Los Angeles says VA ‘dumped’ patient at shelter

The graying veteran in a wheelchair was found in the parking lot of a Westside cold weather shelter wearing hospital pants, carrying a urine bottle and screaming for help.

Senior officials at the Los Angeles city attorney’s office say they believe James Boykin was “dumped” Dec. 1 at the shelter after his toe was removed at the nearby Department of Veterans Affairs medical center because of a bone infection. Moreover, according to city prosecutors, VA officials blocked an investigation that could have shed light on whether there were other similar incidents.

“This was an unprecedented interference with an investigation,” said Jeffrey B. Isaacs, who heads the office’s criminal and special litigation branch.

VA officials strongly dispute the allegations involving Boykin, adding that the city does not have authority to conduct a criminal investigation on federal property. Three internal inquiries and an investigation by the VA’s Office of Inspector General found no evidence that Boykin was sent to the shelter against his will or without the means and ability to care for himself.

“We actually scour the street, the shelters, the jails to find [veterans] that we can get into our programs,” said Dr. Dean Norman, chief of staff at the VA Greater Los Angeles Healthcare System. “So for us to be accused of dumping just doesn’t make sense at all.”

For Boykin, there is no doubt. “They … kicked me out,” he told The Times. “I’m telling them, ‘Hey, man, what’s wrong with y’all? What are you going to discharge me for? Where am I going? They just pushed me out.”

The dispute raises questions about whether the department is fully living up to its commitment to keep veterans off the streets. Vets make up close to one in five of the county’s homeless.

The hospital was challenged before about the discharge of a homeless veteran.

Union Rescue Mission officials said they sent a barefoot veteran with a bandaged face back to the same VA hospital after a taxi dropped him off at their downtown facility one night in 2007. He had been treated for injuries from a fall. Hospital officials said at the time that the man chose to go to the mission, but he told shelter staff that he didn’t want to be there.

Since 2005, the city attorney’s office has aggressively pursued hospitals that dump homeless patients on the streets or at shelters without following proper discharge procedures. The office has reached settlements with five private healthcare providers and collected millions in payments. But in this case, prosecutors said, their hands are tied.

The city attorney doesn’t have jurisdiction to prosecute a federal facility. And the prosecutors said VA attorneys denied their request to interview employees to determine whether there were grounds to charge those involved in Boykin’s discharge.

Patricia Geffner, assistant regional counsel for the VA, said the authority to investigate rests with the inspector general’s office. The office’s report said patients, like Boykin, who refuse to leave have become “a dilemma and cost burden” for many hospitals.

“We found from our interview with the patient and staff documentation that the patient refused discharge when he was medically stable and believed that he had a right to be a system patient indefinitely,” Assistant Inspector General Dr. John D. Daigh Jr. wrote in the report.

Neither side in the case disputes that the 73-year-old self-described Navy intelligence officer (records show he spent four years in the Army) can be a handful. He has been homeless for years, but “by choice more than condition,” as he puts it. He has a history of drug use and has been diagnosed with schizophrenia, diabetes and other health conditions, according to the inspector general’s report.

The report said Boykin was offered placements in transitional housing programs several weeks after his surgery. He declined because they required substance abuse treatment, medication compliance or contributions from his Social Security income. However, according to the report, he agreed to go to a shelter and signed discharge instructions telling him to collect medications from the system pharmacy and return for outpatient services.

“Patients with decision-making capacity ultimately have the right to make their own decisions, even unwise ones,” the report said.

A first attempt to send Boykin to a shelter failed because he arrived late and space wasn’t available, the report said. Instead, he was given vouchers and sent by taxi to a hotel for the night. The next day he was sent by taxi to a collection point for a winter shelter that had just opened at the National Guard Armory, the report said. But no bus came. After waiting an hour, the taxi driver drove him back to the VA, which summoned another taxi to take Boykin to the shelter.

Before sending Boykin, two VA staff members drove to the shelter to confirm it could take him, according to the report

Isaacs called the report a “whitewash.”

“The bottom line is they took a person who was in bad shape mentally and physically … a patient who they had care and custody of, and put him in a position where his personal safety was at risk,” he said.

When Boykin reached the shelter, he could not find his diabetes medicine or remember how to change his dressings, according to shelter staff. The taxi drivers told a city investigator that Boykin appeared confused about where he was going and asked whether there would be someone to take care of him, records show.

Carrie Gatlin Siqueiros, who was then overseeing the shelter for the Union Rescue Mission, said Boykin was “clearly upset” about being left in the parking lot and could not get himself inside with all his belongings. She had the police notified, then drove to the VA, where she said staff agreed to collect Boykin in the morning.

“This is a shelter that shuts down during the day, so he would have been put on a bus, dropped off on a street corner at 6 o’clock the next morning, had we not intervened,” Siqueiros said.

Siqueiros said VA employees didn’t come to the shelter before sending Boykin. She said program manager Ziad Kalioundji did log four phone calls from a VA social worker. But the social worker failed to provide the required information for a proper patient transfer, she said.

According to Kalioundji, the social worker asked if the facility was wheelchair accessible. Kalioundji said yes, but added that guests need to be self-reliant. Kalioundji said he asked whether the patient was able to get in and out of a cot on his own. “She answered no … hung up the phone and ended the conversation before I could conclude that the potential patient was not a candidate for the winter shelter program,” Kalioundji wrote in an incident report.

The VA’s Norman said Boykin was supposed to spend only one night at the shelter. But Boykin said, “They didn’t say nothing about that. They just said I’m going to the shelter.”

The hospital has tightened its discharge protocols to ensure better communication between the institutions involved, Norman said. If there is any question about a placement, he said, staff must clear it with a senior social worker and himself. And as of last Dec. 3, the hospital is no longer discharging patients to winter shelters, according to protocols reviewed by The Times.

However, VA officials acknowledged that procedures for discharging patients vary among their medical facilities. Critics worry that other veterans hospitals might be cutting corners with patients like Boykin, who is now in transitional housing at the West L.A. campus while he waits for a permanent placement.

“Yes, he’s a difficult man to work with,” Siqueiros said. “And, yes, he is not easy to place, but that doesn’t mean you dump him on somebody else and go well, ‘It’s your problem now.’ ”

alexandra.zavis@latimes.com

richard.winton@latimes.com