The revelation in December that Samaritan Health Systems will shut down the only Poison Control Center in Phoenix passed as a blip on the public radar, coming as it did between Christmas and New Year's.
But the decision is sending waves of outrage and panic through the medical community, and prompting at least one state representative to push for legislation ensuring that some sort of poison center be maintained in the state's most populous county.
Caught by surprise, the Phoenix Fire Department is scrambling to plan for emergencies involving poisoned people or toxic chemical spills. Area medical groups and physicians--particularly those that work with children--fear that losing the center will damage their ability to treat patients.
The reaction has placed Samaritan in an uncomfortable position, drawing fire for scrapping a money-losing program that it took over seven years ago as a public service.
"If you want to make somebody angry, change something," says Samaritan Vice President Dan Green.
Citing budget problems, Samaritan says it will phase out the privately funded center over the next few months, passing its responsibilities to a state-supported poison center run by the University of Arizona in Tucson. A final closing date has not been set, although the Samaritan center is already forwarding calls to Tucson from midnight to 8 a.m.
There is no need for two centers in the state, says Green, and the Tucson center can be upgraded to serve the rest of Arizona.
"We need to reduce our costs," Green says. "We're going through some major restructuring to adapt to the health-care market. What we are trying to do here is take a service that is now being provided by two locations and consolidate them into one."
But medical groups and some public officials are livid at what they characterize as an arbitrary, abrupt decision that will cost Phoenix a valuable medical resource.
Like all health-care systems, Samaritan is having to rein in costs, and critics of the center's closing do not fault the company if it no longer wants to foot a large part of the bill for the center.
But, they say, by deciding quietly to phase the center out and move its responsibilities to Tucson, Samaritan has pre-empted the possibility that someone else might step in, take over the existing program and prevent it from being dismantled.
"Samaritan didn't really ask for anyone to help keep it open," says Mary Rimsza, head of the pediatrics department at Maricopa County Medical Center. "The medical community feels that we would like to help support the center. We will help with funding and other projects."
The Tucson center, critics say, does not have the staff of trained toxicologists and nurses now in Phoenix, but instead relies mostly on pharmacists who cannot provide the potentially life-saving clinical advice needed in an emergency.
"In order to maintain the pool of expertise that we have here, we need a poison center," says Jay Blum, chief of critical care for CIGNA Healthplan. "Do we want to go ahead and deal with a center that is 110 miles away and has unknown ability to upgrade their personnel?"
While acknowledging that most states don't have two poison centers, Rimsza and others say that losing the Phoenix facility would make this one of the largest cities in the country without a local center.
"This is a very contentious issue," says Blum. "We would be the only city of our size except for Miami that did not have a poison center. . . . It really does serve the community. It saves lives."
For more than a decade, the Poison Control Center, now headquartered at Good Samaritan Hospital, has been one of the city's little-noticed gems, an on-call pool of nurses and specially trained doctors available day and night to answer questions about poisons and toxic exposures.
And the public has gotten the service basically for free. Samaritan pays about $750,000 a year to staff it, Green says, and the United Way and private donors chip in additional funds.
Green points out that Samaritan volunteered to take over the center in 1987 when St. Luke's Hospital--where the program was founded--decided it could no longer afford it.
"If we hadn't taken it over, St. Luke's was committed to shutting the program down," Green says.
More than 60,000 calls come in each year to nurses stationed round-the-clock in front of computer terminals and surrounded by mounds of books on poisons. Several doctors certified in toxicology are also on call to deal with emergencies.
Frantic parents call when a child has gotten into the medicine cabinet. The Phoenix Fire Department maintains direct lines to the center so paramedics can tap quickly into the center's expertise when facing hazardous materials. Emergency 911 operators refer calls to the center, and doctors consult it when treating patients.
"If this thing goes away, in truth, we've got to rewrite our standard operations procedures," says Steve Storment, deputy chief of training for the Phoenix Fire Department. As a matter of policy, paramedics and the department's hazardous materials team immediately contact the Samaritan center in emergencies involving toxins, he says.
That means about 500 times a year, the fire department counts on the center for coaching and information on hazardous chemical situations, Storment says. In some cases, he says, paramedics in the field with a poisoned patient are not allowed to administer antidotes without permission from one of the center's trained toxicologists.
Wes Powell, the department's assistant chief for emergency medical services, says emergency services in Phoenix could be severely strained when the center is closed. The center's doctors prevent an unknown number of unnecessary ambulance runs by dealing with minor problems over the phone, he says.
If the Tucson center--which itself deals with more than 60,000 calls a year--is unable to provide the same level of service as Samaritan, Powell fears that "thousands" of minor calls will result in ambulance transport as paramedics err on the side of safety.
"My suspicion is that a lot of these will be going to the hospital," Powell says.
Powell, who says he learned of the planned closing through newspaper reports, says Samaritan has assured him that the same level of services will be available from the Tucson center.
Samaritan's Green says his company is working with the Tucson center to make sure there is no drop in service. The Tucson center already has a state-funded 800 number, and can be called for free from anywhere in the state.
"What the fire department needs is access to toxicologists," Green says. "It's just a question of where the phone calls are taken to make sure the services are made available."
But many are skeptical of the Tucson center's ability to fill the role now played by Samaritan's center. (Ted Tong, director of the Tucson center, did not return calls seeking comment.)
Until recently, the Tucson center was funded partially by the state legislature directly, and by taxpayers indirectly through a subsidy given by the University of Arizona.
But last year, the university said it was scrapping its $300,000 contribution, and the Tucson center itself would have closed on January 1 if donors had not bailed it out.
The Tucson center is now pleading with the legislature for $1.2 million so that it can stay open and prepare to absorb the extra calls that will come when the Samaritan center closes. In the past, the Tucson center has received about $500,000 a year from the stae.
The Tucson center's dependence on the annual political and budgetary whims of the legislature is not comforting to many.
"If their funding is soft, how are they going to accept the volume of calls that have been historically coming to the [Samaritan] center every year?" Powell asks. "It may be that when Samaritan goes out of business, all these calls are answered in Tucson and nothing will change. But it's difficult for me to believe that, given their current level of funding, there isn't going to be some slippage."
Powell says he has asked the state Emergency Medical Services Council, on which he sits, to explore what impact the Samaritan closing will have and whether Tucson will be able to fill the void.
State Representative Susan Gerard is pushing for more than just study.
Gerard flatly contends that the loss of a Phoenix center is unacceptable, and faults Samaritan for not giving anyone a chance to salvage the operation.
And she is not at all happy that the University of Arizona will have the state's sole center after the school cut its own $300,000 contribution to it last year.
"They'll be in a monopoly situation and be able to blackmail us and use scare tactics to extort more money," Gerard says.
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Gerard says she will push legislation to require that any state-funded poison center must have operations in both Pima and Maricopa counties, forcing the university to establish some sort of branch center here.
She may also try, she says, to have a poison-control contract put out for bid every few years, to enhance competition and force the level of service to remain high.
Green says he doubts whether any other hospital in the Valley would want to jump into the poison center business, since they would only be duplicating services that should be available from Tucson.