Calif. County Grand Jury Requests Revival of Program to Filter Out 9-1-1 Abusers

The San Diego Union-Tribune

June 07—The county grand jury says San Diego should immediately revive a program that reduced unnecessary 911 calls by using a software filter to weed out the most frequent callers: the homeless, the mentally ill and drug addicts.

The program saved the city money and drew national praise from 2010 through 2016, but city officials let it expire a year ago when the federal and state grants funding it ran out.

In a seven-page report released this week, the grand jury says that was a shortsighted decision the City Council should reverse Monday when it's scheduled to adopt a budget for the fiscal year that starts July 1.

The civic watchdog panel estimates the annual cost to resume filtering 911 calls would be $280,000, far less than the roughly $500,000 per year the city was saving with the filtering, which it called the "resource access program."

City spokeswoman Katie Keach said Thursday by email that city officials see "great value" in the program and plan to require it be revived by a new emergency medical services provider San Diego is scheduled to select next year.

The grand jury says the program saved the city money and helped shrink response times to more pressing emergencies than those typically called in by the homeless, mentally ill and drug addicts.

The software filter allowed city officials to build a history, or profile, for each individual who was placing multiple calls to 911 within a particular year.

That profile included the number of calls, length of time between the calls, the nature of the incidents and the treatment required.

Then paramedics contacted frequent callers to let them know about social services, mental health resources, shelters and other help available to them. Some were also assigned case managers.

Meanwhile, the city started to flag 911 calls from frequent callers and route them differently than an ordinary 911 call. Instead of sending those calls only to paramedics, they were sometimes routed to a wider network of service providers, including law enforcement, homeless outreach teams and social workers.

Because the software provided dispatchers and other officials data right as the call was coming in, they could immediately make decisions on how to route each call from a frequent caller.

The city started with 25 to 30 "mega-users," who were defined as people calling 911 at least 52 times per year—a rate of once a week.

Officials then added two more categories: "super-users," defined as 26 or more calls per year; and "frequent users," defined as eight or more calls per year.

"Their calls were often related to hunger, loneliness and the harsh circumstances of living on the streets," the grand jury reports says. "These issues require long-term social and behavioral health services rather than the short-term, medically oriented treatments available in emergency rooms."

To make the program possible, the city sought and received a state exemption from a requirement that 911 callers get taken to emergency rooms.

This allowed officials to treat some callers in the field and to take others to alternative places better suited to the subject of their 911 call.

When a study compared the 12 months before someone was flagged as a frequent caller to the 12 months after they were flagged, it showed 325 fewer emergency room calls for an estimated savings of $543,000.

The program was launched in 2010 with a $15 million federal grant, a $2.5 million state grant and $1 million from the Alliance Healthcare Foundation.

When that funding ran out, the council considered providing money to keep the program alive, the grand jury report says.

But the council ultimately chose not to when American Medical Response, which operates the city's ambulances under a contract that expires next year, said assigning paramedics to the program was spiking response times and subjecting the company to city fines.

The grand jury report expresses skepticism about that stance, noting that AMR recently sought and received an increase in ambulance fees from the city based on an increase in unnecessary 911 calls.

"This, of course, is precisely the problem that the resource access program was developed to solve," the report says.

The council and Mayor Kevin Faulconer must formally respond to the report by Sept. 4.