AWARE Aims to Tackle Wisconsin's Drinking Problem

Now healthy, Patsy Wagner models one of the T-shirts she designed many long months after a disastrous meeting with a drunk driver.

On a February evening in 2007, University of Wisconsin-Madison freshman Patsy Wagner was crossing Langdon Street, heading back to her lakeshore dormitory after a sorority meeting. She didn't even see the car that hit her. The impact threw her against the windshield, and the driver kept on going. Caught under the car, she was dragged 45 feet down the street as witnesses screamed at the driver to stop.

"While I was pinned under the car, bleeding and screaming, I could feel him bouncing the car as he remained sitting in the driver's seat, drinking," Wagner told the court.

Police found an open beer and an uncapped bottle of Jack Daniel's in the car, and discovered the driver sitting in a snow bank. He told police, "God, I'm so drunk."

In May that year, while out on probation for injuring Wagner, the driver was again arrested - a fourth citation for drunken driving. As his public defender told the court, "He realizes he has a serious problem with alcohol."

He's not alone. Wisconsin has a problem with alcohol. The state's binge drinking and underage drinking rates top the charts. Meanwhile, its penalties for drunk driving are among the most lenient in the country. In Wisconsin, first-offense drunken driving is a civil forfeiture, similar to a parking ticket. A fourth offense conviction of drunken driving is a misdemeanor.

Wisconsin is one of only two states with penalties that lenient. Neighboring Minnesota, Iowa and Illinois all have "three-strike rules," in which the third offense is considered a felony.

Almost every day, Wisconsin physicians treat patients like Patsy Wagner in emergency departments and operating rooms.

Alcohol has become a public health emergency in the state. So in November 2008, the leaders of UW Health called a press conference at the Wisconsin State Capitol to announce a coalition aimed at combating problem drinking in the Badger State. The All-Wisconsin Alcohol Risk Education (AWARE) coalition is calling attention to the health and safety problems created by abusive alcohol use, asking partners from across the state to join a fight for law changes.

Under the bright lights of television cameras, a crowd of reporters, lawmakers and lobbyists gathered in the Senate Parlor to hear the three UW Health CEOs explain that the annual economic impact of alcohol-related health and social problems in Wisconsin is nearly $5 billion. Every year, alcohol is responsible for 1,300 deaths, 8,500 traffic crashes, 6,800 traffic injuries, 2,400 substantiated cases of child abuse and 90,000 arrests.

"Wisconsin is an island of excessive consumption of alcohol and it is well past the time to change direction and join the mainstream," said Robert Golden, MD, dean of the University of Wisconsin School of Medicine and Public Health (SMPH), at the press conference. "Instead of leading in alcohol abuse, we should point the way - as we have in so many other areas - and address our collective problem with compassion, vigilance and dedication."

Golden said that the SMPH uses a unique approach to teach medical students how to recognize and care for people with alcohol problems. Its Wisconsin Partnership Program has awarded more than $2.8 million to 12 regional and statewide initiatives directed at alcohol and other drug abuse prevention, early intervention and treatment services. And Richard Brown, MD, of the Department of Family Medicine, directs a $12.6 million federal grant aimed at developing alcohol screening and assistance programs across the state.

Golden's comments on the need to change Wisconsin's drinking culture landed him in The New York Times, and he was interviewed by a BBC broadcaster who said England, too, is struggling with the unfortunate results of alcohol abuse.

But the school can't do it alone. Golden explained that the AWARE coalition wants a third-strike-for-drunken-driving rule like our neighboring states already have. It also wants higher penalties for first-offense drunken driving citations.

"Wisconsin law treats first time offenders lightly," Golden said. "Yet first-time drunken drivers account for 68 percent of all fatal and serious injury accidents."

Alcohol's effect on UW Hospital and Clinics is truly astounding, said Donna Katen-Bahensky, hospital president and CEO, at the press conference.

"As western Wisconsin's Level-One Trauma Center, we treat impaired drivers and their victims almost every day," Katen-Bahensky said. "In 2007, 30 percent of motor-vehicle accident admissions to our emergency room involved alcohol, a jump from 2000, when 11 percent were alcohol-related."

Wisconsin laws governing how insurance treats drunk drivers are outmoded, as well. It is one of only two states in which the law requires auto insurance to pay for auto repairs even if the driver is drinking. Yet, ironically, Wisconsin law allows health insurance companies to deny coverage for the impaired driver's hospital bill. This law also discourages health care providers from screening patients for alcohol abuse and other addictive disorders.

"Every patient who comes into the emergency room is treated," Katen-Bahensky said. "Yet in the case of drunken drivers, the hospital can be denied payment. This puts a burden on the hospital and on taxpayers, who pay for the care of drunken drivers through higher premiums."
Alcoholics consume more than just liquor; they account for a staggering amount of health care dollars. A UW Health analysis showed that the hospital spends more than 16 percent of its charity care dollars on people who arrive legally intoxicated. The average blood alcohol limit of those patients is 0.22, nearly three times the legal limit. The result, Katen-Bahensky said, is "a health care catastrophe."

And the problem continues to get worse.

In recent years, the level of care the hospital has provided to patients who arrive legally intoxicated has grown steadily. From July 2005 to June 2008, the hospital treated nearly 1,400 patients with blood alcohol level of 0.08 or above.

"And we didn't see these patients just once, we saw them many, many times," Katen-Bahensky said.

On average, over the last three years alone, those 1,400 patients visited the hospital nearly 6,000 times. And 30 percent of the time, they entered the hospital through the emergency room.

Patsy Wagner had not been drinking when the ambulance brought her to UW Hospital after she was run over by the drunk driver on Langdon Street. Physicians determined that she had a fractured clavicle, two fractured vertebrae in her neck, a fractured eye socket, a broken nose and countless lacerations on her face and legs. She was forced to withdraw from UW to go home to Boston to recover.

Wagner wore a neck brace for months and had to have more surgery in 2008 to rebuild her nose so that she could breathe properly.

Take Wagner's case and multiply it by hundreds, and you have some idea of the scene at the UW Hospital Emergency Department. Lee Faucher, MD '96, sees every day the toll that excessive drinking takes.

"I am the one who has to come out of the operating room and tell the loved ones that the patient didn't make it," says Faucher, director of trauma and co-director of the UW Hospital Burn Center.

Faucher has become an enthusiastic advocate of the AWARE project, appearing at press conferences and in media interviews to promote the idea that Wisconsin needs to get its drinking under control. He's also helping with a companion anti-drunk driving effort being promoted by Dane County Executive Kathleen Falk.

In fact, despite Wisconsin's long love affair with alcohol, a number of health care, law enforcement and other civic organizations have joined as partners in the AWARE coalition. Dozens of people have signed on to the AWARE Web site at UW Health to offer support and to tell personal stories of how alcohol has harmed them and the people they love.

One of them is Mary Grace Quinlan, a Boston artist - and Patsy Wagner's mother. Quinlan says her family loves Wisconsin. They've had a cottage in Door County for nearly a century and vacation there every summer.

"I'm so thrilled about this coalition," Quinlan says. "Wisconsin needs to address the problem of drinking and drunk driving."

As part of her healing process, Wagner has been addressing the problem through a Web site she developed, www.savethepedestrians.com, where she sells T-shirts she created that read "Save the Pedestrians" and "Keys Please: You're Wasted."

Wagner is now a student at the University of St. Andrews in Scotland. Although she still contends with lingering problems from the accident, she says she has no hard feelings toward the state and may be returning.

"I adored Madison, I still do, and I miss it very much," she says. "Honestly, I couldn't have been at a better place when this happened, I can't even describe the support that my friends, teachers and sorority sisters gave me during the whole ordeal. I would love to come back to Madison. I am definitely considering it for graduate school."

Maybe by then, Wisconsin will have become more AWARE of its alcohol problem and will have made progress in addressing it.

by Susan Lampert Smith
This article appears in the winter 2009 issue of Quarterly.