30 January 2009

A Bitter Pill to Swallow


Washington State, like many other states, in deep in a budgetary crisis.   This is largely, of course, due to the economic catastrophe that is envoloping the nation (GDP down 3.8% in 4Q 2008?  Yikes!)  Exacerbating the crisis is the cowardly leadership in Olympia, where Governor Gregiore, browbeaten by the anti-tax nuts, has pledged to pass a budget for the upcoming year with no new taxes.   Which sounds great on the face of it until you consider that taxes pay for things.

Important things.

Things that will not exist if the government didn't fund them.

Take, for example, the Washington Poison Center.  

Now I've ribbed them in the past, not entirely fairly, but I need to say this publicly: the Poison Center is an absolutely essential service and a critical element of emergency care.   

  • You find your two-year-old kid sitting on the kitchen floor with an open bottle of Windex in front of him -- who do you call?
  • A patient comes in with an overdose of three different drugs the ER docs have never even heard of -- who do you call?
  • You splash an industrial solvent in your eyes and need to know how to decontaminate and whether to go to the ER -- who do you call?

Well, in Washington, you may not have anybody to call any more.   Gov Gregiore, cutting an apocalyptic swath through all the state's social services, has halved the funding for the Poison Center, which will result in the end of the poison center's hotline services.   So when someone comes to my ER in 2010 having ingested a massive amount of home-made colloidal silver, (yes, we really saw that a few years back and they were as blue as smurfs), we will have nobody to call for management advice and will have to muddle by with whatever we can find on Google.

If you are inclined, there is a page on the WA Poison Center web site explaining the crisis and providing links for the public to contact their legislators to avert this cut.

And when you hear the anti-tax activists braying about our taxes being "too high," make sure you ask them which essential services you are willing to live without.   If you live in Washington, you may be about to find out.


  1. necessity is the mother of invention. does each state need to fund a tox center? regional adjacent states could pool resources to fund one call center.

  2. jz has a good idea, but I'd take it a step further. Why not a national poison hotline? But no matter how it's structured, there should be someone to call when minutes count.

    I childproofed my house up to the rafters, but one of my daughters was DETERMINED that every bottle said "drink me." The Tylenol incident was scary (while I was distracted by her sister's febrile seizure she downed the bottle, less one dose). My last call was when she drank my make up. The operator chuckled and asked if it was moisturizing or oil control. Either way she needed no treatment, but the formulation would determine how long it would be before she produced "porcelain ivory" poo. Never made a single call for her 2 sisters...

  3. In veterinary medicine, we have the Ntaional Animal Poison Control Center (NAPCC). It's charged to the caller at $30/case which includes unlimited followup calls at no additional fee, or $20 for 5 min plus $2.95 for each additional minute with no followup calls. A credit card must be used to get the flat rate, but they have a 900 number for the other payment arrangement. This works great as far as I, a veterinarian in private practice, am concerned. I either have the clients call them first, or I can call and bill it to the client's credit card, or I can call using my own card, and pass the fee on the client if I am so inclined. Couldn't something like this, on the human side, be billed to a medical insurance company if the ER doc made the call??

  4. Webhill,

    Yeah, poison control could be fee for service, but why stop there? We could charge a fee every time you need to cal 911, and have people pay a membership fee for coverage by the local private fire department.

    Or we could just acknowledge this as a public service, best paid for by tax dollars and freely available to all who need it.

  5. Gregoire is cutting high profile services so that she can get "the people" of Washington to vote for a tax hike proposition.

    She promised not to raise taxes herself, but did say she wouldn't veto any tax increase laws that cross her desk.

    Politics as usual.

  6. Boy, now that sounds like a brilliant idea. NOT!

  7. Well, yes - it would be lovely to have taxpayer funded poison control centers. However, as they say, you can't get blood from a stone, and in this economic climate, it might be worth it to at least have the privately funded option available!At least, what I'm saying is personally I would rather have a fee-for-service poison control available, than none at all. Because honestly, if I were worried about my kid having a potential toxic exposure, I would pay the freakin' $30 out of pocket no problem.

  8. Well, of course your wack-job governor is willing to cut the budget on critical items (although a national or regional PCC would work just fine)......it's her way of trying to not make hard decisions: Like a three year old threatening to hold their breath and DIE unless they get their way.

    Too bad you guys didn't elect an adult - but there aren't many adults in politics anymore.

  9. Hoding up poison centers as cost effective use of government is a farce. Make them more efficient, fine.

    Give charcoal early if possible. Supportive care. Observe for 6 hours. Don't need some tax payer funded agency to tell me that. Any good ER doc knows, or can look up antidotes for others.

    sheesh SF, you are such a dependent, breath holding, little liberal

  10. Incidentally, with the stock market crashing, people losing their jobs or taking pay cuts (my dad just agreed to a 15% pay cut for instance), AND liberals in office w/higher taxes to go along with that if you are so lucky as to be producing income, I'm sure there will be more poisonings.

    Sure, let's raise taxes and see how many people we can help put out of their misery. What's the tipping point for higher taxes coupled with a 40% loss in net worth leading to suicidality?

    Or maybe what JZ suggested. There's no special reason why each state has to have its own program.

  11. "AND liberals in office w/higher taxes to go along with that if you are so lucky as to be producing income..."

    Yes Nurse K and just WHO left office after totally screwing up this country for the last 8 years? Why of course it was the liberals fault.

    PS: I do think regional call centers may have a role as long as the idea is not to cut services to the point where there are excessive waits. Also, the pharmacists manningthe call centers must be familiar with possible emergencies outside their region.

  12. Since the 800 number is a national number that connects you to the closest Poison Control Center, this will probably just place the burden on other states/regions.

    Regardless of the outcome of this. All parents should be familiar with that number (800)222-1222.

    When dealing with a poisoning, I call this number before contacting medical command for possible orders. Not many emergency physicians are as up to date as the PCC, on treatment of toxins. New York City seems to be the only place where this is not true. Dr. Goldfrank is the director of both the PCC and Belleview's ED.

  13. Many ingestions are noit as simple as charcoal and observe, if things go bed what next. The poison center can be very helpful here.
    And, more importantly, how do they save us money? They prevent many ED visits by home management of non-toxic and trivial ingestions where an ED visit can be prevented.

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