A 2008 change restricting Emergency Medical Service transports to Health Services has changed the calculus for students weighing the costs and benefits of calling EMS. Since the change, the number of intoxication incidents serviced by Health Services has decreased by 29 percent. Last year, the number of students who signed waivers declining EMS care reached its highest point since 2006-2007, the first year for which data is available.
In the summer of 2008, the Rhode Island Department of Health informed the University that without a physician present during nights and weekends, Health Services does not qualify as an emergency medical facility and would no longer be allowed to accept transports. Before then, students who were EMS'd could be taken to Health Services to be treated by nurses on nights and weekends. Since the policy change, students EMS'd during those times have been taken to hospitals and charged accordingly.
In the following years, fewer students have received treatment for intoxication. Students have expressed concern over the cost of hospital treatment for intoxication and a desire for on-campus care. According to the administration, before the change, students were receiving care when they did not truly need it, and the costs of bringing a doctor to campus during nights and weekends outweigh the benefits.
Though EMS does not charge patients for ambulance transportation, the policy change means those patients must now be transported to a hospital. Because they are no longer under Brown's inpatient care, patients are instead subject to a health insurance co-pay, according to EMS Service Chief Amy Sanderson.
Alex E. '15 was EMS'd this semester shortly after arriving at Brown. In addition to the cost of inpatient care at Rhode Island Hospital, he said he was charged EMS expenses by the hospital because Brown EMS was busy with other calls.
"I wasn't aware of the additional charges," Alex said. "(Acute intoxication supervision) seemed like it was advertised as a free resource."
"It was a pain ... and a learning experience about being held responsible for your actions — in a bad way," Alex said.
Edward Wheeler, director of Health Services, said the 2008 change was caused by the state's ultimatum. "It reflects their policies, not those of the University."
But Margaret Klawunn, vice president for campus life and student services, said the University would have eventually implemented the changes anyway.
"The way it was set up, it was not a current model of care," Klawunn said of Health Services' handling of intoxication incidents. With no doctor to supervise students, there were liability issues, she said.
"Most of those who did go through Health Services inpatient were people who didn't need medical care," she said. In 2008, the University was conducting an external review of Health Services. The review eventually led to a consensus that Health Services should reduce its involvement with cases of student intoxication, Klawunn said.
Following the review, Health Services began to reduce its support for intoxication incidents. While walk-ins were accepted 24 hours a day for the 2008-2009 school year, in 2009 Health Services began closing at 11 p.m. Monday through Thursday. In 2010, the Inpatient Unit closed its doors for all nights and weekends.
In the same period, the total number of students treated for intoxication has steadily declined. In 2007-2008, the year before the policy shift, 193 students received treatment for intoxication. Last year, that number was 136.
Meanwhile, signed refusals — people who decline EMS treatment — reached their highest number last year.
Students expressed a desire for a middle ground between refusing care and facing the costs of hospital treatment.
When Justina Lee '15 was EMS'd for intoxication, she said she was not asked if she wanted care and that she believes she did not need it. "It would be better if there was some option available at Brown," she said.
"It cost so much money and was so inconvenient," Lee said of her hospital treatment.
Alex also said he did not think he needed hospital care and was ready to attend an early morning running practice the next day, he said.
"I was pushed into a situation where I had to pay," Alex said.
"Especially in the moderate case, where students may or may not need to go to the hospital, people will think twice about calling EMS," he said.
But a physician could not be hired to staff Health Services during nights and weekends because of the prohibitive cost, Klawunn said. "It's impossible to meet all needs."
