SIOUX FALLS, S.D. - Substance abuse is one of most expensive health problems in the United States with an annual cost of $510 billion.
Sioux Falls and Minnehaha County officials are working to find a solution to treat a high needs population, people who are "chronically inebriated" or are suffering from an untreated mental illness.
This group of individuals have a hard time accessing resources, so frequently they go to the emergency room or stay at the jail's sobering center.
Not only are these some of the most expensive services the community provides, community leaders say they only put a band aid on a much bigger issue.
“It's significant, and it's growing, and the opioid crisis is making it even more difficult,” Sanford Health Director of Trauma and Emergency Care, Monica Huber said. “Sioux Falls needs a solution to this social issue that we have.”
Many people with a medical emergency due to their drug and alcohol addiction are seeking out two short term solutions: a 48 hour maximum commitment at the Minnehaha County Jail sobering center or a trip to the emergency room.
It's something emergency room staff see every day.
“Weekends, some of those types of days have a higher volume,” Avera Mckennen Chief Nursing Officer Lori Popkes said.
“There's probably 100 people, 100 patients that frequently come to one of the emergency departments in this city,” Huber said.
Dealing with these patients can create safety challenges.
“Some of them, because they are inebriated, are hard to work with in the emergency department. They have a tendency to be violent,” Huber said.
Not only are they be difficult to treat, medical professionals say they can crowd emergency rooms.
“It is really designed for as its titled, emergencies that are truly acute. So, think of a patient having a heart attack, a patient having a stroke,” Popkes said.
To make matters worse, the ER isn’t set up to provide the level of care they actually need.
“When you think about somebody who has experienced a situation with substance abuse, a lot of times that's more of a chronic situation, and there is nothing that we are going to do in an emergency department setting, for lack of a better word, fix that,” Popkes said.
“It is a very expense place to get care, especially if you don't need it,” Huber said.
These frequently flyers can rack up thousands of dollars in debt.
“I can see patients with $100,0000 bills. I mean if you think cat scans, MRIs, blood tests, all of those things,” Huber said.
Hospitals and tax payers have to foot the costs of many unpaid medical bills.
“It contributes to the bad debt and a lot of those bills need to be written off at the medical center. There are some county funds that help pay for those bills,” Huber said.
The other option frequently used for care is the jail.
“The South Dakota law allows them to be held in a detox facility, jail, or hospital until they are no longer incapacitated by the effects of drinking drugs or alcohol to the point where they are no longer a danger to themselves,” Minnehaha County Jail Warden Jeff Gromer said.
But there isn't a lot of room for people who aren't actually arrested.
“We're full. We're full the vast majority of the time. The jail is fairly full,” Gromer said.
So, like the hospital, this option can also result in safety issues.
“Now you're putting someone who’s highly under the influence, incapacitated, and you're putting them in a confined situation with people that aren't, and people that are charged with a crime. It's inherently problematic,” Gromer said.
The total number of protective custody holds booked into jail is rising.
“We see a lot of the same people over and over again,” Gromer said.
In 2015 the number of protective custody holds was 2,437.
In 2016 it was 2,903.
By the end of October this year the county had already seen 3,113.
And the number of people booked into jail detox went from 688 in 2015 to 797 in 2016. As of October 31st the number for 2017 is 764.
Many people are booked over and over again.
One person in Minnehaha County has been booked into jail 176 times.
“As we get some of these colder days, and until we get something established for the winter, we'll have guys that will be in once or twice a day, in and out, and in and out, and in and out,” Gromer said.
So, the community is tasked with a difficult question.
“How could we really deal with these people more effectively, more affordably, and help make the community safer,” Sheriff Mike Milstead said.
A group of professionals in Minnehaha County are starting to think the answer might be at this triage center in Las Vegas.
“The nice thing about the triage center option in my mind is that many of these resources are alive and existing in our current community. It's just a way to triage people into that care and centrally locate some of those services so people can get that the service that they need,” Milstead said.
One of the biggest challenges is getting people hooked into resources that can help them.
Just like Sioux Falls, Las Vegas has many resources to treat mental illness and addiction, but now it has a one stop shop for people to start treatment.
“I can tell you with great pride that just over 60% of those almost 6,000 people that came through our doors (in 2017) are sober today they are clean today,” Westcare Foundation Senior Vice President for the Northwest Region, John Lee said.
Community leaders stressed the problem in Sioux Falls isn't that the community doesn’t have resources for people who are frequently utilizing emergency resources, it's that it is difficult for that population to find them or get to them.
They hope establishing a place where a team can access each individual and guide them to resources in the community, will actually provide a way for them to find the long term solution they need to stay sober and healthy.