Drug epidemic exacts health-care tolls that can’t be measured in dollars
The opioid epidemic has taken a toll on Washington Health System. Many tolls, actually.
Finances are not on the top rung.
Inpatient treatment costs about $2,000 a day, which, in most instances, are covered by health insurance. An estimated 2 to 3 percent of WHS patients are not insured, but that expense likewise is largely covered.
“Patients without insurance wind up being in charity care,” said Gary Weinstein, president and chief executive officer of the Washington-based system, who provided those figures.
“Part of our nonprofit mission is to take all comers. That’s why we do fundraising and why philanthropy is important to us.”
Stepping up security, a necessary endeavor, adds to the operating expense. Cameras have been installed “to avoid drug drops” in the behavioral health unit, where, Weinstein said, visitors also are not allowed to bring in stuffed animals and food and drink while seeing a patient.
This crisis, however, is exacting other, greater tolls on a system that employs 2,400 at Washington Hospital, WHS-Greene hospital, physicians offices and Greenbriar Treatment Center. It has fostered an environment of concern, fear, pressure and frustration among many staffers.
Weinstein said the areas impacted the most are, in order: emergency; medical/surgical nursing floors; obstetrics, and doctors and doctors offices.
An emergency department serves as the front line in this war. This is where overdose victims are transported, “an average of about one a day at Washington Hospital,” Weinstein said, adding that is comparable to the rate at health centers statewide.
“It’s tough on morale in the ED,” he said. “They see patients in crisis, patients who are angry. There is a lot of fear and anxiety, and some discouragement.”
Discouragement among health professionals often occurs when an overdose victim, who had received Narcan from Emergency Medical Services, awakens in the hospital but declines its offer to place him or her in a rehabilitation program – called “a warm handoff.”
“They come to and start having a craving for heroin again,” Weinstein said. “We have to get them right then or they’ll be on the street looking for their next fix.”
He said emergency personnel also are at risk from patients who “may have needles or residue fentanyl. There’s bad stuff out there.”
Ramped-up security measures not only are intended to protect employees, but to prevent drugs from being brought in. “We can’t police every visitor who comes into a room,” Weinstein said.
The crisis extends to the youngest population. WHS’s obstetrics unit is dealing with a bump in neonatal abstinence syndrome, a grouping of issues that afflict a newborn who was exposed to illegal or prescription drugs while in the mother’s womb.
A little more than 10 percent (93 of 895) of babies born there were diagnosed with NAS in fiscal 2017, up from 5 to 7 percent over the previous five years. Weinstein said affected infants are hospitalized five to seven days longer than the others, adding to costs and taxing social services such as Children & Youth.
Well-meaning physicians also have been under siege for prescribing pain medications that have led to addiction. “Back in the late ’90s, the pharmaceutical industry came up with these wonder drugs it said were not addictive. It turned out they were,” Weinstein said. “At that point, it’s tough to get the genie back in the bottle.
“We’ve been working on pain control after surgery. We used to typically use opiates. Now we use other pain-control methods.”
Other organizations in the region are feeling Washington Health System’s pain – financial and otherwise.
Canonsburg Hospital
Julie Ference, nurse manager of Canonsburg Hospital’s emergency department, said her department probably doesn’t admit as many overdose patients as its counterpart in Washington. “But we do see a couple a week,” she said, lamenting the emotional cost.
“It’s the mental breakdown that they get of that person not being in treatment, or not being able to complete treatment, or that person not being able to get into treatment,” said Ference, who is also a member of the Washington County Opioid Task Force.
She said Canonsburg Hospital hasn’t had to increase security, but staff have had to call police to collect drugs brought onto the premises.
“We find a lot of patients that come in with stamp bags on them,” Ference said.
Ambulance & Chair
It costs Washington Ambulance & Chair Service about $1,000 each time it responds to a call involving a drug overdose and, oftentimes the bill gets absorbed at the business, said Billie Morris, company president.
“In many, many, many cases, no one is paying for them,” Morris said. “If they refuse to go to the hospital, we can’t bill Medicaid. It’s a loss.”
“It’s creating a financial crisis for the majority of the ambulance services,” she added.
Her service responded to 207 drug overdoses between January and September. It also responded to 280 such calls last year.
The service receives the opioid antidote naloxone it uses on overdose victims for free from UPMC by way of its command services, said Rodney Rohrer, the manager of the service.
Autopsies are costly as well. Washington County Coroner Tim Warco said it costs taxpayers about $2,000 for an autopsy on a drug overdose victim.