Calls for Monroe County, hospitals to step up addiction intervention in ER
Gates, N.Y. (WHAM) - What happened when a man addicted to heroin went to the emergency room for treatment has made him an unlikely ally: a police chief.
Now Gates Police Chief James VanBrederode is demanding change and he's calling on Monroe County's top health official to make it happen.
"It's time to change the way business is done," VanBrederode said in a letter to the Commissioner of Public Health Keith Gram
When an addicted person makes a decision to seek treatment, there is a narrow window of time before withdrawal and need for the drug becomes so overwhelming that they use again.
"It's like every day playing Russian roulette," said John, an addict who only wanted to be identified by his first name. "You don't know if this is going to be the one you don't wake up from."
Laid up by a construction accident five years ago, doctors sent John home with pain pills - hundreds of them. Now, it takes 10 bags of heroin every day to stave off the withdrawal that otherwise leaves him unable to function.
"You beat yourself up because you try to make it without it, and you just can't," John told 13WHAM's Jane Flasch.
On November 18, John was in the midst of a four-day binge without food or sleep. He loaded more heroin into a syringe and called his best friend Randy Cimino.
"He started off with, 'I've had enough,'" Cimino said. "'I'm going to shoot ten bags of heroin and call it a day. It's over for me. I'll never get sober.'"
It was 11:30 on a Sunday night. Cimino, who runs Gates to Recovery, called Chief VanBrederode. Together, they got John to the emergency room at Strong Memorial Hospital with the goal to get him sober but also for access to a mental health specialists and to get a referral on a place for rehab.
But when he arrived at the hospital, John said he was given a sandwich, a blanket and a chair to sleep in. He never saw a doctor or an addiction counselor.
"I would have liked to see a doctor, an addiction therapist," John said. "I'm looking for the light at the end of the tunnel but I'm so used to having the door shut. The door shuts when you start to get somewhere."
"The emergency rooms are in the old mindset," said Chief VanBrederode. He noted police and courts have switched from arrest and punishment to putting therapy for the addiction first. "We need for ERs to connect the dots and hook them up with services and not just send them back out on the street."
On November 26, VanBrederode wrote to Commissioner of Public Health Michael Mendoza, calling on him to intervene to require hospitals to address addiction treatment in the emergency rooms.
Dr. Mendoza told 13WHAM News the county does not have a say in the policies of private hospitals. Yet it has successfully worked with them to make changes. One key is providing overdose medication such as Narcan for heroin users to take home with them after visiting the ER.
Another step is called the Bridge Program. ERs now offer drugs such as suboxone to ease the effects of withdrawal for users who want to seek treatment.
"We are making progress; at the same time we know there are gaps," Dr. Mendoza said.
Dr. Keith Grams is the Chairman of Emergency Medicine for Rochester Regional Health. He said addicts seeking treatment who show up in the ER are evaluated, given treatment options, then get a follow-up phone call.
"Most of the time all they care about is getting out of the emergency department and back on the street," Dr. Grams said.
"Since we've instituted these bridge programs we've been underwhelmed by the demand," Dr. Mendoza said. "These services are in place, we just want people to ask for them."
He said he "respects the passion" of Chief VanBrederode and intends to respond to his letter.
In a statement, officials at Strong Memorial Hospital said addiction specialists do evaluations in the ER and also provide counseling and information about rehab programs. Citing privacy, they could not discuss John's case or why he may not have been offered any of those services.
John said he's ready to get clean, but doesn't know how.
"What I've done has never worked," he said. "I'm like a dog chasing my tail and I can never catch it. I'm 48 years old and I'm tired."
Statement from Strong Memorial Hospital:
"In the ED, we stabilize and treat all patients, including those with addiction or who have overdosed. Strong Memorial Hospital’s Toxicology Consult Service is staffed by specialists in addiction medicine; they routinely evaluate patients in the ED who appear to be in active withdrawal and provide buprenorphine immediately when necessary. They then recommend a long-term treatment plan, usually involving referrals to addiction treatment providers in the community.
"Patients with acute psychiatric issues are referred to our Comprehensive Psychiatric Emergency Program.
"For patients with non-acute mental health needs, our ED social workers counsel them on the outpatient mental health treatment options available.
"Patients who are not medically stable are admitted for inpatient care.
"For patients with addiction who are medically stable, in addition to the Toxicology consult service, our ED social workers provide counseling on the treatment options and resources available to them after they leave the hospital.
"UR Medicine has been assisting primary care physicians in our community to receive training and certification as buprenorphine prescribers, so that more PCPs are equipped to care for patients recovering from opioid addition. These efforts are being coordinated with the EDs at both Highland and Strong to provide bridge services – where patients who need it can receive buprenorphine in the ED, then bridge to a treatment program and then to long-term care support in primary care."