By GINGER ADAMS OTIS and MELISSA KLEIN
July 12, 2009 --
These bums are costing you a fortune.
Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.
For a chronic caller like Alardo -- who phones 911 four or five times a week -- the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.
In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years -- and taxpayers pick up his tab, too.
Ricky and Robert are among the dozens of "frequent fliers" who clog the 911 system, tie up city ambulances, crowd emergency rooms and burn through Medicaid money.
An ambulance ride alone can run as much as $800, and an ER visit can cost, conservatively, $400 a pop, according to estimates from medical experts.
City officials don't track frequent fliers or the costs associated with their transport and hospital care, but anecdotal numbers from ER and EMS workers suggest there are dozens throughout the city.
"We have a system that is extremely dysfunctional. We have no place to put these people," an EMS medic said.
A paramedic working downtown said some frequent fliers think they'll get faster treatment if they arrive at an ER by ambulance, rather than walk in.
"They know what to say to our call takers," he said.
Or they'll tell a bystander, "Oh, I have chest pains," the medic said.
Alardo, 53, phones 911 so regularly, medics know which calls are likely his.
"When Ricky passes on, I'll probably even go to his funeral," said one medic who works in Washington Heights. "I've seen him almost every day for the last 13 years."
An inebriated Alardo lauded the medics last week, saying they "treat me like a king."
A few hours later, he called for an ambulance to pick him up on Bennett Avenue. He went into the hospital at about 4 p.m. and slept for hours.
His fellow frequent flier Robert said he has called 911 as many as 50 times since becoming homeless three years ago.
He said he would tell the 911 operator he had chest pains or was suicidal.
But, he confessed last week, "I'm not really suicidal."
Robert, 40, said he was looking for a place to sleep, get a meal and get the medications he takes for depression.
He said he stopped his 911 habit after an ambulance driver "chewed him out."
"I haven't called an ambulance for about a month," Robert said.
By law, EMS workers cannot refuse to treat or transport any patient. And ERs have to at least evaluate and stabilize homeless patients.
The drain on the city's strapped medical system is huge. Medicaid reimbursements don't come close to covering the costs of frequent-flier visits.
Medicaid pays just $175 for a basic ER visit and only $186 for the cost of an $800 advanced-care ambulance.
At a minimum, ERs give vitamins, showers, hot food and a bed to their homeless patients. But those who come in with underlying medical conditions require X-rays, cardiograms and medicines that can push the cost of an ER visit well above the average $400.
"They take space. They take nursing resources. They're a drain on the staff's energy level and emotions," said Dr. Jeffrey Brenner, of Camden, NJ, who has studied the issue. "They're costing the system in both direct and hidden ways."
Brenner's research found Medicaid paid $46 million for the top 1 percent of Camden's frequent fliers, or 1,035 patients, during a five-year period.
A pilot program at Bellevue Hospital has cut ER visits by 67 percent among "high-cost" Medicaid patients by finding them their own doctors, housing and even cellphones to keep in touch with their doctors, according to a recent report by the United Hospital Fund.
But it will be hard to break the habit of vagrants who view the ER as their personal retreat.
"It's not always easy to pick up these guys and take them in," one medic said. "But our policy is: 'You call, we haul.' We have no other choice."