Officials on Monday launched an investigation into allegations that two county hospitals routinely leave discharged patients on skid row, and one county supervisor said the practice means there should be a fundamental reexamination of how hospitals deal with the homeless.
County supervisors have criticized what the Los Angeles Police Department has called the regular practice of suburban law enforcement agencies and some hospitals "dumping" homeless people, criminals and drug addicts on skid row.
But the supervisors were demanding answers after two hospitals they oversee, Martin Luther King Jr./Drew Medical Center and County-USC Medical Center, were cited as two that leave discharged patients downtown.
"These actions are unacceptable," Supervisor Mike Antonovich says in a motion he plans to introduce today.
Antonovich wants the Department of Public Social Services to work with the hospitals to evaluate patients before they are sent to outside facilities on skid row or elsewhere. Right now, officials at the hospitals perform that function.
Antonovich aide Tony Bell said the supervisor wants to examine moving some of the homeless and mental health services concentrated on skid row into the county's five public hospitals and surrounding areas across the region.
That would mark a major shift in county policy, which has focused the vast majority of services for the homeless, as well as drug and alcohol treatment programs, in a few square blocks of downtown Los Angeles. Critics say this concentration has helped make skid row a dumping ground for troubled people from across the county.
"Right now the argument is all the resources are down there," Bell said. "Wouldn't it make sense to bring more resources to the hospitals?"
The LAPD has accused three hospitals, King/Drew as well as Hollywood Presbyterian Medical Center and Kaiser Permanente West Los Angeles, of sending discharged patients in taxis to skid row.
Representatives of the three hospitals said in interviews last week that the practice is in the best interests of the patients because skid row offers the best chance of their receiving the follow-up services -- as well as shelter -- that they need once they are discharged.
They also said the patients are sent to skid row only after they are healthy enough for discharge.
A drop-off list compiled by the Union Rescue Mission listed several other hospitals, including County-USC. A spokesman for the county Health Services Department said Monday that County-USC also leaves discharged homeless patients on skid row.
"We're not putting people in a place they don't want to go," said John Wallace, a health department spokesman. "What we try to do is facilitate them getting back to the community where they came from originally.... We provide transportation assistance in the form of bus tokens and taxi vouchers."
The LAPD has also accused several law enforcement agencies of dumping, but they deny the charge. Last week, city and state officials pledged a new attack on skid row's persistent problems, beginning with a crackdown on rampant drug dealing, which police say generates roughly one-fifth of the city's drug arrests.
In response to the furor, the Health Services Department on Monday ordered a review of discharges from all of its five county hospitals and said it would ask each hospital's chief executive "to designate a person responsible for patient discharges to ensure that no patient is inappropriately discharged to skid row."
Also on Monday, Thomas L. Garthwaite, director and chief medical officer of the department, gave supervisors a report in which he defended the hospitals against LAPD allegations that some patients appear to be seriously ill.
"It is the department's policy that patients are not to be discharged unless they are medically stable," Garthwaite wrote.
In a letter to Police Chief William J. Bratton on Monday, he also said that discharged patients delivered to skid row were those who lived in the area and that there is no evidence that hospitals have sent other patients there for social services.
Some LAPD officials said they have seen patients with more than one hospital bracelet dropped on skid row, even though they seemed incoherent and unable to take care of themselves.
Antonovich's idea of moving some homeless and drug services intrigues some social service providers.
Dr. Lisa Levsen-Abdishoo, medical director of L.A. Mission Community Clinic, said coordination of efforts by clinics, service providers and hospitals was crucial to serving the needs of skid row patients.
"The best scenario for us is when there's some kind of coordination of care. Then we will be expecting the patient, they won't just get out of the taxi and end up on the streets."
Levsen-Abdishoo said that several projects are underway to coordinate efforts of County-USC and several skid row clinics, including the Weingart Center and a UCLA-run facility in the Union Rescue Mission.
"Some of the things we are trying to do," Levsen-Abdishoo said, are "to better coordinate care between the county hospital and us, to have staff from the clinics inside the medical center, serving as a liaison between the hospital and us."
Another project would target frequent users of hospital services and assign them a primary medical home and a case manager who would make sure the person got to his or her doctors' appointments.
Levsen-Abdishoo said she hoped that clinic staff members working with the hospitals would have access to patients' records "so that we can immediately pick up where the hospital left off."
But the basic issue, she said, is one of capacity, as the number of patients skid row clinics see continues to climb.
"Our clinic has grown significantly," she said, "but the capacity is not quite enough to meet the needs."