911 High Utilizers Committee

Judge Polly Jackson Spencer

Probate Court No. One

Bexar County, Texas

• Additional Committee Members present– Karen Hogan, Staff Attorney Probate Ct. 1– Sue Bean-Court Investigator Probate Ct. 2– Dan Crutchfield-Court Investigator Probate 1– Joann Tobias Molina- APS Regional Director– Sonia Samples-APS Subject Matter Expert– Sonja Baggett-Bexar MRA QIS Manager

• Serving as primary judge for Mental Health in Bexar County discovered many persons using 911 calls for non-emergency reasons

• Cost to community

• Potential risk as ambulances and police cars respond to non-emergencies which creates potential danger to community

• Began a task force in 2003

• Probate Court invited community interest groups– Police Department– Fire Department/EMS– Adult Protective Services– Local MH and MR authorities

• Agreements to share information only with each other without any publication of the shared information

• Agreements to cooperate between community interest groups

• Entities would report to each other if entity had contact with the individual

• Format is a monthly meeting• Meeting is at lunch time• May bring your own lunch or lunch provided• Before meeting each group is asked to submit

by email names of persons identified by the entity of a high utilizer of Emergency services

• Each entity is asked by email to check before the meeting if the named person has any history with the entity so when the meeting occurs, current information will be shared.

• Benefits of collaboration– All entities who provide services are at the

table and can discuss the history of the person, the attempts to provide help which have worked and which do not work

State of Texas-Health information between patient and physician is privileged not to be disclosed except by court order. Texas Rules of Evidence 509 defines the privilege

Each State will have a rule protecting physician patient privilege

• HIPAA Health Insurance Portability and Accountability Act of 1996 applies to any entity that is– A health care provider that conducts transactions in

electronic form– A health care clearinghouse– A health plan– Our 911 task force is not any of the above; however

one entity is a mental health care provider that conducts transactions in electronic form

• Some of the exceptions to HIPAA which allow covered entities to disclose protected health information are

• Victims of abuse, neglect or domestic violence• Uses and disclosures for health oversight

activities• Disclosures for judicial and administrative

proceedings• Disclosures for law enforcement purposes• Uses and disclosures to avert a serious threat to

health or safety

• In Texas 911 audio recordings records are public information and are not privileged

• Texas Government Code Chapter 552

• Texas Law regarding 911 calls is addressed Texas Penal Code Chapter 42 Disorderly Conduct and Related Offenses

• Section 42.061-Silent or Abusive Calls to 9-1-1 Service• (b) a person commits an offence if the person makes a

telephone call to 9-1-1 when there is not an emergency and knowingly and intentionally

• (1) remains silent; or• (2) makes abusive or harassing statement to a pubic safety

answering point employee• (d) an offense under this section is a Class B misdemeanor (in

Texas punishable• fine not to exceed $2,000 confinement in jail for a term not to

exceed 180 days; or both fine and confinement.)

• Texas Law allows the court to initiate a proceeding to determine if a person living in the county no longer has capacity and the appointment of a guardian would be in the citizens best interest

• Case Study One – Elderly woman lived alone in her own home– She suffered from dementia– Her home alarm system would get 911 referrals– She could not remember the code to disable the

alarm– The committee discussed the matter.– The court initiated the appointment of a guardian ad

litem to investigate if she had capacity– The physician statement indicated that woman should

no longer live at home alone – 911 calls diminished with the change in residence

• Case Study Two– Bed bound woman called EMS daily to

request that EMT prepare a sandwich as she was hungry

– EMT did prepare her a sandwich for many days

• Case Study Three

– Mr. Green was an Adult who had cognitive challenges who lived “independently” in an apartment

– Mr. Green used very abusive language to request help

– Mr. Green was banned from entering the local Social Security Office

– Mr. Green would call APS local office ten or twenty times daily requesting food, money for taxis, etc

– Mr. Green would sell is prescription medication for cash to buy clothes and shoes and for specialized haircuts

– Mr. Green was receiving assistance from almost every agency in San Antonio, yet none of the agencies were aware of the other agency involvement

– A special task force just for Mr. Green was established

– One person estimated Mr. Green was utilizing the staff and resources equal to a quarter million dollars for him to live “independently” in the community

– A guardian ad litem appointed– He was evaluated that he did not have

capacity and a guardian was appointed

– The guardian appointed is a state agency– The State agency found him appropriate

placement and his 911 calls have diminished

• Guardianship is not an answer to all problem 911 callers

• Members of the task force include specially training CIT officers who will assist by making welfare checks for persons who are discussed

• Some persons receive help through voluntary and involuntary Mental health Treatment

• Frequent 911 callers Helps on the internet

• US Department of Justice

• Office of Community Oriented Policing

• Problem Oriented Guide for Police Services No. 19

• Misuse and Abuse of 911by Rana Sampson