In my tenure at Seventh Circle Of Hell Hospital, it was observed on more than one occasion that we didn't see 3000 patients a week; actually, we saw 150 patients 20 times apiece. Which came far closer to the truth than anyone wanted to admit.
But King of the Cockroaches (as many refer to the patients who refuse to die, despite massive doses of radiation) was everyone's favorite, Mr. Shipley. And when I say everyone, I mean, everyone within 100 miles.
No mere gainsaying and hyperbole this, because on countless occasions, I personally witnessed paramedics from 3 cities away, who hadn't worked our area in years, or even decades, observe no more of him than Mr. Shipley's Santa-white mane of hair poking out from under an ambulance blanket as he lay waiting in the hallway for a room, who then kicked the gurney as they went past, and greeted him by name. And they all knew to take his cane away from him, because when sober he was the nicest guy you'd ever meet, but when he was drunk (about 90% of every waking moment) he was a mean mofo of a drunkaholic to deal with, not above whacking you with his county-supplied walking stick.
His modus operandi was stupid simple. He would get drunk, on whatever. He would fall down. His drinking buddies on Waste Of Skin Row would call 9-1-1, and report he was having a seizure. He would be picked up by paramedics. He would be brought to the hospital. He would receive multi-thousand dollars' worth of full-court work up, including head CT, all while roundly m*****f****** everyone around. He would sober up somewhat, along a blood alcohol continuum from 700 to the low 200s. He would be admitted. He would elope. Then he would get drunk, on whatever, and begin the cycle anew.
One July, a new resident guilty of nothing but unsupervised greenness, ill-advisedly called medical records, and requested Mr. Shipley's medical file. About 15 minutes later, two file clerks rolled up with two mini-shopping carts, and dumped the equivalent of four Manhattan telephone directories on the resident's desk. It was seriously a stack 3-4 feet tall.
"That's everything for this year, doc. If you want anything more, I'm going to have to call in some help to haul it all upstairs."
Conservative guesstimates put Shipley's recidivism in the ER at upwards of 250 visits/year. One week, I worked 5 12-hour shifts, but he beat me, arriving there 6 times. I discharged him one early morning and he was back in the ER before I was, on the same day. Assuming a generously low rate of $2K/visit, you figure it out.
Even at Califrutopian real estate prices, it would have been cheaper for the County to buy Shipley a modest house, and have enough left over to employ both round-the-clock bartenders, and nurses, plus all the distilled consumables he required, with change back from what his medical care was costing annually(and been able to resell the house, someday). And Shipley was merely one of hundreds in our little slice of paradise by the Pacific.
I only half-mockingly proposed that instead of my third shift every week, they instead purchase a 40-pass. party bus, a paper shredder, and a couple of cases of 40 ouncers and other stuff. I outlined that I'd drive around downtown picking up our favorite derelicts, get them on the bus with free beer and booze, and deliver them, suitably lubricated, to a different city west of the Rockies every week. After helpfully shredding all their personal IDs and paperwork. Portland, Salt Lake City, Denver, Albuquerque, whatever.
There was some slight risk that those cities' constables might have figured out what was going on, when 40 bums they'd previously not seen arrived, all claiming to be from the greater SoCal area, and all without a shred of documentation in proof thereof. But such was a minor irritation, because
1) They might send the bums back to us, but we'd still have gained a few days respite from their predations on our medical resources.
2) They might retaliate by sending us their bums, but at least we'd get new faces, and perhaps set up a Bum Exchange Program among the various metropolii, which might also broaden the horizons of the bums in question, and give everyone new folks to play with.
3) Most likely, once they realized they weren't in Kansas anymore (or rather, were in Kansas, but wanted to be in L.A.) the bums would avoid the cops, and set out to return homeward. And pass a liquor store on the way. And that, quite simply, would be the end of that Grand Scheme.
I could never get the Head Wheels to go for my plan, but they were suitably impressed that I'd thought it through so thoroughly.
Leaving us, day in and day out, stuck in the clutches of the federal EMTALA act, mandating that we have to lather, rinse, and repeat, for everyone, despite the futility and wastefulness of the effort. Next time your grandmother has to wait in the waiting room, or her ambulance gets diverted three hospitals away for her heart attack, be sure afterwards to take pen in hand, and thank your congressman. And please remember, you're picking up the check.