‘Needless’ Calls Tax 911 System in Santa Ana : Aid: Fire officials worry that because of the health care crisis, people are overburdening the emergency program to deal with routine medical problems.

With no trace of panic in her voice, the woman on the phone asked the Fire Department dispatcher who answered her 911 call to send paramedics to administer emergency first aid for a 60-year-old relative who had fallen and accidentally hurt his hand with a screwdriver.

His condition did not seem critical, dispatcher Gina Barrett learned. The man was walking and talking normally.

But his hand was bleeding, the caller insisted, “and I want someone to take a look at it.”

Responding to a “Code 3” call for a stabbing--with red lights flashing and sirens wailing--a four-member fire engine crew arrived at the central city address in seven minutes.

But it took the emergency team even less time to determine that there was no real emergency. The call was classified a “needless” one.

As Santa Ana’s population continues to grow and the number of 911 calls keep pace, fire officials worry that the emergency medical system is in danger of becoming overtaxed by the similarly growing number of needless--or unjustified--calls for emergency first aid.

Aggravating the problem, officials said recently, are legitimate calls for aid that otherwise might have been avoided, if the city’s poor had been able to afford routine medical attention.

Pregnant women “will wait until their water breaks and labor has set in and it’s too late and they call 911. That becomes a righteous call,” said Santa Ana Fire Chief Allen (Bud) Carter, who added that the women in many instances have not had regular prenatal care and are thus considered “high-risk” patients.

“More and more people are using the 911 system to deal with their (routine) medical problems,” Carter told City Council members recently. “Ten percent of my ($26.4-million annual) budget is spent dealing with the health care crisis.”

It’s a problem that cuts across a broad swath of the city’s population--from newly unemployed workers who lost health insurance coverage along with their jobs, to underemployed immigrants working as day laborers with no health benefits, to those who have little understanding of the 911 system and call even if there is no life-threatening emergency.

Paramedics who regularly work the downtown area claim to know many homeless people at least by sight, if not by name, just as a family practitioner would know his regular patients.

Over the past two full years, the number of emergency medical service calls has risen by 26%. And by late October of this year, the number of calls had already surpassed last year’s record of 18,048.

During the month of September alone, there were more than 1,000 calls to the Santa Ana Fire Department for emergency medical aid. And of those, more than one out of every four did not require medical assistance.

Dispatchers and paramedics alike say there are some who willfully abuse the system and know exactly how to describe their illnesses with hopes that transport in an emergency vehicle guarantees admittance to a crowded hospital emergency room.

Two years ago, responding to complaints from local hospitals, Santa Ana officials developed a program to ensure equal distribution of indigent or uninsured patients to emergency rooms.

Some “hospitals thought they were getting more than their share of our patients and a high percentage of our patients are unfunded,” said paramedic coordinator Eric Widell.

While preparing a pasta dinner midway through their 24-hour shift, paramedics Bill Lackey and Danny Morehouse and other firefighters recalled one notorious patient--Margo, a homeless woman whom they believe feigns unconsciousness to get some sleep in a hospital emergency ward.

“I have responded to (calls about) her 17 times,” said Lackey, who has worked as a paramedic for eight years. “But medics in this city . . . tend to err on the side of the patient rather than take a risk.”

Lawyers at the Legal Aid Society of Orange County, whose impoverished clients can rarely afford health care and are sometimes being dunned over delinquent bills for paramedic services, see another side of the problem.

“One of the saddest cases we had was someone who tried to get medical care for a broken jaw by shoplifting,” said Robert Cohen, the local Legal Aid Society’s executive director. “He thought if he was arrested, the county would have to take care of him. To his dismay, he was just ticketed and released.”

One recent Friday, just as the calls for weekend, rush-hour traffic accidents were beginning to come in, Fire Department dispatchers Barrett and Mike Gates talked of the difficulty of determining the severity of a case before dispatching an emergency unit to the scene.

Just before and after the accidental stabbing call, for example, they had received calls about a traffic accident in which the injured person did not need to be taken to a hospital, and another about someone suffering a severe headache that medics later determined was a possible stroke.

“You want ‘em, we send ‘em,” Barrett said.

If the injury or illness is not life-threatening, officials said, patients will be encouraged to find their own way to a hospital. But if the patient or family members insist on transportation, the medics will oblige.

One call that is usually greeted with skepticism by dispatchers and paramedics alike is the “hyperventilating female in her 20s, difficulty breathing. You try not to . . . make up your mind (beforehand), but you know when you get there, there will be 30 people in the room and she’s going to be upset with her boyfriend,” Lackey said.

Later that evening, Lackey and Dennis Marinello thought they had one such case when the dispatcher’s voice crackled over their radio: “Twenty-five-year-old female, conscious, difficulty breathing.” This case, however, was different.

By the time they reached the woman’s South Minnie Street apartment, they had been told that she was five months pregnant and suffering an asthma attack. Although she was seeing a physician for her pregnancy, she had not told him of her 13-year bout with asthma that she treated with ventilators purchased in Mexico without a prescription.

Lackey and Marinello gave her oxygen and stabilized her before taking her to a hospital.

“For her to be getting any (prenatal care) at all is fantastic,” said Widell, the coordinator of paramedic services. “But if she had had ongoing care (for the asthma), we would not have had a problem.”

Because illegal immigrants do not qualify for state-supported medical care unless it is a life-threatening emergency, their only choice is to call 911, said Nativo V. Lopez, national co-director of Hermandad Mexicana Nacional, an immigrant rights group.

“If we had more primary health care clinics where lower income people could have preventive health care, we would end up saving a hell of a lot of money,” Lopez said.

While the “needless” calls can tie up units for 20 to 30 minutes and the city’s resources are not without limits, the paramedic coordinator said Santa Ana does have the ability to call on other jurisdictions for assistance.

“We do run out of paramedics. We do have to request paramedics from other jurisdictions to come into the city,” Widell said. “But what you have to look at (is) the potential for not having units available . . . the potential for other cities to also be busy.”

But more than the ability to meet the increasing demand for service, one of the biggest headaches for the city now is money, and how to get patients to pay their bills for emergency medical services.

With a collection rate of only 30%--compared to 48% in Anaheim and 55% in Huntington Beach--fire officials estimate they lose about $1 million a year just in uncollected accounts.

When citizens call 911, the officials said, many do not realize that they will charged for the call--$132 for “advanced life support” service that includes the more serious cases that are handled by paramedics, and $79 for “basic life support” calls handled by firefighters and emergency medical technicians. If the patient is transported to the hospital, an additional $168 is tacked on to the bill.

Hoping to boost revenue for the 911 service, Santa Ana has followed the example of other cities and begun placing a $6 charge on water bills every two months for EMS. Customers who do not want to pay the subscription fee can cross it out. But those who pay the fee have the assurance they will not be billed for the service if they ever need it.

After one full cycle of residential billings, city officials report that one out of every five households that receive water bills have signed up. The challenge, they added, is to conduct a bilingual marketing campaign to reach the thousands of residents who live in crowded apartment buildings and do not receive separate water bills.

And the city will also have to re-educate its residents on how and when to use 911.

“For the many, many, many cultures that we have in this city, there is ignorance about our medical system and 911 is pretty much the last resort,” Widell said. “They pretty much figure that 911 is the end-all or the answer to all of their problems . . . maybe the first resort.”

Maybe in the future, he added, paramedics will become more like physicians’ assistants and dispense medicine or treat minor ailments.

“I think if we got to that point, we would all be a lot better off. It’s going to be a hell of a lot easier to do that than it will be to educate many of the cultures and educate as many people as we have in the city.”