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Tuesday, August 5th 2008

No More Patient Dumping Hopefully

Los Angeles Skid Row

A Los Angeles city ordinance is going to prohibit patient dumping on skid row. That practice by some Los Angeles hospitals (many of them affluent) got wide media coverage after several high profile cases.

I’ve made some non-normative comments on this problem of patient dumping in the past. I’ve helped play social worker and discharge plan for many indigent patients. It can be tough and often, for the able bodied, the solution is to give them a bus voucher and a list of resources available for the homeless outside the hospital and send them on their way.

True, many of the cases presented in Los Angeles, involve the frail, the disabled and the demented being simply left on the street which raises the gile and I cannot imagine such ever happening at anywhere I’ve rotated. I just wonder if a Los Angeles city ordinance (I haven’t read it) or a California legislature bill will draw enough nuance.

Admitting there are some horrific procedural problems, let me make my two controversial points again. First, this happens,

[H]ospitals are worried the new ordinance may put an undue burden on them. While several have admitted failings and are revising procedures for discharge planning, they also say many patients refuse to leave.

In hospitals, patients have a “nice, warm bed, three meals a day and maybe even a television and people waiting on them. They are literally saying to us, ‘I don’t want to go. If you discharge me, I will call the L.A. Times,’” said Carol Meyer, director of governmental relations for the Los Angeles County’s Department of Health Services.

I won’t say often, but I’ve seen more than my fair share of the homeless attempting to make the hospital a home or using the hospital as a shelter. With the prevalence of mental illness and disability amongst the homeless the picture painted by the media of their condition at discharge can be misleading.

Take for example this infamous case, which prompted criminal charges against a Kaiser Permanente Hospital. There are some horrific elements of this case of patient dumping (where are her clothes?) but most of the lean by the Los Angeles Times piece is unbalanced by reasonable investigation. We don’t know if that patient was medically fit for discharge from that story. We have no idea what this patient’s baseline is, for instance. She acted confused after she got out of the cab? Maybe she carries some dementia.

Second, these are private businesses not social agencies. Really, the inpatient setting is not the best place to address many of the chronic illnesses which afflict the homeless and which exist as their baseline. Yeah, if you want to challenge Kaiser’s non-profit status go ahead but these are businesses. It’s easy to charge them with the costs of providing, not only acute care as they’re now required, but also social work services for a range of non-funded patients because they cannot shift the costs to you, the funded patient, seeing as what they can charge is limited by a cabal of health insurers and prohibitions on balanced billing. But I wonder how sympathetic the outcry would be if:

- Every Los Angeles hospital took an extra $100 per hospital day directly out of every paying Angelino patient’s wallet
- If your ER wait time went from eight to sixteen hours because the hospital beds were being held by homeless patients simply waiting to get a shelter bed

In past posts I challenged those offended by the stories of patient dumping to pony up. Show the voided check of your donation to a homeless shelter to help fund more beds, show your pictures of your work with Habitat for Humanity almost every weekend, take the homeless directly into your home. There were some real problems with the way some seemingly greedy Los Angeles hospitals handled the discharge of homeless patients, but those cases are a branch…not the root of the problem. And I doubt a Los Angeles city ordinance against patient dumping is even a small step towards fixing the root of the problem.