The Free Taxi Ride

Years ago I was working with New York City as an EMT out of Queens General Hospital.  I remember being in shock after picking up an otherwise non-ill appearing man who gave a complaint that I currently cannot recall.  We took him in a city ambulance to the local hospital.  The part that shocked me was that he never entered the hospital.  He thanked us and proceeded to go across the street to do his shopping. He never was sick and never intended to enter the ED doors.   We served as free transportation for him.   He expressed no qualms regarding his actions.  The only conclusion I can draw today was that, in his eyes, it cost him nothing.   He was able to get away with it.   He had a complete disconnect not only from the ethical issues of what he did, but the costs being eaten by the city government for the taxi ride.

The same issues apply daily in the care I provide in the Emergency Department.   There are multiples of patients who use the ED as primary care who are donning the latest Iphones, wearing expensive leather jackets, downed in expensive Aeropostel and Uggs clothing.  They are at a lost when I ask them who provides their primary care.  “I just go to the hospital!” Attempts to explain to these people the importance of routine primary care by an appropriately trained individual falls on deaf ears.  They will openly admit that the use of clinics and primary care facilities will cost them money.  They have nothing in the game.  Hence, using one of the most expensive forms of medical care, which often isn’t the best care, continues to be used and abused.

I recently questioned an administrator regarding the potential logic of opening up various clinics.   Perhaps a pediatric clinic on Tuesdays staffed with board certified pediatricians, Wednesday an adult primary care clinic staffed by Internists, and so on.  It seemed like a perfect solution to me to guarantee good follow up with individuals most appropriately trained to assure convalescence and preventive care.  “We looked into this, and financially it isn’t viable.”  In other words, my translation of this statement is that the hospitals can collect more state money for emergent care for non emergent patients than they would receive if they set up and established local clinic care.  Follow the dollar signs.   The current government bureaucracy continues to do a disservice to the very individuals they are supposed to protect.

Emergency care being a safety net and providing primary care is something that will never end.  However, I wonder how much general abuse would stop if the general public had to send in their taxes monthly rather than not realize that they are disappearing from their paychecks until April 15th.  In other words, each month a payment would have to be sent in no differently than a payment to a cell phone carrier.  The statement of “let the government do it” would be reconnected to the concept that the government is us.  Abuse local services? – Your taxes go up.   Your monthly payment to the local government-taxing agent goes up.   Don’t pay?  Sorry – your garbage will no longer be collected.  Don’t pay?  Sorry, your mail service stops.

Will this ever happen.  Of course not.  Still, free taxi rides are destroying the system.


  • Jake says:

    Paying taxes monthly would be futile; the people that abuse EMS are not paying taxes.

    • One of the affluent hospital systems I work for has its fair share of abusers too. It is a universal problem. Reality, though, is that the government support systems have been manipulated and are broken/being gamed. I remember being in residency in Philadelphia living on near to no money on a resident’s salary . Individuals would present wearing Nike sneakers and sporting leather jackets requesting work notes, clinic level care (which would require upfront presentation of a copay), and prescriptions for over-the-counter items such as Tylenol (this way they didn’t have to pay for them). I would leave my shift to walk to my apartment and these same folks would be routinely playing basketball in the courtyard outside the local supermarket – not injured. Not “disabled” as they claimed. Policing of the system is what is lacking. If you and I lack funds to buy something we need, we aren’t buying ipod players, iphones, or leather jackets.


  • Ricky says:

    This is an ongoing problem even in New Jersey. I work in Jersey city and the daily abusers just keep on coming

  • marten says:

    I’ve been saying this for years. Now….with Obama and his healthcare reform nonsense, I wonder if it’ll get better or worse….

    • Medicine is not a perfect science. Combine this with the treatment of Emergency medical services as a right and not a resource, along with the concurrent legal climate which affects all of our actions in EMS/Medicine, I believe the system will continue to erode until a critical point is reached.

  • marten says:

    Dr. Barnett,

    I’ve also done the calculations over time for what it costs taxpayers in terms of Medicaid pt’s abusing the ED. You take the average ED bill, on top of the ambulance rides (usually Medicaid will only pay $99 for a BLS transport) and add them together and its well over $1500 per person…even if you say $1,000 per person…multiply that by the tens of thousands of people per day across the country that abuse the system…and tell me your total? Sick isn’t it? And whats this countries deficit?

    • The issue is how to address this. We live in a legally punitive system. EMS squads are rarely released by base command due to “the rare case”. The situation is even worsened once these patients arrive at the ER. My understanding of EMTALA is that there is no definition of who does the medical screening. Hence, hospitals tend to consider medical screening as escalating up the level to a NP, PA or MD. Shouldn’t a seasoned ED RN be able to screen during triage and complete the EMTALA requirement? Legal fears motivate the over ordering of tests in the ED as well. It is a broken system.


  • Fred Nordstrom says:

    -*I have had several of these after 25+ years in EMS, some even use us to see who the ER Dr. is or on busy nites just to see who we were bringing in.

  • Anna Menchaca says:

    First and foremost its young, under educated people with whom are on public assistance or have no insurance or jobs that use the Ambulance as a taxi. I had a young lady call for an miscarriage, upon arrival to E.R. she pulled out her I.V., jumped off my cot and walked across the street. I found out later that across the street there was a recreational pharmacy. I basically gave her a ride so she could cop drugs. Now on the other hand the senior citizen population has to be convinced to go to the Emergency Room ( unless they are lonely and have a mild case of dementia, then they call allot). The senior population is concerned in racking up medical bills. Most only have medicare and that only usually covers 80 % of costs. The young could care less we are a taxi and the Emergency room is a clinic. Abuse and fraud is a big problem. We also as a society do not educate the public on what is a true emergency and what justifies prudent use of Emergency Rooms and 911 ( for taxi service) Even medicare has medical necessity compliance guidelines for use of Ambulances and E.R.’s. State medicaid programs need to step up to the plate and require some education, regulation and guidelines as well as potential penalties for fraud. We demand responsibility from our seniors who really need our services more and more frequently ( due to age and medical histories) than the young medicaid abusers. Anna Menchaca EMT-P Proud member of the Chicago Fire Dept.

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