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Fines alone won't fix 'patient dumping' of homeless

L.A.'s city attorney is right to demand that hospitals do more to see that homeless patients aren't 'dumped'

Los Angeles City Atty. Mike Feuer announced on Wednesday that his office had reached an agreement with Glendale Adventist Medical Center over allegations that the respected hospital had improperly discharged a homeless patient to the streets of skid row. Although the hospital staunchly denied any wrongdoing, it agreed to pay $700,000 in civil fines — $100,000 of that as a donation to a homeless services provider — and adopt new protocols for discharging homeless patients. This is the third hospital in less than a year that Feuer has settled with over charges of so-called patient dumping on skid row. His office has assessed a total of more than $1.5 million in fines.

Feuer is to be commended for his efforts to thwart a vile practice — discharging men and women back to dangerous conditions once their immediate health crisis has passed. He declared that "patient dumping disgusts me," and few would disagree.

But if it's challenging for outreach agencies to find the right services and housing for the homeless, it's just as daunting, if not more so, for hospitals required to do it as a condition for discharging homeless patients.

Hospital social workers struggle to find permanent supportive housing available for patients upon discharge. Failing that, they may find a temporary shelter bed, but homeless patients often won't go to shelters. Some refuse to sign discharge papers, refuse to take prescribed medications or change their minds en route to shelters, all of which hamstring hospitals in their efforts to discharge properly, according to a spokesperson for the Hospital Assn. of Southern California. Even advocates for the homeless say it's unrealistic to expect hospitals to find housing for all of their homeless patients. Hospitals can't solve homelessness.

The city attorney's office says it recognizes the challenges, but it rightly refuses to countenance inaction. It wants hospitals to plan for a homeless person's more complicated discharge at the beginning of his or her stay, not at the end, preparing the patient for an easier return. And hospitals should work on discharging the homeless to local community providers. Recuperative centers also offer refuge for newly released patients, and recent partnerships between government agencies, nonprofits and local hospitals are strengthening that network.

That promising work is a reminder that the homeless often are buffeted by myriad problems, and that addressing those problems in isolation is both ineffective and cruel. Hospitals can treat these men and women for illness, but decency demands more. Only a comprehensive approach — one that includes housing and counseling, among other services — can begin to restore the homeless to stable lives.

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