Man visits emergency room 1,200 times in five years

OAKLAND, Calif. -- It's a mystery, Gregory Goins insists, why his chest begins to hurt when it does.

He might be riding the bus, walking down the street, or dozing on a park bench. Suddenly, the pain comes on, spreading through his rib cage, and Goins remembers just how sick a man he is.

That's when his thoughts turn to the emergency room at Highland Hospital. He knows there are doctors and nurses there, ready to help. There are medicines and EKG machines. There are sandwiches.

So Goins finds the nearest pay phone, punches 911, and soon the ambulance comes.

Almost every day now, the ambulance comes to pick him up.

Goins is the ultimate "frequent flier," the label that emergency-room workers give their most regular visitors. He has been to Highland Hospital's emergency room more than 1,200 times since 1996, recently at the rate of once or twice a day.

Emergency overload

His case, while extreme, is rooted in a widespread problem: America's emergency rooms face a growing crush of patients, many uninsured and lacking other access to medical care. Among them are regular visitors who look to emergency rooms to provide food, human interaction or perhaps just a warm place to sit for a while.

No one else may consider their needs an emergency. But those patients do, and that's enough to get them in the door.

"There's a moral and legal obligation to take every complaint seriously," says Dr. Richard O'Brien, a spokesman for the American College of Emergency Physicians.

That includes even the complaints of someone like Gregory Goins.

His emergency-room visits, ambulance rides and hospital stays have cost taxpayers an estimated $900,000. He has been called a shameless manipulator of the system, a burden on overworked nurses and doctors, and a danger to other citizens in need of ambulances and hospital beds.

Goins is all of this. But he is something else, as well. The staff at Highland hate to see him coming, yet many miss him when he stays away. Amid the emergency room's anonymous stream of injury and illness, there is comfort in a familiar face -- even when it belongs to someone as maddening as Goins.

"Gregory, Gregory, Gregory." The sheriff's deputy shakes his head as Goins is wheeled in for the 1,209th time to the emergency room at Highland, a public hospital that takes all comers.

"Gregory!" a nurse shouts. "I haven't seen you for a while."

"You gotta be kidding me," another nurse says. "This is his second time this week for me."

A paramedic briefs one of the nurses. It's the usual: chest pains and shortness of breath. In a few minutes, they'll take Goins back to an exam room for tests. For now, he remains parked by the wall, haranguing everyone near him.

"Hey, Shorty." "Hey, man, can you get me a soda?" "Nurse, nurse, can I ask you something? Will you marry me?" "Hey, you know me?"

Everyone here knows Goins.

A man called 'Shamu'

Guards and paramedics call him "Shamu," after the SeaWorld whale, a nickname bestowed a few years ago when he weighed more than 300 pounds. He is 60 pounds lighter now, more walrus than whale, with a belly that bulges out through his unbuttoned shirt. Even his smile is walrus-like, with two yellow tusks poking out from an otherwise empty upper gum.

He is 47 years old, penniless, jobless and, until recently, homeless. He has a history of cocaine abuse, though he says he is off drugs now.

Highland's emergency room is the center of his universe, one of the few places where people actually talk to him.

They cannot make him go away, because Goins is truly ill. He has alarmingly high blood pressure, a chronic condition that has thickened the walls of his heart and made him vulnerable to strokes and heart attacks.

Goins somehow survived a massive stroke last year, barely worse for the wear, and now he and the doctors at Highland have settled into a routine: He summons an ambulance once or twice a day. Emergency-room staff hook him up to an electrocardiograph, confirm that he's within his usual readings, and admonish him to take his blood-pressure pills. On the way out, Goins tosses his prescriptions into the trash.

Enjoying the 'circus'

"He really enjoys the circus effect, the ability to have that kind of impact," says Dr. Eric Snoey, an emergency physician. "He's got his 15 minutes of notoriety every day of the week."

Doctors and nurses shake their heads at Goins' irresponsibility, his rudeness, his stench. But many confess that a day without Goins doesn't seem complete.

"Greg is our most famous patient," Snoey says. "He really is like a dysfunctional family member."

About three years ago, a committee that was formed especially to deal with Goins decided to make his visits less appealing. Nurses kept him away from exam rooms, where he often fell asleep. Instead, they gave him EKGs in an uncomfortable chair in the triage area. A restraining order banned him from the hospital unless he was receiving medical care.

His typical two-hour turnaround time was reduced to 30 minutes, but it only seemed to bring him back for more. Doctors eventually threw up their hands.

"There's no system in the world created to manage someone like him," says Dr. Barry Simon, director of the emergency department.

Last winter, Goins' daily visits abruptly stopped. He had been jailed for violating an order banning him from a local cafe, where he'd made himself unwelcome by defecating on the floor.

Released in July, Goins immediately resumed his daily routine at Highland -- until late August, when he was jailed for a few days for getting belligerent in the emergency room, then jailed again for visiting the off-limits cafe.

When he's not behind bars, Goins lives in a group home for developmentally disabled men. There, home director Vincent Bush nags Goins to take his blood-pressure pills, change his sheets and brush his teeth.

Goins says he appreciates what people are doing for him. But he doesn't see his visits to Highland as something he needs to change.

"Last year, they told me my bill was a quarter-million dollars," he says. "I said, 'So what? I'm sick. Take care of me.'"