Law change aids intervention in hospital

By Carol M. Ostrom
Seattle Times staff reporter

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There's nothing like being carried into a hospital emergency room, broken and bleeding, to focus a patient's attention on kicking a drug or alcohol problem.

That was Dr. Larry Gentilello's conclusion in 1999, after studying alcohol-related injuries at Harborview Medical Center. Thirty minutes of counseling while still in the hospital, he found, dramatically reduced the chances those patients would return with new injuries.

Gentilello spread the word to other hospitals around the state: Test patients for substance abuse and get them some counseling, advised Gentilello, then Harborview's associate director of trauma intensive care.

But the hospitals told him they wouldn't agree to test patients, citing a state law allowing insurers to refuse to pay charges for patients injured while under the influence. "If we draw a drug-and-alcohol level (test), the insurance company won't pay the bill, we won't get reimbursed, the doctors won't get paid, and we'll go under," Gentilello recalled administrators telling him.

Yesterday, Gov. Gary Locke signed into law a provision repealing the state law, and barring insurers from denying coverage solely because an injury was the result of intoxication by drugs or alcohol. The original law, drafted by a national association of insurance commissioners, was passed in 1947, said Gentilello, now a University of Texas professor and department chairman at Parkland Memorial Hospital in Dallas.

Forty-two states had similar laws. Washington is the sixth to drop the provision, said Gentilello, who has been on a three-year quest to change laws here and elsewhere. Although the bill to repeal the law was introduced in this state in each of the previous two legislative sessions, it got nowhere with state lawmakers.

Credit the testimony of Francine Terrell for grabbing the Legislature's attention this year, Gentilello said: Not only was she dedicated to the cause, she could speak firsthand about the need for such a change.

In 1992, Terrell told lawmakers earlier this year, she arrived at Harborview Medical Center after a drug-induced fall. She had a smashed head and a swollen brain, one of many prior drug-related injuries.

She said the tough-talk counseling she got that day changed her life. "The trauma intervention functioned as my catalyst," said Terrell, 49, now a graduate nursing student and nurse at Harborview.

What happened to Terrell isn't unusual, said Chris Dunn, a University of Washington Department of Psychiatry faculty member who counsels patients at Harborview and teaches resident doctors there.
 
"Crisis isn't always a disaster — it can be a real turning point," he said. For one thing, "the consequences of their actions are so immediate." Often, getting hurt brings out the best in people, he said: "They get very brave, lying there staring at the ceiling, thinking about changing their lives."

Dr. Eileen Bulger, a trauma surgeon at Harborview and a representative of the state chapter of the American College of Surgeons Committee on Trauma, also told legislators they should change the law.

Because an insurer might not pay the bill, some doctors simply refuse to document alcohol or drug use.

Major insurers in Washington said they don't invoke the clause allowing them to refuse to pay, and did not oppose the change in the law. But Gentilello said he knew of cases here and in other states in which insurers refused to pay after someone was injured while impaired.

A recent case in Connecticut involved a 19-year-old man, legally intoxicated, who ran up a hospital bill of almost $244,000. The insurer's refusal to pay was upheld by the appeals court.

Now, Dunn hopes doctors will feel free to test patients and call in counselors to help them.

Helping patients that way will also make life more rewarding for staffers in ERs, he said.

"You get tired of opening up people's bellies in the OR (operating room) and having them smell like Budweiser," Dunn said. "A brief intervention service does a lot for morale for the staff."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

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