I read The Herald's Dec. 30, front-page article about the 27 percent rise in DUI arrests in Rock Hill as well as the follow-up editorial comments in the Wednesday Herald. Whether this increase is attributable to more police enforcement or to more people driving drunk is debatable. Suffice to say, the carnage caused by inebriated drivers continues to be a major public health problem.
The national Substance Abuse and Mental Health Services Administration has introduced an initiative that has been scientifically proven to increase the detection of drunk drivers by use of screening and brief intervention in emergency rooms, trauma centers and primary care settings. Even though the effectiveness of screening has been proven by many studies over the past 10 years, there remains a barrier to implementing screening and brief intervention in South Carolina -- the Alcohol Exclusion Law.
Some arcane laws are just silly. In Utah, it's illegal to fish from horseback. In Kentucky, you can't dye a duckling blue and offer it for sale -- unless you are selling more than six. But other arcane laws are both silly and dangerous.
South Carolina has an outdated law on the books that impedes detection of drunk drivers, increases health care costs and the practice of defensive medicine, and discourages the screening of problem drinkers. Fishing while riding horseback doesn't pose much of a public threat these days, but drunk drivers certainly do -- and it is time for South Carolina to repeal the Alcohol Exclusion Law.
The Alcohol Exclusion Law allows an insurance company to refuse to cover medical costs if the injured party is under the influence of alcohol or drugs. That puts doctors in a tough position. Their Hippocratic Oath says they must treat the patient fully, but if that patient is intoxicated, it means they might never get paid for an enormously expensive medical procedure. Rather than going out of business, doctors have found an unhappy solution: Unless they absolutely must screen for emergency medical reasons, they simply don't check to see if the patient is intoxicated. Doctors cannot be blamed for this practice, but it represents an unhappy and dangerous compromise that has severe consequences.
The cost of not screening for alcohol is devastating. A study at University of Texas Southwestern Medical Center at Dallas demonstrated that when trauma patients are screened for alcohol problems and receive just a 30-minute "brief intervention" (essentially a combination of education and counseling), they have 28 fewer drinks per week and are 48 percent less likely to be readmitted to a hospital than patients who do not receive such an intervention. If it weren't for the Alcohol Exclusion Law, hospitals would screen tomorrow. Imagine the repeat DUIs and the broken lives such screening would prevent.
The idea behind adopting the original Alcohol Exclusion Law was understandable. The theory was that people who knew they wouldn't be covered if they had an accident while under the influence would abstain from drinking and be less inclined to cause social disruption. But the deterrent effect of the law has failed -- it just doesn't work.
Obstacle to counseling
The Alcohol Exclusion Law may -- in cases when it can actually be invoked -- reduce short-term costs to insurers on a one-time basis, but in the long run, problem drinking is incredibly expensive to insurers. It is estimated that $19 billion is spent in America annually on alcohol-related health care expenses alone. In putting up obstacles to alcohol counseling, insurers are not only failing to put many of their members on course for a much healthier lifestyle, they also are costing themselves money. A second study out of the University of Texas Southwestern Medical Center at Dallas showed that for every dollar spent on alcohol counseling for injured patients, there is a savings of $3.81 in overall health expenditures.
Groups ranging from the American Medical Association to Mothers Against Drunk Driving have spoken out against the Alcohol Exclusion Law, which has recently been repealed in nine states, including North Carolina. Even the National Association of Insurance Commissioners -- the group that drafted the original model legislation almost 60 years ago -- now recommends that such laws be repealed. Organizations supporting repeal of the Alcohol Exclusion Law in South Carolina include: the Behavior Health Services Alliance, the South Carolina Medical Association and the South Carolina Hospital Association.
Faces and Voices of Recovery Tri-County (FAVOR Tri-County) urges all citizens to ask their state senators and representatives to vote for repeal of the Alcohol Exclusion Law. State Rep. Carl Gullick, R-York, has introduced H. 4059, which will accomplish that if passed. State Sen. Dave Thomas, R-Greenville, will introduce the Senate version of the bill in the near future.
Failing to identify and treat substance use in emergency services is likely to cost South Carolina businesses and residents $148 million each year in extra health-care expenses. Screening and brief intervention in hospital ERs yields $351 in savings per patient through reduced re-injury and re-hospitalization costs.
Whether you're worried about reducing DUIs, getting more people cleaned up or improving the bottom line of our shaky health-care system, it is high time to put an old, bad law out to pasture.
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