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L.A. files patient `dumping' charges
The Los Angeles city attorney's office filed false-imprisonment and dependent-care-endangerment charges against hospital giant Kaiser Permanente on Wednesday, the first criminal prosecution of a medical center accused of "dumping" patients on skid row.
The charges stem from an incident earlier this year when a 63-year-old patient from Kaiser Permanente's Bellflower hospital was videotaped as she left a taxi in gown and socks, and then wandered skid row streets.
In addition to the criminal charges, the city attorney filed a civil lawsuit against Kaiser, using a state law on unfair business practices that city prosecutors usually implement against unscrupulous slumlords to force them to clean up their buildings. The suit seeks a judge's order to forbid all Kaiser medical facilities from dumping homeless patients on skid row or impose financial sanctions if it violates the order.
Kaiser is one of 10 area hospitals under investigation by city prosecutors for allegedly discharging patients to the 50-block area of downtown that is known for missions and homeless encampments. City Atty. Rocky Delgadillo said Wednesday that the Kaiser case was a first step in holding hospitals accountable for dumping.
"We seek to end the inhumane and illegal practice," Delgadillo said. "We believe this is the right action to take and it speaks to this region's values. We are in the right place at the right time to hold Kaiser accountable."
A Kaiser spokeswoman on Wednesday said she was "very surprised" by the charges.
"I can't understand how these charges would be levied based on what I know of the incident," said Diana Bonta, vice president of public affairs for Kaiser Southern California.
She said Kaiser had changed some of its practices since the March incident to better serve discharged homeless patients.
"As soon as we heard about it, we said this is not how we do business," she said. "And we apologized. Since then, we have been talking not only with the city attorney's office, but we've worked with the agencies that service the homeless."
The indictment marks a turning point in the city's yearlong effort to halt the practice by hospitals, as well as some outside law enforcement agencies, of dumping patients and criminals on downtown's troubled skid row.
The push comes as city leaders are trying to crack down on crime and blight in the district, which has the largest concentration of homeless people in the western United States.
The LAPD recently began more aggressive police patrols, and Mayor Antonio Villaraigosa has vowed to find more housing to get transients off the street. In Sacramento, lawmakers earlier this year passed legislation designed to reduce dumping homeless people by requiring all municipalities to devise plans to help their homeless populations.
Legal experts said the Kaiser lawsuit was novel but did have some legal precedent.
"This may be a bit of creative lawyering, but when they first used these kind of tactics against slumlords, it raised eyebrows but worked," said Laurie Levenson, a law professor at Loyola Law School.
"Corporations can be charged with crimes," she said. "In many ways it is better to go after the corporate entity as a prosecutor when it is a matter of policy and practice."
Unfamiliar with skid row
Prosecutors said they decided to file the Kaiser case first in part because they had strong evidence and a compelling victim. Reyes, who was homeless and lived mostly in a public park in Gardena, had never lived on skid row and was unfamiliar with the area, they said.
City officials have been in contact with Reyes since the March incident, when a "dumping cam" at the Union Rescue Mission, installed last year after Los Angeles police began accusing hospitals and police agencies elsewhere of dumping people on skid row, captured Reyes' arrival in the downtown zone. She wandered for about three minutes on busy San Pedro Street and then on the sidewalk before workers at the mission brought her inside.
Reyes, who was interviewed after the incident, said she could not remember what happened after she left the hospital or how she got to skid row.
According to the 20-page court filing, Reyes was brought by ambulance to the Bellflower hospital on March 17. At the time, she was suffering from dementia, living in the park and "regularly collecting and recycling cans and bottles as a way to generate income for herself," court documents said.
Reyes spent three days at the hospital for treatment of facial wounds. The day she was discharged, March 20, hospital staff members wrote on her chart that she was "non-talkative," "forgetful" and "disoriented," according to court documents.
"Despite these findings," prosecutors said, "the Kaiser Bellflower staff made no other efforts to assess or treat her medical condition."
Instead, the documents say, hospital staff "summoned a taxicab and directed the taxi driver to transport Ms. Reyes to skid row, approximately 16 miles away
. [She] was literally rushed out of the hospital and into the taxi even though the hospital staff could not locate her clothes
. [T]hey escorted her to the taxi without any pants, even though Ms. Reyes expressed concern about her clothes."
Court documents allege that Reyes was not told that she was being taken to skid row.
After Reyes arrived at skid row, Union Rescue Mission staff members worked out a special arrangement so that she could remain in the facility during the day rather than check out the next morning and re-apply for a bed later in the day. But three days after her discharge from Bellflower, according to the documents, Reyes "lost consciousness in the bathroom of URM, falling and suffering head trauma."
Jeff Isaacs, head of the city attorney's criminal division, said Reyes was subsequently hospitalized at Los Angeles County-USC Medical Center, where she was diagnosed with pneumonia, anemia and dementia, a progressive brain dysfunction, and remained in the hospital for at least 45 days. A guardian has been appointed to protect her interests, Isaacs said.
Reyes also is being represented by the American Civil Liberties Union of Southern California and Public Counsel. Representatives from both organizations said Wednesday that they planned to file a second lawsuit on Reyes' behalf soon.
"This is the first case in the nation where there is a joint effort by government and civil rights groups to halt the practice of hospital dumping," said Mark Rosenbaum, the ACLU's legal director.
Rosenbaum said that meetings with Kaiser and hospitals failed to yield reform — and that was part of the reason for the court filings. "It is like they lit a match to the Hippocratic oath," he said.
Dan Grunfeld, president and chief executive officer of Public Counsel, the largest pro-bono legal firm in the nation, echoed that sentiment. "This is as stark a case as you are likely to find," he said. "You have a relatively older woman in adult diapers and gown dumped on a skid row sidewalk. That is a pretty profound statement. Ms Reyes is not alone. There are a lot of Ms. Reyes' out there. We hope to achieve a systemic change."
Several hospitals accused
The LAPD has accused several hospitals of dumping patients on skid row over the last year and a half, including Kaiser's West Los Angeles hospital, Martin Luther King Jr./Drew Medical Center and Los Angeles Metropolitan Medical Center. Officials at those hospitals have denied dumping patients, though some have said they had taken homeless patients to skid row service providers.
City prosecutors said they spent months examining more than 40 allegations that hospitals had dropped patients on skid row after discharge, often against the patient's wishes. The investigation yielded 15 potential cases, they said.
The cases included a man with a foot wound who was dropped on skid row by a taxi after being discharged from a Covina area hospital and a man left outside the Union Rescue Mission last year with a head gash.
If convicted, Kaiser Permanente would be placed on probation that would limit its behavior and contain potential penalties. Any criminal finding could influence a medical facility's bonding and its ratings by medical organizations.
Kaiser's Bonta said the hospital group was committed to treating homeless patients with respect and care. After the Reyes case, Kaiser stopped using taxis to transport patients to skid row. It now uses a van service. Hospital officials are instructed to notify skid row providers in advance if they are sending a discharged patient there. Moreover, the van driver is supposed to escort the patient inside the facility and ensure that a handoff occurs, she said.
"These issues with the homeless are difficult and complex," Bonta said. "It takes all of us working together to find the best way to ensure that care is rendered through this process."