AMA hits laws impeding screening of drunk patients

Honolulu -- Physicians want better screening for alcohol and drugs in patients coming into emergency departments. They're asking states to help them by repealing laws that were passed long before addiction treatment was widely available and trauma centers were commonplace.

These state statutes are based on a model law, the Uniform Accident and Sickness Policy Provision, which includes language permitting insurance companies to refuse to pay for treatment for intoxicated patients' injuries. Since the model law was first proposed more than 50 years ago, 37 states and Washington, D.C., have adopted it.

As a result, screening just isn't done, and valuable chances to help addicted patients are lost.

Physicians at the AMA Interim Meeting last month voted to support state medical and specialty societies and public health associations in efforts to get the laws off the books.

"ERs are less likely to screen for alcohol and drugs because visits won't be covered by [patients'] insurance," said Michael E. Migliori, MD, an ophthalmologist from Providence, R.I., and an AMA delegate. "Repealing the laws will hopefully reduce the recidivism and allow injuries to be covered."

More than 40% of patients treated in EDs are believed to be under the influence of alcohol or other intoxicants, according to information presented at the meeting. But studies estimate that less than 15% of injured hospital patients are screened for alcohol and referred for counseling.

Consequently, while the injuries that result from drug and alcohol use are treated, any addiction a patient might have isn't addressed, even though intervention could do much to help a patient.

More than 40 studies show that brief interventions against alcohol in health care settings, such as EDs and trauma centers, reduce DUIs, alcohol-related traffic violations, alcohol-related arrests and readmissions to hospitals for alcohol-related injuries.

Alcohol use is a leading factor contributing to injuries, and injuries are the leading cause of death among people younger than 45 years old and the third leading cause of overall mortality. Physicians say these statistics show that it's time for state laws to change so that doctors can link more people with help.

"This identifies a major problem," said Richard A. Geline, MD, an AMA delegate and an orthopedic surgeon from Skokie, Ill.

In addition to helping patients, better alcohol and drug screening and intervention in EDs could result in a $1.82 billion net savings in direct medical costs over a three-year period, according to a cost-benefit analysis by the University of Washington.

With its new policy, the AMA joins a call put forward by the National Assn. of Insurance Commissioners in 2001. At that time, the NIAC proposed a new model law that would prohibit insurers from denying payment for intoxicated patients' care.

Until states change their laws, screening will continue to be a nonpriority in most EDs.

"Emergency physicians in ERs around the country stand in a unique position to intervene," said Jo Linder, MD, an alternate AMA delegate and an emergency physician from Falmouth, Maine. "But these laws are a strong deterrent."