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In reporting from frontlines on ER's heaviest users, access is everything

In reporting from frontlines on ER's heaviest users, access is everything

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Finding a way to report cheek by jowl with doctors and nurses in a busy ER is not an easy assignment. If security doesn’t throw you out immediately, you might find yourself quickly wrapped into a full body cast of HIPPA forms. You’ll need a connection to make this work.

“One important thing is to find your advocate,” John Gonzales, a former senior writer for the Center for Health Reporting, told fellows at the 2016 California Fellowship this week. “You got to find someone who is going to be there for you when you’re having trouble with access.”

Gonzales found his advocate, an ER doctor named Jim Dunford, who also serves as San Diego’s medical director. It was Dunford who ensured that Gonzales and his photographers had the access  — and HIPPA authorizations — they needed for a deeply reported series called Health Care 911. The five-part series, which ran in the San Diego Union-Tribune, exposed the problem of health care super users and the chronic strain they place on the medical system.

“The reason we got him on board with that is because this is something his paramedic crews had been bellyaching about for years and years on end: ‘We’re not social workers here.’ Most of the folks who were using 911 repeatedly needed something besides emergency care — housing, mental health services, behavioral health services, wraparound services. There was no way they could sustain this type of approach.”

With Dunford as his entry ticket, Gonzales was able to find and interview repeat ER users such as Raohl Hursh, a homeless man battling addiction and mental illness who’d been to ER twice in four hours, 12 times in the previous month.

“In being on the ground and finding advocates, I was not only able to get the numbers, I was also able to get the characters and the why’s — this is why you’re going to have repeated use of 911. Not only because of substance abuse and homelessness, but because this guy is epileptic, needs regular treatment and doesn’t get it. The folks who end up being their long-term medical care providers are the paramedics.”

After reporters have done a bit of reporting, Gonzales urges them to create a project map that lays out the different stories and elements in their series. “With something big, I would really recommend going in with a really solid plan that’s a touchstone for all of the issues you want to hit,” he said.

For Health Care 911, that included a broad overview story; the view from the streets with paramedics; inside the ER; portraits of frequent users; and an exploration of possible solutions. Along the way, the series took pains to remind readers that this was a problem that affects everybody. “All through the five stories we tried to pepper in there what this means to you,” Gonzales said, whether it’s longer wait times for 911 calls, burnt-out paramedics or merchants dealing daily with passed-out addicts in their doorways.

A few years after the series ran in the San Diego Union-Tribune, Gonzales returned to the city to follow-up on the story. “The difference though, is that because we proposed possible solutions, some of those had been implemented,” he said.

After the 2012 stories, Dr. Dunford had been able to marshal the political capital needed to create a new outreach program, in which six community paramedics canvas known hotspots in search of homeless residents and frequent 911 users. They carry iPads loaded with software that shows real-time 911 calls and last known locations. The goal is to connect frequent users with detox services and case managers — and keep them out of the ER.

“That second project was able to show the impact of Dr. Dunford’s efforts, that the city had indeed made some inroads in reducing frequent use,” Gonzales said. “And even more importantly, it also showed it had a long way to go.”

[Photo by Ed Schipul via Flickr.]

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