Homeless Dumping & The Wild World of LA Skid Row Charities

Proposals to criminalize the practice of discharging homeless hospital patients to the streets don't address the peculiar institutional structure of homeless support in Los Angeles.

The LA Times (Richard Winton & Andrew Blankstein) reports that California and Los Angeles officials are proposing legislation to make it a crime for hospitals to dump homeless patients on the street when they are discharged. 

This follows some publicized cases, such as one where a paraplegic man, Gabino Olvera, was left with just a colostomy bag and a hospital gown on a Skid Row street by a Hollywood Presbyterian Medical Center van.  Despite its name, Hollywood Presbyterian is a for-profit hospital that was sold by Tenet Healthcare (NYSE: THC) in 2004 to CHA Medical Group, a small hospital chain based in Seoul, Korea.  But there have been other instances of apparent dumping traced to hosptals in the Kaiser system, which are charities:  the $9.3 billion Kaiser Foundation Hospitals (EIN 94-1105628 Form 990) are part of the $22.0 billion Kaiser Health Plan system (EIN 94-1340523 Form 990). 

But it turns out that even the paraplegic case was more complicated than it looks.  The LA Times obtained a video that shows the man being wheeled on a gurney into the Midnight Mission (EIN 95-1691293 Form 990) in the LA Skid Row district and a minute later being wheeled right back out again.  In other words, the mission refused to accept him before he was later left on the street.  Midnight Mission has dormitory space for 300, and it provides about 65 beds a night on its parking lot as an alternative to sleeping on the street.  It also provides various services to homeless people in the Skid Row district, with a staff of 130 in a 90,000 square foot building.  For many years it was run by the well-known recovering alcoholic Clancy Imislund, who remains its secretary.  Dick Van Dyke, a long time volunteer, led the capital campaign to build the glowing new facility.  But it apparently has no room for a paraplegic with a colostomy bag. 

LA's Skid Row has more than its share of mega-charities of this sort, serving the 90,000 homeless (including 35,000 chronic homeless) in Los Angeles county.  Union Rescue Mission (EIN 95-1709293 Form 990), a block away from Midnight Mission, has a thousand beds, a staff of 122 and a budget of $44 million and is the largest homeless shelter in the US.  But missing in this picture are recuperative beds for homeless leaving hospitals.  Another LA Times story on the limits of homeless care (Cara Mia DiMassa and Richard Winton) points out that the JWCH Institute (EIN 95-2289916 Form 990) has just twenty recuperation beds paid for by LA Homeless Services Authority. 

The systemic problem was laid out last December in an Op-Ed piece in the LA Times by Michael R. Cousineau, director of the Center for Community Health Studies at the USC Keck School of Medicine.  (Dumping the Homeless on Hospitals, December 31, 2006)  He makes the obvious point that if you force hospitals to put up homeless people, fewer people can get admitted to hospitals.  No camera captures the homeless people who leave emergency rooms because the waiting line is too long. 

He lays the blame for homeless dumping on the city officials (who are the ones now calling for criminal penalties) and also on homeless advocates who have not paid sufficient attention to the big picture of homelessness, particularly its medical dimension.  It's not enough to provide substance abuse treatment, job training, and meals.  (We've already discussed the new housing first approach to homeless care that gets homeless people out of sheters and into apartments with no strings attached, precisely because it is so expensive and wasteful to put homeless people up in hospital beds and jails.)

The LA Times maintains a portal collecting stories relating to homelessness in Los Angeles, a map of Skid Row and its service providers, and summary statistics.

Comments

[Danny Vice]

The last time I was unfortunate enough to require hospital care, I stayed for a few hours and the hospital ran some routine tests. The bill ran into the thousands although the tests conducted were simple $75 clinical sample tests.

Private hospitals thrive on massive revenue, city subsidies and tax advantages. How often after all do you see a hospital having a "going out of business" sale? What would a used bed pad be worth anyway?

Hospitals who thrive on it's monopoly of the sick while receiving perks and incentives from public sources should be banned from releasing a patient into a potentially harmful environment that's incompatible with his/her ailments.

The fact that the hospital should be sued in order to compel the hospital into civilized health practices is an outrage. Our government has seen fit to regulate everything else in hospital operations, yet the user of those operations is beholden to the hospitals option of securing their welfare?

Perhaps a private hospital can't be forced to provide treatment, but it should certainly be required to insure that it doesn't release patients into an environment that is likely to make the condition(s) worse.

If it's true that the hospital made a commitment to change their practice and still has not, then I would expect (and hope) that the hospital will be sued senseless to established a precedent in this case that equals the apathy it has shown towards it's customers (patients). We'll be watching this case to see what the legal outcome is.

Those who paint the issue as a Religious issue (as the name Presbyterian means nothing - its private business).... or a political issue....the hospital is likely staffed with people from both political pursuations... aren't doing the issue any favors whatsoever.

Osolating people, by branding whole classes of people who aren't involved in what the hospital did is negligent and discourages valuable support from these groups.

If we accuse Dems of purpetuating this act, we basically drive them away from the issue... if we do the same with republicans - we drive them away... This issue needs MAXIMUM support from everyone who is receptive to caring. Those who want to play games with the story, only end up hurting the cause in the end.

Focus on the hospital. It's their failed policy and careless apathy that lead to the dumping of this man... and the more folks who speak out on it, the better!

Danny Vice
The Weekly Vice
http://weeklyviceblogspot.com

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I don't agree with criminalizing efforts like this. The government really needs to just let charities do their job. They need to get out of the way.

[Used Bucket Trucks]

Well at least they brought him to a local shelter...however, they should have checked with the shelter to see if they had enough room first and then take him back to the hospital if the shelter did not...as it appears was the case. Since when did humanity become so selfish?

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What help will be provided to families who have already lost their homes? Our goverment only talks about assistance for those who are about to lose their homes.

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