Legislators and health care professionals released a proposal last week to divert people with behavioral, alcohol and substance abuse problems away from emergency rooms. The three-year pilot program would start in the capital city in 2014, and the hope is that the number of rescue calls would drop significantly.
But in an interview yesterday, Johnston Mayor Joseph Polisena says the plan will not affect his decision to deny mutual aid to Providence.
"I do not regret my decision. My responsibility is for the citizens of Johnston, not the citizens of Providence," he said.
The proposal, presented by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, is called the "Sobering Treatment Opportunity Program," or STOP. It was presented last Thursday by BHDDH to the Special Senate Commission to Study Emergency Department Diversion. If the program is deemed successful, the state could consider replicating it in other parts of the state.
Under the proposal, BHDDH would oversee a privately run 15-bed facility, where patients would stay for initial recovery, with supported housing capabilities for another 20 people. That facility could include detoxification capabilities or simply refer patients to detox programs elsewhere. Transportation, which is now provided by rescue for these calls, would switch to a transport van service manned with an EMT and a homeless outreach worker - saving approximately $420 per call. Overnight stays at the facility would cost about $200 - significantly less than a $2,000 visit to an emergency room.
Polisena, who has worked as a fireman, EMT and registered nurse, says he is skeptical that the program would be effective. He pointed to instances where symptoms are deceiving. For example, someone who is slurring speech might appear drunk but it could actually be due to a diabetic issue. Someone who passes out could have a brain bleed or aneurysm.
"I think it's a lawsuit waiting to happen. Whether they're habitual callers or not, that's what they pay taxes for. If they call five times a week, you have an obligation to go," he said. "If you could predict what's wrong it would be easy, but you can't do that."
Still, he says it's "none of my business."
"Whatever Providence wants to do, they have to live by their decisions," he said.
Senator Joshua Miller (D-Dist. 28, Cranston, Providence), who co-chairs the commission with Senator Paul Jabour (D-Dist. 5, Providence), said that similar programs in Massachusetts and elsewhere have proven successful.
"Most of the real hurdles are behind us. Everything costs money, but this program is a cost savings for everyone involved in caring for the people who it would affect, and would be more effective at getting people sober and off the streets," Miller said.
Funding for the program is still up in the air, but would likely tap into the state and municipal departments that would benefit financially. State Medicaid Director Elena Nicolella also said in a press release that it is likely that a high number of the patients would qualify for Medicaid, with reimbursements covering some costs. Additional funding would need to be included in the 2014 state budget in order to move forward.
Providence Safety Commissioner Stephen Paré referenced the plan back in August 2012, as Johnston pulled out of a longstanding mutual aid agreement. Paré said the city could not afford to purchase another rescue but noted that they were looking at ways to cut down on the number of calls. At the time, he predicted that 75 percent of EMS calls are non-emergent.
"There's not an easy solution," Paré said in an earlier interview with the Sun Rise. "I don't believe the solution is to stop mutual aid."
The commissioner was unavailable for follow-up comment this week.
The decision to discontinue mutual aid came after months of stalled discussions with Providence about a more equitable agreement. In 2011 Johnston Rescue responded to 473 calls in Providence - nearly 10 percent of calls overall. By comparison, Providence came to Johnston only 23 times.
Those calls represent real costs to the town. A basic life support call costs just over $1,000 on average. Over the summer, Johnston - along with North Providence and East Providence - requested that Providence reimburse the municipalities where insurance was an issue, allowing them to recoup at least $500 per call. For example, if insurance paid out $300, Providence would reimburse $200.
Additional costs are incurred through overtime, particularly if calls occur during shift changes. Polisena added that wear and tear on the vehicles and fuel costs are other financial factors to his decision.
North Providence and East Providence have since reversed their decision and are providing some mutual aid service to Providence. Polisena says he would not do the same until significant change was made in the capital city - namely purchasing new rescues. Providence's six rescues respond to 32,000 calls annually.
Johnston, on the other hand, has three rescues, which cover 26 square miles. Polisena said the rescues purchased by the town cost roughly $230,000 - an investment he believes is necessary in the neighboring city.
"Why should we subsidize the City of Providence," he said. "If I had to do it over again, I'd make the same decision."
BHDDH has been instructed to hone the proposal over the next month to have something closer to a request for proposal by the next meeting of the special commission, which is not yet scheduled.