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January 27, 2010
Exclusive: Budget Cuts in New York Threaten State’s Poison Control Centers
Pretty soon, New Yorkers will lose some of their poison control centers throughout the state. Does it matter? Ask a parent, a paramedic, a nurse, or a pediatrician.
Poison control centers are one of the few entities that serve us well in peace and under threat of WMD or terrorism. But we should take caution from an old song: “you don’t know what you’ve got until it is gone.”
“Those who ignore history are condemned to repeat it.” – George Santayana
This is one time when I wish I was wrong when I predicted New York State would put poison control centers on the chopping block. Just a few months ago,I warned aboutthe growing assault on public preparedness, child emergency care, injury prevention and medication safety in the form of drastic cuts or outright closures of regional poison centers as a result of dramatic budget shortfalls in mismanaged states. Washington State, California and Michigan have already seen the ax fall outright on their centers or slashing their budgets – the impact of which will increasingly be felt not by the legislators or other band of merry knaves, but by the people – old or young, rich or poor who are and will continue to receive less than optimal care as a result of these budget cuts.
And, as predicted, New York is the latest state that has decided to attack poison center funding and in the process attack the value of its services and most worrisome the very people these centers protect and serve.
Background
The annual support from New York State for the five NY State PCCs and one educational center is approximately $5 million to provide for and help protect the citizens of New York – nearly 20 million people (19,490,297) according to Census Bureau estimates. The cost per person is roughly 34.5 cents; 40 cents if we take out children and teens. Given that New York is strategically, economically and symbolically one of the most important states in the Union, the issue of defunding should never rear its ugly head. But NY PCC funding was threatened in the past. That cannot occur again. But surprise! It is happening again, and this time with a less than supportive governor. At least in the 1990s and early 2000s, we had support in the executive office. In fact, we had it at the state house, too. Everyone wanted us, but no one wanted the cost coming from their budget! It got settled, everyone sang Kumbaya and we were promised such an assault on one entity with clear public benefit would not occur again. Famous last words!
Gov. Paterson is hoping the citizens of New York can’t add – he thinks we will buy into the government math lesson he is now peddling. Consider his arithmetically flawed approach to New York’s fiscal woes: cut a couple million dollars of poison center funding to rescue the state from being almost $8 billion in debt! The fact that the geniuses in Albany – legislators who cannot control their pork spending to the tune of putting the state $7.4 billion in the red – think cutting $2–3 million will make a difference in the debt servicing is hardly inspiring. At that rate, it will only take a few centuries to get into the black.
Gov. Paterson has stated he will cut everything across the board. That may sound fine for the sound bites, the special interest groups, lobbyists and folks working in the executive branch in Albany. But it isn’t fine, because it suggests that all budget entities are equal when nothing could be further from the truth. This faux egalitarianism designed to deflect criticism or mollify special interest groups ignores the obvious and tries to put a curtain around the elephant in the room – namely that not all things funded by the government are equivalent in terms of social good, nor ought to exist or exist at current levels. Some are nice but can be done without, others are clearly untouchable if we want to provide for the common good. Alas there seem to be some disagreement on who is to benefit and who is to be sacrificed. But to anyone who knows a billion is a lot bigger than a million has it pretty figured out.
It is a no-brainer to cut costs when you are in debt. But it is a foolish maneuver to lump every budget item into the cost cutting bin. And it is idiocy for anyone to consider all categories of expenditures as equivalent categories of expenditures…they are not!
According to New York State Division of Housing and Community Renewal site, and the Governor’s office release, the Executive Budget recommends 2010-11 All Funds spending of $134.0 billion, an increase of $787 million or 0.6 percent from the prior year. State Operating Funds spending (excludes federal funds and long-term capital) would total $79.9 billion in 2010-11, an increase of $745 million or 0.9 percent. Spending recommended in the 2010-11 Executive Budget is well below the projected rate of inflation (2 percent) and the requirements of Governor Paterson's proposed spending cap. If enacted, this spending cap initiative would generate an over $1 billion surplus in the following 2011-12 fiscal year, which would be returned directly to more than one million property taxpayers in the form of a progressive circuit-breaker tax credit that averages over $1,000 per recipient.
Are you getting the roller coaster image? Today we tighten our belts, lose important services, lay off people, cause the loss of high paying jobs and eliminate programs. Then next year we are awash in cash. Does this make any sense? And call me too practical, but if you project having a billion in surplus funds next year, do you really need to eliminate $2 million this year? Will you notice it? Really? No, but the citizens will if you eliminate their poison centers.
It is almost amusing, and highly insightful, to consider what the Governor’s budget director, Robert Megna, was quoted as saying in a Newsday article by Dan Janison not too long after he was appointed, "I was a bit shocked" – referring to the first time he saw the cost of debt service for the coming fiscal year. Hmm, so how much did he study up on the job before getting it?
Supporters of Governor David A. Paterson applaud him for instituting key reforms to put New York on the road to economic and fiscal recovery. How clever do you need to be to take a blowtorch to the budget? The real art is in knowing what needs to be cut; the real courage is actually doing it. He should receive no political points, pundit praise or pats on the back for cutting everything. On the contrary! We need to call him out to justify his decisions when they represent high impact programs especially at low cost.
Poison Control Centers and the Benefits They Provide
“Family Security Matters (FSM)” is a powerful phrase that evokes a variety of images, concerns and issues. FSM was born out of a post 9/11 world to provide state of the art information and a forum for our readers at a time when terrorism threatens our domestic security. Yet there are other contemporary dangers to the health and well being of our families beyond Jihad and geoglobal threats. And the security, safety and health of the family, our family…well, it matters.
Most of us associated with FSM are concerned about the potential for another WMD assault on the U.S. Near-universal agreement is the notion “not if but when” it happens again on U.S. soil. And most FSM readers, and writers, have families – and care about their health and safety. But risks to health occur without jihad and external threats. They are predictable and daily. To address this wide range of threats, we need a safety net to rely upon when all else fails. We need sentinels, guardians to watch out for us, even when we’re not paying attention. And we need reliable information that can readily be utilized by the public and professionals; information that our family is able to rely upon. Where do you find such protectors, such information sources? At your regional poison control center (PCC).
Poison Control Centers provide around the clock expertise in all things toxic and are the “go to” expertise for law enforcement, health care facilities, health care professionals, pre-hospital EMS, professional education programs (nursing, medical school, residencies, pharmacists and the list goes on…), parents, teens, public health, the media on all things toxicological.
Having been a toxicologist for a fair number of years, one of the things I’m most proud of our poison control team – from the staff to nurses, pharmacologists and physicians – is that we are the human touch in an emergency. While we are highly trained, it is the humanity with which we provide our expertise that parents and just about everyone who calls us. From the nurse in the ICU to the doc in the ER , to the cop arriving on scene at a local rave to – well, you get the picture –what they remember is the time we took to provide a sense of calm and help the caller or victim get through the crisis – perceived or real.
The specialty trained health care professionals at your LOCAL poison control center have been a trusted partner to parents, health care professionals, law enforcement, public health, emergency management, emergency medical services, hospitals, community organizations, child care advocates, elder services, medical/nursing/pharmacy and other professional schools. The list goes on and on in terms of the depth and breadth of individuals and organizations that rely upon and benefit from the training, expertise, advice and assistance of regional poison control centers. But that is all about to change. Welcome to the world of irresponsible budget cuts as ineffectual solution for years of rampant wasteful spending courtesy of our elected officials.
Poison control centers (PCC) are one of the most important weapons against a wide array of disruptive challenges that we all face in a post 9/11 world. As a concentrated body of highly skilled, well-trained specialists in the field of poisons PCC provide the expertise, training and guidance to first responders, law enforcement, fire/rescue, hospitals, emergency management and public health on all things poisonous – biological toxins, chemical weapons, industrial chemicals, radiation as well as being one of the few 24 hour a day expert resources providing near unlimited, science-based access to best practices in acute medical management. When chlorine tankers derail, PCC are behind the scenes offering guidance. When people come down with strange illnesses, PCC are called. When anthrax is spread in the US (think 2001) PCC were hand in glove “go to” people along with infectious disease, CDC and public health experts.
Poison control centers are much more than just information sources and health care providers. Poison control centers are also sources of research – and best practices how to reduce injuries, cut down on dangerous prescribing patterns and improve patient care.
Did you know teenagers consider poison control centers among the most trustworthy sources for information – in some cases more so than their pediatrician or even best friends? We’ve tapped into that to develop adolescent friendly outreach.
We also are sentinels for emerging trends or threats to health – poison control centers have been responsible for identifying dangerous products and helped lead to their restriction or outright banning. And we provide a form of post marketing surveillance for adverse events associated with new medications.
Given all the other things poison centers do, even if the surviving two can handle the calls and medical care (unlikely) will they also be able to educate, identify, respond and even remain in a preventive medicine role?
When the music stops – who has a chair?
It is a no-brainer the strategic value of New York City – symbolically as well as functionally – and its PCC; but other regions in the state are critical. The Long Island PCC protects about 3 million people in an important cross roads region, with people and facilities that are critical infrastructure in their own right and/or support NYC. Consider Long Island – home to some of the most advanced medical, military and scientific research facilities; or across the water from Millstone Nuclear, numerous known and less identified strategic entities, rad/chemical sources; and of note, where the corporate executive and general employment pool for NYC and in the summer probably half of the media, national corporate and a sizable amount of political leadership as well as most of the entertainment industry reside.
Consider other parts of New York State – are they any less deserving of a regional center because they are not New York City? It is a fair bet your home town deserves the protections of a PCC, too! For between 25 and 50 cents per person annually, can we afford not to support this vital system that provides daily service to any and all of us in one way or another?
The Folly of New York Budget Slashing Theory
Now the governor and his budget minions will counter that they aren’t shutting down all the centers, but just a few and by consolidating it will save the state, and by inference “your” money, but without loss of care – access or quality – for the citizens. Hmmm, sound familiar? Sounds like politician, or management, speak for downsize, outsource, and in the process diminish quality of service. Only the village idiot and his slow brother would validate the logic that two centers can provide the same level of care, timeliness and extent of services that five can.
The governor may argue, disingenuously at best or just plain forked tongue at worst, that five centers for a state of almost 20 million people was in fact way too many. Really? And that is based on government budget logic 101? The same logic that got New York into billions of dollars of debt to begin with? Even if you were to swallow that snake oil (and I’d be happy to treat you except my center might be on the chopping block so call now if you have a bad reaction to the elixir) consider this: In a very short amount of time any savings realized by cutting a couple million dollars from the NY State Poison Center budget will be lost in the blink of an eye!Cutting poison control services ultimately results in greater health care costs – i.e. MORE deficit spending. Why, you ask? Because poison centers save money, reduce unnecessary hospitalizations. We are very, very good at determining who needs to be managed at home (low cost medical care courtesy of “doctor mom” under the supervision of the toxicology nurses and doctors at each center) and who needs to be treated in a health care facility (cha-ching, cha-ching). While cost benefit studies vary regionally and based upon the toxicant, demographics and other factors, no one challenges the fact that poison centers save money – to the tune of at least three to 20 times what they cost – per year! In an era of 4 percent returns on CDs, is there anyone who would balk at spending a dollar to make three, 10 or 20 over the course of a year? Yet that is precisely what Gov. Paterson is proposing – to cut a program that is recognized for saving lives and money! Leave it to government and our elected officials to turn gold into lead.
It’s a numbers game – sadly, all of health care has devolved into a “too many in need for too few services” situation. There’s a shortage of primary care physicians in many regions. And the result is long wait times to be seen or people just go to the emergency department, which is a poor use of high tech medicine for generally low tech illnesses. Now imagine you have a child who you think has gobbled down a few of Granny’s meds and you have to wait because two centers are covering a region normally handled by five centers – what, you don’t think you’ll have hold times on the phone? Think again! After a few minutes sweating it out with worry over your child or your elderly parent, what are you going to do? You’ll say the heck with this and head over to your local hospital. This results in inappropriate usage, time delays, potential harm from exposure to health care facilities which attract contagion, and oh yes, a big hospital bill! Imagine all the calls that we help manage in their homes now going to the hospital. So much for the $2 million saved! That will be gone in a few months or less. How’s that math working now?
The next bit of legerdemain that the governor might share is the notion that if all budget items are cut, then everyone is being treated equally. There is a major fundamental flaw to that notion – not all government services are equal in terms of the public benefit that they confer. Trees are pretty, but health care is life-saving. You decide – more trees, more regional poison control centers – which by the way employ people – people in our own country.
One of the benefits that will be lost if three centers are eliminated is the regionality of the centers – the local knowledge. As of now each center knows the strengths, weakness and general capabilities of the hospitals in their catchment areas – many of us know which specialists, emergency rooms and nursing care are well suited to the poisoning emergency we are managing – that matters. Not all hospitals are created equally – why not match the most suited facility to the patients needs whenever possible? This is especially true in many areas where multiple health care facilities are nearby geographically. Does this matter? Does local knowledge matter? You decide.
Regionality and by extension geographic proximity matter for another reason – the other services most regional poison centers provide, such as local training and support to a wide array of advocacy groups like Child Care Councils, parent teacher organizations, EMS/Fire Rescue, law enforcement, public health, medical examiners office, as well as area health care facilities and so many other agencies. Poison control centers provide training and educational programs for the public as well as professionals. New York is a big state – check the map. Two centers are going to cover a region that extends from the Canadian border to New England, New Jersey, out on a long island, conveniently named Long Island, and, well, you get the point.
“The measure of a society is judged by how well it treats its weakest members.” – Gandhi
Children are our future – axiomatic, overstated and, one would think, a profound grasp of the obvious that they are our most precious resource. But in reality, while that may be true, children are also abused, they are trafficked, they are ignored or abandoned, they are explorers prone to injury and then they grow up to become adolescents where they experiment, take risks, get injured, as well as demonstrate the indomitable spirit youth is imbued with to change the world. And if we are very fortunate, somehow children manage to get to adulthood relatively unscathed. But there is a whole lot of mileage and risk between points “A” and “B.” Kids don’t come with an instruction book and the world is a dangerous place.
So who do parents trust to help them get their kids safely through the danger years? If you are like most parents, “poison control” and “the pediatrician” are two answers that immediately come to mind. I’ve yet to meet an individual who has not personally or through a close friend, colleague, relative or neighbor, shared a poison control story – their child got into something weird in the garage, the toddler got into grandparent medications, someone took too many of their medications by mistake – common stories and all concluded with the same thought – “I don’t know what I would have done without them (the poison center).” Soon you just might face that situation!
Actually, Gandhi’s statement had more to do with the elderly and animals than children. Dostoyevsky had a similar quote, but he emphasized prisoners. Children can’t even be named the least among us in a contest of quotations about the least among us! If only kids could pay taxes and vote, things would be different. But then again, those who care for or about them DO vote and pay taxes.
As an aside, increasingly the elderly are becoming part of an important poison control patient group. Who takes more medications and more combinations – sometimes a dizzying array of prescribed and over the counter products than many of our seniors? And who are you going to call when you have a medication question, therapeutic error or unintentional overdose? Think two words – Poison Control!
And in keeping with Gandhi’s original text, emphasizing the value of animals, yes, our centers often are called upon to help Fluffy and Fido as well. Even snakes, hamsters, horses and bunny rabbits have been known to benefit from our expertise.
Let’s not forget that the poor always have it worse in any society. And for many, poison control is one of the few readily available sources of medical information or care. Did I mention we are free to the caller, free to law enforcement, EMS, the public in general, and in most areas of the country, no charge to the health care facility? But when we get shrunk or axed, once again the poor will lose another source of help.
In this era of HMO medicine, shortages, overcrowding and uncontrolled health care spending, PCC are one of the few 24/7/365 all access, toll free, cost free to the end user (except for that which comes out of their taxes – a whopping 25–50 cents per person per year) medical services around. And for chump change that provides enormous good from one end of the country to another, PCC are on the chopping block. So much for the needs of the many.
Cutting the number of centers will cut the level and availability of care – there is no way around it – the existing centers are staffed to handle their catchment areas. We at the Long Island Poison Center are staffed to handle our region of approximately 3 million people, not counting other areas we cover from time to time. Can we hand more, yes. But half the state? Can any one center handle half or all the population of New York at current staffing and facility levels? No! Not unless the governor plans on enlarging the two centers that will remain…in which case where was that money savings?
It is disingenuous to say that two centers can handle the work of five. Oh numerically if you ask an efficiency expert or time management calculation – yes based upon so many hours in the day, minutes per call and remaining professionals handling the calls, in a best case scenario, the phones might, might be handled in a timely manner – which of course is government speak for you dial as a toddler, your problem is addressed when you hit puberty.
Moreover, can you put a price on compassionate care? It has been said that biostatistics are the story of people with the tears wiped away. That is probably true. Especially since statistics are like bikinis, what they reveal interesting and what they conceal essential. Handling patients and handling them well are two different outcomes; alas most bean counters consider them equal
No less important is timely information. Time is tissue in our line of work. Imagine being a frantic parent, wondering if your child will be harmed by an exposure. For you seconds are a lifetime. Imagine waiting minutes – that is an eternity! One has to wonder, based upon the governor’s decision, if he truly believes the time difference is meaningless and merely the cost of doing business. For a caregiver, from the moment one experiences a potentially toxic encounter the clock is ticking. If it is harmless – as many of the calls turn out to be – then the clock doesn’t matter. Stay home, you’ll be fine. And in fact, thanks to poison centers, many who might otherwise go to a hospital (and run the risk of catching something infectious) and tying up an emergency room bed, and racking up unnecessary expenses – this can often be prevented.
But who can tell you, who will tell you whether you have had a non toxic or toxic exposure if poison centers are closed? If, like the governor, you are willing to bet on the “come” line then, like any risk management predictions why should we worry? But when I hear risk management projections, or politicians telling me two is as good as five, or the “experts” say there won’t be any danger from their new policies, I am immediately reminded of the Ford Pinto – the internal and external combustion automobile. Ford and their risk managers’ “land of okay” meant only a handful of people would be burned. How many children will be poisoned severely in the current “land of okay” by this batch of risk management calculations? Can we afford to find out?
Discussion
There are other contemporary dangers to the health and well being of our families beyond Jihad and geoglobal threats. And the security, safety and health of the family, our family…well, it matters. To address this wide range of threats, we need a safety net to rely upon when all else fails. We need sentinels, guardians to watch out for us, even when we’re not paying attention. And we need reliable information that can readily be utilized by the public and professionals; information that our family is able to rely upon. Where do you find such protectors, such information sources? At your regional poison control center (PCC). PCC are part of the critical infrastructure known as homeland security or domestic preparedness – but the number is dwindling and with it a level of our ability to respond to threats. When will we put an end to these symbolic (in terms of their value) but largely unnecessary, ineffectual and potentially dangerous budget cuts?
Just as Family Security…Matters, your local poison control centers MATTER…to you, to me, to our community and nation; they are a critical resource and safety feature the loss of which will result in incalculable harm.
Conclusion
Poison Centers are a tried and true system that is universally respected and valued among the true stakeholders – parents, professionals, patients. Only the politicians seem to think we can be outsourced, downsized or eliminated.
You read Family Security Matters out of concern over your loved ones’ (family) safety. Cutting poison centers is a blow to emergency preparedness. Poison Control Centers are one of the few entities that serve us well in peace and under threat of WMD or terrorism. But we should take caution from an old song: “you don’t know what you’ve got until it is gone.” And time is running out.
FamilySecurityMatters.org Contributing Editor Dr. Robin McFee is a physician and medical toxicologist. An expert in WMD preparedness, Dr. McFee is the former director and co-founder of the Center for Bioterrorism Preparedness (CB PREP) and was bioweapons-WMD advisor to the Regional Domestic Security Task Force Region 7 after 9/11, as well as an advisor on avian and swine flu preparedness to numerous agencies and organizations. Dr. McFee is a member of the Global Terrorism, Political Instability and International Crime Council of ASIS International. She has authored numerous articles on terrorism, health care and preparedness, and coauthored two books: Toxico-Terrorism by McGraw Hill and The Handbook of Nuclear, Chemical and Biological Agents, published by Informa/CRC Press.
