Homeless Patient Policy May Shift

Stung by allegations that hospitals regularly dump patients on skid row, the Hospital Assn. of Southern California is urging its members to revamp their policies for dealing with homeless patients.

The trade group, which represents about 95% of the county’s hospitals, said medical centers should require written consent before transporting any homeless patients from the hospitals to ensure that they are going of their own free will.

The recommendation comes as the Los Angeles city attorney’s office is investigating allegations that numerous hospitals across the county have regularly dumped patients on skid row, which is believed to have the largest concentration of homeless people in the Western United States.

Earlier this week, authorities released a videotape of what they said was the dumping of a 63-year-old patient -- dressed in a hospital gown and slippers -- from Kaiser Permanente’s Bellflower facility on the streets of skid row. That elicited an apology from hospital officials but renewed calls by several members of the Los Angeles City Council for area hospitals to review their discharge practices.

Area hospitals have been under fire since late last year, when the Los Angeles Police Department named a handful of hospitals that officials believe had dropped off patients on skid row. Those hospitals -- including Kaiser Permanente West Los Angeles -- said they had no other choice when discharging homeless patients with nowhere else to go and who need the services of the missions and other providers concentrated there.

Four members of the council -- Eric Garcetti, Wendy Greuel, Jan Perry and Bill Rosendahl -- wrote a letter earlier this week to the chief executives of the 78 acute care hospitals in the county, asking them to stop the practice of releasing patients to the streets of skid row.

“You should no longer make the assumption or claim that there is a support network that has the capacity to deal with whoever arrives at the doors of the agencies that serve the indigent in downtown Los Angeles,” the letter said. “It is imperative that the practice of ‘dumping’ people here in the interest of expeditiously moving them from your facilities stop immediately.”

Jim Lott, executive vice president of the Hospital Assn., said he had also met with hospital executives about the issue.

In a letter responding to the council members, Lott wrote that by obtaining written permission from patients before transport, “only homeless patients discharged by our hospitals who want to go to skid row will be provided transportation to that location. Further, we believe that every attempt should be made to connect discharged homeless patients with the social services they need when they leave a hospital.”

In an interview Friday, Lott said that recommendation had been made in part to stave off possible action by the city attorney.

“The written consent is the biggest issue for us,” Lott said. “There’s some vulnerability there.”

Getting written permission to transport a homeless person anywhere after discharge from a hospital, he added, “makes good common sense.”

But hospital officials, including Lott, also say they are limited in how much they can do for homeless patients, for a variety of reasons, such as the availability of local services, fiscal constraints and society’s unwillingness to solve the underlying causes of homelessness.

“Ninety percent of this is not our problem,” Lott said. “Having elected officials land on this hard is putting a lot of energy away from what needs to be addressed. The politicians are dodging the real issue -- that they can’t get the political will together to provide for the needs of homeless across the county.”

In an interview Friday, a spokesman for Kaiser Permanente said the organization is in the process of reviewing its own discharge policies for homeless patients, as well as the circumstances that led to the videotaped arrival of the 63-year-old patient on skid row. The patient, Carol Ann Reyes, was dropped off by a taxi near an entrance to the Union Rescue Mission. The video shows her wandering for about three minutes in busy San Pedro Street and then on the sidewalk before a mission staff member escorts her inside the nearby building.

“The whole process will be scrutinized at the highest level of our hospital,” said Jim Anderson, the Kaiser spokesman. He said he believed that hospital staff members intended to send Reyes to the Union Rescue Mission but said it was “very poorly done.”

Releasing the woman in a hospital gown and slippers was against proper procedure, said Anderson. He called that decision “flat-out a human error, and it should not have happened. The people involved have had it brought to their attention.”