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Also posted over at Paramedicine 101 and at Research Blogging.
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Go check out the rest of the excellent material at both sites.
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There is a budget deficit and cuts need to be made. Cuts would need to be made, even without a deficit, but the cuts should be intelligent cuts. Politicians choose programs to cut because they don’t think that there is a constituency that will be upset, rather than because of any actual savings or excess spending.
So, to celebrate National Poison Prevention Week (March 20 – March 26), politicians decided to kill the PCCs (Poison Control Centers).
No, they’re just cutting the funding a little bit.
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From $29.3 million down to $2 million.
Assume that you make $29.3 thousand dollars per year. Now assume that your pay is cut to $2 thousand per year. How is that going to work?
Maybe you live in an area with a high cost of living. Double the numbers. From $58.6 thousand per year cut to $4 thousand per year. Does that work?
Let’s put this in terms of vital signs. Take your blood pressure and cut it by 93% (for example, borderline hypertension – 140/90 would be cut to 9/6).
Are you still alive?
Maybe.
But for how long?
What about heart rate? Cut it by 93% (for example, borderline tachycardia – 100 would be cut to 7).
Are you still alive?
How about respirations? Cut respiratory rate by 93% (for example, borderline tachypnea – 20 would be cut to less than 1 1/2)
Are you still alive?
Oxygen saturation? Cut it by 93% (for example, the highest oxygen saturation possible – 100% would be cut to 7%).
Are you still alive?
Is there any reason to expect that the Poison Control Centers will survive when their budget is suddenly eliminated?
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But are the Poison Control Centers useful or just there to make people feel good?
Good question.
Let’s look at some research that examines this question.
By quickly assessing potentially toxic exposures and making judgments on their severity, poison center personnel frequently manage patients at home with repeat telephone follow-up as needed, preventing unnecessary evaluations in emergency departments, physicians’ offices, and urgent care centers. We desired to make conservative estimates on the financial savings to the public through our PCC providing home management.[1]
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They surveyed callers and calculated the costs of care based on what people said they would do if there were no Poison Control Center to call.
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Four medical directors of EMS in the Phoenix area were contacted and all stated that virtually every potentially exposed patient who was evaluated after EMS were summoned would be transported to an ED if a PCC was unavailable to provide advice and management, both for patient safety and for medico-legal reasons. Thus, patients who would have summoned EMS would also have received care in an ED.[1]
An interesting point is that the authors do not include any cost for the 911 system. How much more would that add to the cost of the care of these patients who could have been managed at home?
And read that last bit carefully.
What will happen if you call the ED (Emergency Department) for advice about a possible poisoning?
The only advice will be to go to the ED. For legal reasons, no other advice is given over the phone.
What will happen if you call anyone else? The same advice will be given.
What will happen if you call 1-800-222-1222? You will get excellent advice about the actual dangers presented by the poison and advice about things to watch for that would indicate that something serious is going on.
People at the Poison Control Centers are some of the last people in the country to give reliable medical advice over the phone. They are staffed with the right people to give out this information.
The rest of us are often complaining that we are too afraid of lawyers to make any decision without consulting some protocol. The only medical opinion we are permitted to have is – Go to the hospital.
We are forcing some of the last reputable people in the government out of existence – just to save an amount of money that will not even affect the budget.
We are fools.
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The National Commission on Fiscal Responsibility and Reform are not even wasting time on small programs like the Poison Control Centers. They don’t even mention Poison Control Centers in their report.[2]
How much would be saved by this cut?
The budget for the 57 Poison Control Center will be cut from $29.3 million to $2 million.
A grand savings of 1/36 of $1 billion, so not even close to being a big part of any budget, except for the PCC budget. It is 93% of the PCC budget.
But is $1 billion even close to being a significant amount?
No.
The goal is to cut $200 billion by 2015 and this would be 1/7,600 of that goal.
What would this save per person in the US?
There are over 300 million people in the US, so the savings of $27.3 million would be a whopping 9 cents per person.
Not even a dime.
This is not like some starving child in Africa, where the point is that it is only a few cents a day.
This is 9 cents per person per year.
True, we can justify almost anything if we divide the cost it by enough people. This isn’t just anything and this will save money, as the research demonstrates.
This is a small amount of money and Poison Control Centers are saving us much more than they cost.
There are better places to cut money. You will not find the Poison Control Centers mentioned anywhere in the report from the National Commission on Fiscal Responsibility and Reform.
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This one Poison Control Center in Arizona is estimated to save more money than the $27.3 million in cuts proposed for all 57 of the Poison Control Centers combined.
Are these cuts the next version of the sub-prime mortgage? Toxic to everything they touch?
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Dr. Leon Gussow at The Poison Review points out that there is a deadline to do something before these cuts go into effect. He writes –
My guess would be that the final budget will arrive at a compromise between funding the full $29.3 million and cutting the amount down to $2 million. Therefore, the next 3 weeks will be crucial in determining the future of PCCs. The American Association of Poison Control Centers is urging voters to contact their representatives in Washington. A tool on their site has all the needed phone numbers, contacts, and addresses, as well as a sample letter.
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Maybe I misunderstand the research. Maybe Dr. Gussow does, too. A more independent opinion would be better.
The opinion of Consumer Reports is presented in – Who ya gonna call? Poison control centers: on call and at risk
Even Consumer Reports agrees that cutting the budget of Poison Control Centers is a huge mistake.
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Footnotes:
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[1] Poison control centers decrease emergency healthcare utilization costs.
LoVecchio F, Curry S, Waszolek K, Klemens J, Hovseth K, Glogan D.
J Med Toxicol. 2008 Dec;4(4):221-4.
PMID: 19031372 [PubMed – indexed for MEDLINE]
Free Full Text PDF can be downloaded from the Journal of Medical Toxicology
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[2] The Moment of Truth: Report of the National Commission on Fiscal Responsibility and Reform
National Commission on Fiscal Responsibility and Reform
FiscalCommission.Gov
Page with a link to the Free Full Text PDF of the final report
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LoVecchio, F., Curry, S., Waszolek, K., Klemens, J., Hovseth, K., & Glogan, D. (2008). Poison control centers decrease emergency healthcare utilization costs Journal of Medical Toxicology, 4 (4), 221-224 DOI: 10.1007/BF03161204
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Who do they think I call when EMS gets on scene of a poisoning? Yeesh, talk about a stupid way to “save” money. Granted I see this kind of short-sighted financial thinking every day at my desk job.