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Hospitals can't cure homelessness

February 28, 2007|Brian Johnston | BRIAN JOHNSTON is the chief of emergency services at White Memorial Hospital, where he's been practicing for more than 30 years.

DESPITE WHAT YOU may have heard about the "dumping" of homeless patients in skid row, you can be sure of this: The 72 public and private hospitals with emergency rooms in L.A. County are committed to providing medical care to meet the needs of everyone, including the poor, the uninsured and the homeless.

This is an enormous, often overwhelming, commitment. Patients who need urgent care are often required to wait for hours in emergency rooms while an overburdened staff treats other patients with more immediate, life-threatening illnesses and injuries. Paramedics who should be out on the street are stuck in the hallways of hospitals waiting to hand off new patients to the emergency room staff.

Contributing mightily to this problem is the logjam caused by the lack of available hospital beds to which patients can be transferred after we emergency room physicians complete our work. It can take 24 hours -- sometimes even 48 -- before a bed becomes available for a patient who needs to stay overnight, in part because these beds are occupied by patients awaiting completion of their discharge plan.

Many of these patients -- about 18,000 a year, according to the Hospital Assn. of Southern California -- are homeless, and the fact that they are homeless makes discharge planning for them a huge challenge. Even after treatment is completed, they often continue to occupy a bed while hospital workers struggle to find follow-up services or a place for them to stay while they recuperate. On average, a homeless hospital patient stays four days in a hospital bed after he or she has been cleared for discharge while hospital workers try to put together an effective discharge plan.

When a story breaks like the one about the 54-year-old homeless man who was allegedly dumped by a hospital van outside a skid row park earlier this month, it's easy to blame the hospitals. The man was sick and vulnerable, after all, and was found crawling in the gutter. There's absolutely no justification for what happened to him.

But it's simplistic to think that it happened because hospitals are callous or because doctors don't care about the homeless or poor people. And it's especially naive to think that the problem can be solved simply by passing an "anti-dumping" law, as proposed by some state and city officials.

The problem is systemic. If there are lines of patients waiting for beds -- but no place for homeless people to go when their treatment is completed -- then there's going to be a problem.

The system, as it works now, is a tragedy and a colossal waste of costly and urgently needed hospital resources. We need more community-based services, more county hospital beds and more county clinic capacity to which we can refer homeless patients when they no longer need to be in a hospital. The 45 post-hospital recuperative beds now available to the entire homeless population in Los Angeles County are woefully inadequate.

We need to triple, if not quadruple, that number and to increase the limited amount of support services and shelter beds now available. The service expansion needs to take place in communities other than downtown L.A. The concentration of homelessness and services on skid row creates an environment of victimization that drives up the need for more healthcare for this population. Skid row is a breeding ground for disease and physical abuse and needs to be cleaned up, and those who prey on the homeless need to be cleared out.

Hospitals exist to provide services to all who need them, but we are frustrated by the increasing numbers of homeless people who may need no more than a Band-Aid, a bed and a meal but who are dropped off at our doorsteps by law enforcement. Emergency rooms should not be used as a shelter of last resort by police officers eager to hand off their charges and get back on the street.

Lastly, hospitals and doctors need to be reimbursed for the healthcare we are providing to homeless and uninsured people every day. Area hospitals provide almost $2 billion of unpaid medical care annually. This burden has caused 10 emergency rooms to close in Los Angeles over the last four years.

Our communities would be better served if our elected officials would concentrate their efforts on the root causes and needs of our homeless population, rather than on the legislation that City Atty. Rocky Delgadillo and state Sen. Gil Cedillo (D-Los Angeles) have proposed, which would victimize hospitals for trying to take care of a population whose needs our elected officials have ignored.

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