Nursing Voices

Thursday, November 16, 2006

No Dumping Allowed


This photograph was taken by the Los Angeles police department on October 22, 2006, and shows an ambulance crew taking a patient to a homeless shelter in Skid Row.

Hospitals, beware, if you’re caught discharging homeless patients to the streets, you could end up in court. The Associated Press reports that a Los Angeles hospital accused of dumping patients in Skid Row is facing criminal charges. The investigation started last March when a 63-year-old woman was discharged from Kaiser Permanente’s Bellflower hospital and was found wandering the streets of Skid Row wearing a hospital gown and slippers. The hospital is being accused of false imprisonment and dependent-care abuse charges. The city is also suing Kaiser under a state law of unfair business practices.

At first, Kaiser defended their practice, noting that there are social service agencies located in Skid Row that can help patients get back on their feet. Then, after a lot of bad publicity, they apologized. Hospital workers can no longer sneak patients into Skid Row. They have to call Skid Row service providers first before they dump patients off at the provider’s doorstep.


We do not live in a perfect world. As a nurse, I believe it’s wrong to discharge patients to the streets, but as someone who recognizes the economic realities of running a business, and make no mistake, health care is a business, I understand why patients are being kicked to the curb. There are no easy answers, and I think things are going to get a lot worse before they get better.

17 Comments:

Blogger Jean-Luc Picard said...

I had no idea this sort of thig was done.

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The closing date for submitting your entry is Wednesday 29th November.

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10:35 AM  
Anonymous Mr. Code Brown said...

I didn't think this was allowed in the first place. My understanding was that the Hospital Social Worker arranged a safe place for the patient to be discharged to.

11:39 AM  
Blogger kaiserfraud said...

This is only the latest in a string of recent Kaiser scandals. For more, see http://corphq.livejournal.com

1:09 PM  
Blogger The Curmudgeon said...

I just wish that hospitals discharged patients when the attending medical professionals agreed that the patient was healthy again -- not according to some mindless schedule set up by a government bureaucrat or insurance company functionary.

People with great support systems -- loyal spouses, nearby adult children, dear friends -- can endure (for awhile at least) the burden of brining the still recovering patient to and from follow up care that formerly was done "in house." But what of the person -- "rich" or poor -- who lives alone? With no support system?

I know, your beyond the scope objection is sustained....

2:10 PM  
Blogger scalpel said...

EMTALA requires that a hospital emergency department evaluate every patient who presents for care for the presence of an emergent medical condition. If the patient has an emergency medical condition, the patient must be stabilized and treated regardless of ability to pay.

There is no regulation that I am aware of that requires a hospital emergency department to provide food and shelter to anyone seeking such comforts who does not have an emergency medical condition. Nor are there any regulations that require a hospital emergency department find shelter for people in the community.

Don't we have enough to do already without acting as shelter-finders for the homeless? If they walk in from the street, they can walk back out to the street.

4:07 PM  
Blogger SQT said...

I don't even know what to say to this. It's sad, but if they come off the street, where do you put them after they no longer need to be hospitalized?

I know a lot of homeless people are also mentally ill and have no place to go. We don't really have a system in place that takes care of people who fall through the cracks.

I remember as a kid my grandparents had to live with us because they couldn't afford to support themselves and pay for the healthcare they needed. If they hadn't had us where would they have ended up?

4:34 PM  
Blogger poody said...

I heard about this just the other day on NPR. When I worked in Houston at Ben Taub the charity hospital we got a patient in the ER who was put on a bus from Charity Hospital in New Orleans and sent to Houston. This was years ago too. Also when I worked in Hawaii we had an alzheimer's alcoholic pt. who had no shit, been put on a plane and sent to Honolulu by the discharging hospital Talk aboout turfing a pt. They must have ponied up a lot of dough in the Er to get rid of that guy. It was heard for me to believe that could happen but it did and does. Iworked for awhle here in the homeless shelter infirmary of the Salvation Army. The county hospital would dc pt's. to the infirmary all the time. With dressing s and casts and once a man had a fistula for dialysis!!!

8:20 PM  
Anonymous richard said...

if interested, have a look at this article

It's the first study i've ever seen attempting to calcuate of the number of discharge from hospital to 'no-fixed-address' mental health clients in a given city, in a given year:

FORCHUK C., RUSSELL G., KINGSTON-MACCLURE S., TURNER K. & DILL S. (2006). From psychiatric ward to the streets and shelters. Journal of Psychiatric and Mental Health Nursing, 13, 301–308.

we need more affordable housing - among other things for the health system...

9:37 PM  
Blogger RX850 said...

This just blows my mind. You are so right, MJ, there are no easy answers.

I'm just surprised there aren't some screaming social workers out there when this happens.

9:57 PM  
Anonymous may said...

it is sad, but there is this thing too: we had a few homeless patients who come in. our social workers arrange for a placement for them, but they refuse to go there. they would rather go back to the streets. so, that's how they are discharged. off the unit, out of the hospital, to the streets.
you couldn't say it any better.
"there are no easy answers" indeed.

1:59 AM  
Blogger ordinary girl said...

I have to say, whilst Britian may have a whole lot of issues within the NHS at the moment, I pray to God that no British medical profession would ever say "they walked in from the streets, let them walk back out to them"! Talk about I will deal with my small problem and then it's someone else's issue!! Whilst it may not be an issue for your hospital/department it most definitely should be an issue for your society and your health system! And frankly, anyone who can be as uncaring as this shouldn't really be in the "caring" profession!!

6:54 AM  
Blogger Forty_Two said...

I can't believe you're so naive. The value of any particular human life as determined by a business is a function of financial resources.

9:28 AM  
Blogger scalpel said...

Say you worked at a restaurant, and the law required you to feed every homeless person that came in. You don't really care, because you aren't paying for it, but you take the orders and serve the food. You are happy to help, being the kind-hearted liberal that you are.

So the stinky dirty scary-looking guy comes in drunk off his ass, cursing loudly and demanding a table. You, wearing your bleeding heart with pride, gladly offer him one. "Have a seat, and I'll bring you a sandwich," you say kindly.

"I don't want no f**king sandwich b*tch. Bring me the Maine lobster and a bottle of your finest champagne. In fact, make it two. And hurry your ass up." After gulping down his meal, he vomits it up on the floor and wipes his vace with the tablecloth before passing out in his chair. You clean up the mess, only to see that he has had diarrhea all over your cloth chair and new carpet as well. A few paying customers leave in disgust, shielding their children as they exit.

The owner of the restaurant has an apartment upstairs, but you aren't sure you really want to give it to him given his poor manners and hygeine. So you change him into some clean clothes scrounged from the kitchen, clean up his mess, and put him to sleep on a couch in the back hallway. He awakens later that evening and walks out.

But he'll be back the next night, and the next night, and the next night....expecting the same free ride.

How many homeless people have any of you actually helped? Or touched? If the closest you ever get to them is looking straight ahead when you pull up to the corner where they are begging, then how dare you accuse me of being uncaring?

11:32 AM  
Blogger JustCallMeJo said...

It's why I'm a nurse and could not be a social worker. I couldn't do case management, either.

"Nursing case management" seems to be an entire field of "how to find chronically ill people a place to live."

And I think *my* job's thankless.
/jo

11:40 AM  
Blogger Cyndy said...

You've opened up a curley one here, Mother Jones. I work in a small, country hospital in Australia, and even though we don't have too many homeless people in our area, there a quite a few aging folk who live in extremely poor conditions on their family farms that usually arrive in an ambulance after a fall or accident at home. Most suffer from a degree of malnourishment, poor hygiene and mismanaged medical conditions (by their own volition, not healthcare providers). They are provided with warmth, care and food, and so become well again. Social ad physical support is put in place, allowing for increased living standards at home and an improved quality of life in the hope that they may not visit us again any time too soon. The patient usually agrees to everything so that they can go home.....and then refuses all intervention once they get there. It usually isn't long between hospital stays, and the pattern repeats itself until the patient is finally assessed as "high care", and awaiting nursing home placement, and the decision is taken out of their hands. In our system, we can maintain these people for up to 30 days at a time, then they must be reassessed, but they don't go backwards from this point; this can just repeat over and over.
The bottom line here is, I guess, you just can't help those who don't want it. There doesn't seem to be a right answer........ ;(

4:10 PM  
Blogger Michael Clifford, L. Ac. said...

I was almost irrate after reading fourt_two's comment. I re-read it again. The only thing that kept me from climbing up on my own soap box was the word "business." Then I had to calm down, because that is his/her shield. Saying that a business determines the VALUE of a human life as a function of their financial resources. But what is missing in that is what is the entity, or entities that run the business. They call them selves human. So here is one human stating that another human only has value if that human has financial resources.
I guess in all fairness I need to say I am uncertain if 42's comment is a slam on business or a justification for this type of evaluation.

But your story MJ was good and regretfully is not being given the time for a discussion that it merits. This issue is complex and as you said there are no easy answers.
But I will toss one out and will get my fire-extinguisher ready in case I get flamed for it. LOL

Re-create the "Civilain Construction Corps" Make it a mandatory two-three year enlistment after high school, before college. Each woman or man is given the choice of 1) military service, 2) Health-care service, or 3) rebuilding our [rapidly] deteriorating infrastructure.
If you choose not to enlist, you are not a citizen and therefore cannot vote, or use our health care system in your old age. You can use it if you pay for it.

OK. I have my fire extinguisher ready.
I will leave with a paraphrase of John F. Kenedy. "Do not settle for the comfort of opinion without furst having experienced the discomfort of genuine thought."

10:06 PM  
Blogger yunsinku said...

no work, no grub
You can use health care system if you pay for it.

10:29 PM  

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