ER VISITS: Kaiser Asks Patients Not to Call 911
Network news programs last night reported on a new Kaiser Permanente authorization protocol, which asks patients to call a special "helpline" instead of dialing 911. ABC's Tom Foreman reported, "Virtually everyone in the country knows in a medical emergency to dial 911, but what if you're not sure if it is an emergency? In Colorado, patients in the Kaiser Permanenete HMO are being told that, when in doubt, to call a helpline operated by the American Medical Response ambulance company, where a technician will help decide if emergency care is needed." Kaiser's Bob Eisenman said, "It provides a mechanism to really make sure we're getting the right level of care for the right member at the right time."
Foreman noted that the new system "has sparked concern among some doctors who say that, as it spreads nationwide, it may cause confusion among patients -- especially the elderly -- about whom to call and when. Paramedics say the new requirement could mean dangerous delays. Alfred Whitehead of the International Association of Fire Fighters said, "When you start ... going through different operators, your response time to a patient is going to be longer, and that's critical. It may be the difference between life or death" (ABC's "World News Tonight," 8/24). NBC's Jim Avila reported, "Exhibit A for the paramedics: [a] phonebank in the cornfields of southern Wisconsin. Kaiser Permanente, one of the largest HMO's in the country, calls this a 'nurse advice line,' nothing more. Dispatchers paid $11 to $17 an hour, using an 18 question protocol to determine if an ambulance is needed" (NBC, "Nightly News," 8/24).
Who Makes the Decision?
ABC's Foreman noted that there "is the question of who is taking the calls to decide if an ambulance is needed. Right now, Colorado's callers are talking to technicians, some with only four weeks of training. Kaiser insists that only medical professionals will take calls as the system is expanded. ... Still, Kaiser expects many questions about this money-saving measure as it goes nationwide in nine months" ("World News Tonight," 8/24). University of New Mexico's Mark Oswald, who studies emergency medicine said, "Clearly, the motive is to save money for the HMO, and every time they say no they save money. It's an experiment, and unfortunately the people who are signed up with this HMO are the people who are being experimented on." NBC's Avila points to "the Insurance Benefit cards issued by Kaiser, which read in case of emergency call a direct line to their center or an 800 number, and do not mention 911 anywhere. Kaiser says it's reissuing those cards, adding 911" ("Nightly News," 8/24).