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Friday, February 9th 2007

Hapless Apologist For All Things Health Care Providers Do

More “appalling” skid row dumping in Los Angeles. Take the emphasis as sarcasm and read on.

A hospital van dropped off a paraplegic man on Skid Row, allegedly leaving him crawling in the street with nothing more than a soiled gown and a broken colostomy bag, police said.

The guilty party appears to be Hollywood Presbyterian Medical Center.

Police said the incident was a case of “homeless dumping” and were questioning officials from the hospital.

“I can’t think of anything colder than that,” said Detective Russ Long. “There was no mission around, no services. It’s the worst area of Skid Row.”

There has been a lot of outrage about this.

City officials have accused more than a dozen hospitals of dumping patients and criminals on Skid Row. Hospital officials have denied the allegations, but some said they had taken homeless patients to Skid Row service providers.

In 2005, Hollywood Presbyterian was accused of homeless dumping.

At the time, a top executive denied the charge, but said Skid Row service providers offered treatment and care for some patients who had nowhere else to go.

Hospitals are doing wrong here. But the level of outrage seems to underlie a sense that these hospitals OWE a very large responsibility to these homeless. The outrage seems disproportional, unless you truly think, say, that the hospital should give him a bed to sleep in.

I have to think that this “dumping” is at least with some mild good intent. Granted, it probably doesn’t do much for ambiance to simply push the homeless out the front door and let them loiter. But, and realizing I don’t have any numbers to back this up, it seems reasonable from my own experience that most of these individuals aren’t coming in of their own volition. Transported to this hospital, they could be miles from their usual stomping grounds. You push them out the door, and how will they find their way back? There is at least a kernel of trying to put them in the right place by driving them to Skid Row.

That obviously isn’t the major issue. The two major issues are:

1) Are these people being dumped before they should be medically discharged?

2) What sort of social services should hospitals be responsible for?

If question one has an affirmative answer this is obviously grotesque. We should realize, despite the nice demonizing rhetoric in the article there is basically nothing to allow us to judge one way or the other in this particular case.

EMTALA does not provide near enough reimbursement to cover the cost of caring for the homeless. So Hollywood Presbyterian has a strong motive to move these patients out, as quickly as possible. But a motive isn’t guilt.

The second question seems to be the one the Los Angeles community is struggling with. We’re talking very pragmatic responsibilities here.

To clothe them (what if he came in as a trauma admit, and his clothes were cut off?), to set up continuing medical care, to find them a place to stay?

I’m really not trying to be heartless (maybe succeeding though), but I have trouble requiring any of these things of hospitals who care for the homeless.

But I am actually interested in other’s opinions. I don’t care what the law does say. I’m interested in social standards and the way it should work. What should the hospital have done differently? Had social workers to find the man a community clinic to visit? Clothed him? Free meds? Found a shelter that would take him? And if they can’t, let him use a hospital bed until a shelter bed opens up? Is that realistic?

How much would you chip into a charity fund to provide those services for the homeless?