Food Run

The call at an intersection in the downtown area is for the "unknown," which could be pretty much anything, but is usually nothing. And so it was in this case.

We pull up to the appointed location to find one of our regulars with his hand in the air, as if he was hailing a taxi. Which he was, except this one doesn't require any out-of-pocket expenses.

"What is it, Mr. Smith?" I ask.

"I want to go to the VA." Big surprise, that. The man is a disabled veteran with a history of mental problems. If I had to do what he did in Vietnam, I probably would, too. But you tend to forget about those things when he calls you four times a week.

"What is bothering you today, sir?"

"I'm hungry."

That's a new one. "Say what?"

"I'm hungry," Mr. Smith repeats, as if I am hard of hearing. "I have no money, and the VA will feed me. Take me to the VA."

There is a federal law called EMTALA, the Emergency Medical Treatment and Active Labor Act, which every EMS provider in the country has beaten into their heads at some point in their career. Known as the anti-dumping law, it is designed to keep hospitals in affluent areas from passing off indigent patients on facilities in poorer areas. Among other things, it makes special provisions for hospital-based services, which I work for, including a nifty one that says that anyone who calls for or otherwise presents to an ambulance is to be treated as if he or she walked in the front door of the hospital itself.

The law does not say, however, that I have to take the patient to the hospital where the patient actually wants to go. I work for a hospital that provides the sole 9-1-1 coverage for the city, so consideration of other people as well as the patient's chief complaint is often a factor in where we go.

Taking him to the Veteran's Hospital, located in an adjoining municipality, would have meant passing at least three other facilities. And the fact that we were a block and a half from one of the city's five hospitals made it mighty tempting to avoid the VA. Alas, Mr. Smith knew how to play the game, and often did. Taking him around the corner would have inevitably resulted in Mr. Smith waiting for us to leave after dropping him at the Emergency Department, after which he would have walked out the door, and found the nearest pay phone not on hospital property. Another call to 9-1-1 would have followed until he found a unit willing to take him to the VA.

After careful consideration of the alternatives, among them the fact that somebody was going to wind up taking him where he wanted to go, I found that I was that not-so-willing unit. Off we went.

After an uneventful ride, we walked in the Emergency Department door of the VA, and Mr. Smith went right to the chair where they register people. The staff just rolled their eyes.

I went up to the charge nurse, and told him of the patient's chief complaint, expecting an incredulous reaction similar to my own. Imagine my slight surprise when he said that this was a common complaint for him. "Oh yeah, he comes in here all the time and says that there is nothing acute wrong with him, he's just hungry and can he have a sandwich."

"And you give it to him?" I ask.

"Yep, its easier than dealing with him when he starts throwing things."

If nothing else, now I have an example to cite when we get the inevitable, "What took you so long, (expletive deleted)?"