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Many of us want to avoid a trip to the emergency room, but according to U-T San Diego research, one small group -- known as "frequent fliers" or users -- visits the ER more than you can imagine.

"We have people that literally will use the emergency department over a hundred times," said James Dunford, the city of San Diego's medical director and an ER doctor for 32 years.

That is more than 100 times in one year, and Dunford said about half of frequent users are homeless, but all have fallen through the cracks.

"They have very complicated medical problems, chronic diseases. They usually have some kind of mental problem, they often times have substance abuse [issues]," said Dunford. "This is a super-user problem that's generating super bills."

The bills are paid for by insured patients and taxpayers.

According to the city Medical Office, 1,136 frequent users are on course to use emergency services at least six times each this year -- costing more than $20 million in ambulance and paramedic charges alone.

Frequent users represent less than 1 percent of the city's population, but they account for more than 17 percent of all paramedic and ambulance calls in the city, according to the city Medical Office,

"This is ground zero for health care reform," said Dunford.

Dunford said it will take a team approach that doesn't exist now to get uninsured frequent users out of the ER and into primary care -- a major step toward getting health care costs under control.

U-T San Diego health reporter John Gonzales spent eight months investigating the problem and said it will take more than money and agencies.

"It's almost as if you have to get beyond that and make an emotional investment, a human investment, and say, 'You know what? I care enough about this to try to solve the problem,'" Gonzales said.

John Gonzales' five-part series titled "Healthcare 911" will begin in Sunday's edition of U-T San Diego. In the series, Gonzales expands on the issue and looks at a test program now trying to fix the problem.