriate care," said Jeff Dye, president of the New Mexico Hospital Association. "Everybody agrees that makes sense."

However, Dye said, "no services under those (agreements) have been delivered to date."

Lovelace, in the meantime, is using a separate room for most of its inebriated patients. That frees up other emergency beds and keeps them separated from the rest of the emergency room population.

Dantis predicts that, one day, hospitals will see great benefit from the detox services.

"They're hopefully going to see such a value in this they will be willing to provide more money," Dantis said.

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