Santa Fe (KRQE) – It’s a few minutes past nine and Santa Fe paramedic Ramos Tsosie is making his way across two lanes of traffic at the busiest intersection in town. He isn’t wearing any gear and aside from a patch on his jacket and a handheld radio clipped to his belt, you’d be hard pressed to pick him out as a fireman. He’s going to talk to a newspaper vendor.
Isaias Garcia is bundled against the morning chill from head to toe. He’s been up since 4:30 a.m., when he rose at a local homeless shelter to take his place on a median, hawking the day’s news. His eyebrows and smile mark the north-south bounds of all that he’s dared to expose to the cold.
The 60-something diabetic is just days removed from an emergency room visit. It’s his fourth, he says, in the last month as he struggles with managing his disease, his homelessness and his life.
Garcia is one of Santa Fe’s most frequent 911 callers — “high utilizers” they’re called — and is part of the city’s Mobile Integrated Health Office project. The half-million-dollar program is an effort to get at the underlying problems plaguing the people who most often pick up the phone to call for help.
Less than one percent of the city’s population accounts for a stunning amount of emergency resources; roughly one out of every five 911 responses is to someone who has called the emergency line at least four times.
Andres Mercado, a Santa Fe firefighter, runs the new program. “If you’ve called 911 seven, eight, 12, 13, 14, 20, 30, 50 times it means that the system is not addressing your issues.”
Santa Fe is one of a few dozen cities in the country trying a mobile integrated health approach to ease the strain on budgets, rescue crews, emergency rooms and on the people calling 911.
Karen Parks used to be one of those people. “I was calling the ambulance a lot for anxiety attacks, medication errors, all sorts of things like that,” she said.
Parks was living below the poverty line and began keeping expired medication. She didn’t want to have to pay for it again. But she had also developed an addiction that too often put her in an unstable condition.
One day, Mercado and two other firefighters showed up at her door without her having called them: “They came to me. They didn’t just call me on the phone and say ‘Hey, you’re calling the ambulance a lot.'”
That was about a year and a half ago. The city was in the midst of a pilot program to see if a Mobile Integrated Health Office, now called MIHO in Santa Fe, was an approach that might work. The firefighters took time to talk to her and see if they could connect her to existing services.
“They really made me feel like an important part of the community. Not just a pain in the butt,” she said. The firefighters showed her that she could still get low-cost prescriptions for medication she really needed. They also showed her how to get rid of pills that might be tempting, tossing them in a bottle of water with used coffee grounds “or something else gross” to spoil them.
The firefighters consulted with local doctors and social workers to find the right services and support groups for Parks’ situation. If they could get her to call a health service provider instead of 911, they’d have success.
It worked. “It made me feel important enough to make the effort myself,” Parks said.
It also freed up city resources for more pressing emergency calls.
That kind of anecdotal success convinced Santa Fe Fire Chief Erik Litzenberg that the program could work on a larger scale. Litzenberg and Mercado reached out to partner with the larger health community. A $300,000 promise from the city was paired with about $200,000 from places like the Southwest Care Center, Presbyterian Medical Services and SVH Support, a non-profit that partners with Christus St. Vincent Regional Medical Center, to fund MIHO for a year.
Mercado and Tsosie are the program’s two full-time employees. A handful of specially trained SFFD firefighters and paramedics round out the city staffers. A social worker, medical director and pharmacist complete the team.
Tsosie’s job on Wednesday included checking in with Garcia, whom he’d helped to get a month-long supply of medication. Another local organization, Healthcare for the Homeless, stepped up to help with that. Tsosie wanted to see if he could get Garcia signed up for a Medicare plan that would give him more options and a reliable supply of medication. It would also free up the money from Healthcare for the Homeless.
“There’s a lot of people out there (already) doing a lot to help all kinds of people,” Tsosie said. “I think at our best, what we’ll be doing is having a synergistic effect and making their efforts more effective.”
“We do not want to become some new agency in town,” Mercado explained. “We think our role is pretty clear, and we just want to make sure that we navigate people so that they get the right care at the right place at the right time at the right cost.”
Tsosie compared the cost to the city of a few hours of his time to the tab run up by frequent 911 callers who often aren’t able to pay for their services.
For a guy who’s spent 18 years on an ambulance crew seeing the same faces call after call, year after year, it’s a different kind of satisfaction: “It’s an enormous relief to be able to have the opportunity and the tools to address the core problems that result in the use of ambulances.”
Rollin Jones, a Santa Fe firefighter as effusive as Tsosie is calm, volunteered to be part of the MIHO team. He’s a born firefighter.
“You go to an emergency, you kick down the door, you put out a fire and it’s like…” he said, looking for the right words. “I still feel like a little kid playing firefighter. I just love it.”
An emergency room nurse as well as a firefighter, Jones sees the strain that heavy 911 users put on the system. He gets a different kind of rush from his work with the MIHO.
“You can’t, like, go hang out with your buddies and be like, ‘Yeah, the other day I secured healthcare for a homeless person!'” he laughs. A moment later, though, he’s extolling the virtues of the program: “You don’t get to brag as much, but you get to help people more … They can always find some kid to kick down a door and put out a fire.”
Jones spent his Wednesday at the Bienvenidos Food Pantry, seeing what it had to offer for another 911 caller who was battling not just diabetes but weeks at a time without a reliable source of food.
Susan Tarver showed him around as a cadre of volunteers packed 80 boxes full of bread, fresh vegetables and other staple foods.
“This place is awesome, man. I love it,” Jones said to Tarver, who explained that the food pantry often packed special boxes for diabetics, the elderly or people who had medical restrictions on their diet.
Again, leveraging an existing resource can hold great promise for the MIHO program.
Kristin Carmichael, the social worker contracted to work with the program, explained: “These are the people who, although they display the greatest need for care, get the least.”
Long intake forms, longer waits and offices that require effort to get to for a population that often doesn’t have independent transportation, put up barriers to service. Having a firefighter hop in a car to go talk face-to-face with the person who’s too often on the phone with 911 dispatchers tears those barriers down.
“This is a radically different approach,” Carmichael said, “This is a shift in thinking to where we got to the client, ask the client what they need, how can we be a partner with them?”
The MIHO team will work with 20 of the most frequent 911 callers for the next three months. Then, the team will move on to another group.
Both Carmichael and Mercado are not just driven, but data-driven, and they plan to meticulously track the program’s benefits, successes and failures. Their inkling is that the MIHO approach will work, but they want to be able to prove it to the city and the non-profits that are paying the bills.
Karen Parks knows it worked for her. She’s out of the transitional housing she was living in when she called 911 so much. She’s religious about when she takes her medication and committed to taking no more than she needs. She has a part-time job working for the local office of the National Alliance on Mental Illness. She also has a new husband and friends who’ve become like family.
“I can’t say enough good things about this program,” she said.