The 70-year-old homeless man had cycled through hospital emergency rooms time after time, costing the public $537,000 in ambulance services alone.

He is San Diego’s most prolific user of 911, accounting for nearly 250 calls in all. And there seemed to be no end to his desperate, expensive pattern.

So the region’s medical, social services and law-enforcement experts decided to take extraordinary measures.

After a series of dangerous, drunken collapses on sidewalks throughout the city, the homeless senior was arrested in September on charges of disorderly conduct and public intoxication. The unique condition for his release on New Year’s Eve: He will have to stay in a live-in facility or risk getting arrested again.


The man’s case illustrates the depth and breadth of efforts to help chronic users of the medical emergency system — as well as save taxpayer dollars spent on their care.

For three years, the California HealthCare Foundation Center for Health Reporting and The San Diego Union-Tribune have produced reports chronicling the city’s innovative push to reduce certain people’s frequent 911 use.

A team of community paramedics was established in the wake of the first series in 2012, and titled “Health Care 911.”

Another package of stories this fall showed that reduction efforts had begun to pay off, with an almost 6 percentage-point drop in the number of 911 calls made by frequent users. That reduction translates to thousands upon thousands of taxpayer dollars saved in emergency services.


The biggest challenge remains convincing frequent users to agree to receiving intensive case management in a system they rarely trust, and one that sometimes releases them too early from detox programs due to a shortage of beds.

For the alpha user of them all, it took a court order.

True to the elusive nature of the 70-year-old homeless man whose professed goal was to “die on the street,” a video shot of an empty podium stood in his place during his Dec. 11 hearing.

County Superior Court Judge Peter L. Gallagher said even though the proceeding was via video conference from jail, the man had waived his right to appear, as some misdemeanor defendants are allowed to do.


Gallagher sentenced the man, who had declined an interview request for this story, to three years probation under the housing restriction.

“Everybody, great job here,” Gallagher told the man’s public defender, San Diego police and representatives for the city’s emergency medical services who were in the courtroom.

“I hate to use the term ‘holistic approach,’ but that’s the term I will use,” Gallagher said later in his chambers, citing judicial ethics and speaking generally of the substance-abuse cases he handles.

“You can get people off the streets and into housing,” he said. “However, if they’re still drinking and they are still using illicit narcotics, the housing is just a place to flop.”


New Year’s Eve release

The city’s top 911 user is scheduled to leave jail on Dec. 31. His new year will include access to mental-health and substance-abuse services, as well as treatment for serious medical problems that brought him very close to his goal of drinking himself to death.

The day after journalists chronicled a Gaslamp Quarter odyssey for the man that ended with his 243rd call to 911, Dr. Jim Dunford, director of San Diego Emergency Medical Services, vowed to come up with a new plan for this patient.

Dunford is a nationally recognized expert on intervention efforts for 911 frequent users, and he’s the chief architect of San Diego’s efforts toward that goal.

For the city’s No. 1 frequent user, he and other city officials gathered to discuss more-effective strategies than the standard approach that had been tried repeatedly: taking him to the ER so he could be stabilized. Each time, he would eventually ask to be discharged back onto the streets.


The brainstorming process brought up the ongoing challenge of communications among the various teams striving to help frequent users. Medical privacy laws bar health providers from sharing key information with law enforcement, social services agencies and others unless a patient grants the access.

Ultimately, the coalition chose the strategy of incarceration and rehabilitation.

On Sept. 30, the city’s top frequent user of 911 services was booked on multiple charges of disorderly conduct.

His use of the ER didn’t stop once he was behind bars. On Oct. 4, a 911 call reported him as a Level 1 “Sick Person” at the Central Jail suffering from nausea, weakness, dizziness and low blood pressure.


He was transported to UC San Diego Medical Center’s emergency room in Hillcrest, then eventually taken back to the jail.

Whenever the man needed subsequent hospital care, a county sheriff’s deputy was asked to accompany him in the ER — so there would be no danger of him talking the health providers into mistakenly releasing him back out in public.

Dunford’s point paramedic for the man, Anne Jensen, was tasked with finding a live-in facility willing to work with his resistant nature.

Though the man’s case was heard in open court, attorneys and officials declined to name the live-in facility designated for him and what treatment he would receive there. They cited patient privacy, but law enforcement and the courts aren’t subject to such regulations like medical providers are.


State legislation

Rep. Doris Matsui, D-Sacramento, has proposed legislation to clarify when the federal patient privacy law known as the Health Insurance Portability and Accountability Act should be invoked, and by whom. She reviewed the San Diego case through her staff and expressed concern.

“It is common for people to inappropriately use HIPAA law as a blanket justification for not exchanging patient information that could be important in administering proper care,” Matsui said.

People who have tried to work with San Diego’s top 911 user have found him to be uncooperative, even combative.

But when he could still walk, he was known to frequent the Gary and Mary West Senior Wellness Center, which at its downtown location offers health and supportive services to seniors.


A medical professional conducting research there, who cited patient privacy laws and requested anonymity, said the man would at times warm up to the center’s staff.

Apparently, he stopped visiting because he didn’t want to abide by certain behavioral rules there.

Gonzales is a senior writer for the California HealthCare Foundation Center for Health Reporting.