Homeless 'Frequent Flier' Patient Struggles To Pay Debt

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Once a week we open up the pages of the Washington Post Magazine for interesting stories about the way we are living. Today we hear about Ken Farnsworth, a man who's come to be known by emergency medical workers as a "frequent flier." That's hospital shorthand for people of poor health and modest means who go in and out of emergency rooms. It doesn't help that Farnsworth is homeless. Over the years he's racked up an estimated half-million dollars in emergency care bills. So-called frequent fliers contribute to rapidly growing costs for hospitals, municipalities and taxpayers. Reporter Dave Jamieson profiled Ken Farnsworth and tells us more about the toll he and others like him take on emergency workers and on the health care system.

MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, in honor of Native American Heritage Month, we meet a young singer who is getting notice both in Indian country and beyond. And we hear from Jordanian journalist Rana Husseini, who's become not only a reporter, but a reluctant activist against a practice many people did not want to admit still exists, honor killing. We'll hear from her in a few minutes.

But first, we talk more about health care, about a little noticed but very important corner of the health care debate. This from the pages of The Washington Post magazine, where we turn just about every week to find interesting stories about the way we live now. And this week's magazine includes the amazing story of Ken Farnsworth.

He is what is known as a frequent flyer in emergency medical care speak, meaning he is one of many Americans of modest means and poor health who routinely go in and out of emergency rooms day after day, their fundamental health issues rarely resolved. But even among that group Ken Farnsworth is an exception. And reporter Dave Jamieson, who wrote the piece, joins us in our studios now to tell us more. Welcome, thank you for joining us.

Mr. DAVE JAMIESON (Washington Post Magazine): Thanks for having me, Michel.

MARTIN: Dave, I just have to read a paragraph to give people a sense of what we are we talking about. This man is a legend, or at least he was a legend among emergency medical personnel in the D.C. area. You say that with each additional ambulance ride his legend grew. After a while it seemed as if every firefighter and medic in the city had a Farnsworth yarn to tell at the bar.

There was the time he leapt clear out of the back of an ambulance as it rolled through northeast Washington, sirens blaring. The medics had told him he was being taken to Washington Adventist Hospital. Farnsworth thought he hadn't been treated well at Washington Adventist in the past, so he swung open the back door, dropped to the street, and hopped the bus to another hospital, both parties happy to be rid of the other.

So - well, so many things you want to know, but how - often did Ken Farnsworth visit an emergency room, in your estimation?

Mr. JAMIESON: In my estimation it was certainly in the hundreds. He has been to individual hospitals like GW on, say, 150 different occasions, same with Washington Hospital Center. There were certain stretches where he would call for an ambulance every day, sometimes more than once in the same day. So, it was a very routine thing for him to go in and out, and sometimes he might land back in the same hospital on the very same day.

MARTIN: You even write about a time he called 911 when he was already in the hospital. Why did he do that?

Mr. JAMIESON: That's right. He encountered a very long wait at Howard one day. So, while his - the paramedics were inside filling out their so-called run sheet, he just walked outside and called for another ambulance. And because the city can't refuse service to anybody, they had to come and pick him up and take him to another hospital.

MARTIN: Take him to another hospital. Now there are those who would hear this and think, well, this is pathology, this is a mental issue. But he in fact, as you discovered, actually did have serious medical conditions.

Mr. JAMIESON: He did.

MARTIN: So - but why did he have to keep going in and out of emergency rooms to get treated for these conditions? Why is that?

Mr. JAMIESON: Well, I came to believe that there was partly maybe something of an emotional component to it. But there was also - it had a lot to do with his living situation. He is a homeless man, has a lot of trouble getting around. So, whenever he encountered a health problem, many of which were very serious, he would - he felt compelled to get to the ER, whether it was by ambulance or through his own travel.

MARTIN: And one of the things I think many people would say as well, okay, if everybody knows - you know, even - there are medical services offered to homeless people, particularly in a large city like Washington, D.C. or the Washington, D.C. metropolitan area. So I think somebody would say, well, why isn't there some system for addressing chronic health problems even if you're in that situation? Because as everybody I think knows by now, emergency room care is terribly expensive. And the hospital's never going to recover the money from them.

Mr. JAMIESON: It is terribly expensive. People have different figures on how expensive it is. Generally, it's somewhere between two and five times more expensive to treat chronic or non-urgent problems in an ER as opposed to through a primary care facility. And a lot of that comes from the fact that an ER simply and obviously isn't designed to treat chronic problems, you know, they are there to treat, you know, emergency situations.

So, they practice a lot defensive medicine in ER's. They run a lot of tests, lot of blood tests and x-rays. And that, as we all know, is how a lot of - a lot of the way in which, you know, our system gets so expensive.

MARTIN: And one of the other surprising things that I learned from your piece is that people like Ken actually take an emotional toll on emergency workers. Why is that?

Mr. JAMIESON: They really do. Well, they see them day after day, often not just for years, sometimes for decades. Especially paramedics who are on the field. You know, a lot of times at a firehouse a call will come over the radio, and just by knowing the street corner that they are directed to they may know who they are going to pick up, you know. So, it becomes very taxing on the emergency responders.

MARTIN: And one of the points you make in the piece is that has implications not just for people like Ken, but also when emergency workers get desensitized. That that can have implications for other people, and you point out the case of David Rosenbaum(ph) The New York Times reporter who was - badly injured in a robbery and was untreated, unseen for hours, in part because, you say, you think that emergency workers misunderstood the issue as that he was just some guy who'd had too much to drink�

Mr. JAMIESON: That's right.

MARTIN: �they didn't realize he'd been the victim of a robbery and was seriously ill, and later died.

Mr. JAMIESON: Right. Rosenbaum was left in the hallway for a very long period at Howard. And anyone who has been to an ER, especially on say a Friday or Saturday night in the city, it can be very overcrowded and chaotic atmosphere. So, you know, Rosenbaum was kind of misdiagnosed very early. And you know, I just feel like if - you can take some frequent flyers out of the system, you're going to take a little stress off of the ER.

MARTIN: And you also discuss some alternatives that some local governments are exploring for so-called frequent flyers. One of them started in California's Bay Area. Can you tell us a little bit more about that, and we only have about a minute-and-a-half left. And I think also, people would like to hear, how is Ken doing now?

Mr. JAMIESON: Sure. Well, the program in San Francisco is very simple. It was -the idea was to proactively go out and find frequent fliers rather - to diagnose their problems out in the field and to get them the help they need, whether it's transitional housing or getting them into a clinic. So, that's been replicated in a few different cities, including D.C. and it has been very successful. They've dramatically cut back on the number of their very top frequent flyers.

And as far as Kenny goes, I would call him something of a mild success story at this point. He had much-needed surgery about a year ago on his throat, which brought him to the ER for years and years. It was a damaged hyoid bone. He had it repaired, and at this point he almost never calls 911. He will still show up at the hospital for certain problems, but he's never, never on the phone calling 911 anymore.

MARTIN: It's a fascinating story.

Mr. JAMIESON: Thank you.

MARTIN: Dave Jamieson is a freelance reporter living in Washington, D.C. His most recent article �The Treatment of Kenny Farnsworth� appeared in this weekend's Washington Post Magazine. If you want to read the piece in its entirety, we will have a link on our Web site. Just go to npr.org. Go to programs, and click on TELL ME MORE. Dave, thank you so much for joining us.

Mr. JAMIESON: Thanks for having me.

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