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After homeless people are treated in hospitals, where should they be sent when they're discharged?

February 23, 2007

THE IMAGE OF A hospital van abandoning a paraplegic man in a skid row gutter is so revolting that it was just a matter of time before elected officials tried to crack down on dumping the homeless. City Atty. Rocky Delgadillo and state Sen. Gil Cedillo (D-Los Angeles) struck first, unveiling a bill this week that would bar hospitals from transporting discharged patients without their written consent anywhere but to their home or another health facility.

The bill would make it easier for local prosecutors to go after hospitals and staff involved in headline-grabbing cases. But the root problem this bill won't fix is that many discharged patients have nowhere to go. Except maybe for skid row.

Today, hospitals are obligated to treat anyone who comes in with a medical emergency, regardless of their ability to pay. Once a patient's condition has been stabilized, however, the only obligation is to provide a plan for follow-up care and to make a good-faith effort to suggest an appropriate provider. Hospitals are not required to make sure the patient receives this care, nor do they have to give patients a ride home -- or anywhere else.

Homeless patients put hospitals in an awkward situation at discharge time. Patients can be simply walked out the door and left there, even if they're still dressed in a hospital gown and fitted with a colostomy bag (as was the paraplegic man dumped on skid row). Because that's inhumane, a hospital might put a homeless patient in a van or a taxi bound for a homeless shelter that can provide some mental health or drug treatment services. Such facilities are concentrated on skid row. But there isn't enough room for all the people who need that kind of help, and when a shelter turns the patient away, he or she may wind up dumped on the street nearby.

That's happening with alarming frequency. Delgadillo's office is investigating more than 50 cases of alleged dumping. Still, the bill that he and Cedillo are pursuing wouldn't put a dent in the underlying problem, which is the shortage of shelters, treatment centers and other badly needed facilities for the tens of thousands of homeless in Los Angeles County, and the lack of an organized plan about what to do with homeless people freshly discharged from hospitals. Instead, it's more likely to prod hospitals to leave their discharged patients at the nearest bus stop or curb.

A more helpful step would be to create a system connecting hospitals to homeless service facilities able to handle follow-up care. But the needs in this area are much greater than the county's capacity to deliver. Until every community can meet the needs of its homeless residents, the region will continue to send them on costly trips to hospital emergency rooms. And when they're discharged, many will still wind up wandering around skid row.

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