Instead of creating a post-treatment plan, hospitals discard the chronically ill and homeless back to the street, according to a recent lawsuit.
In September 2014, a 38-year-old woman with a history of mental illness was found distraught in the heart of Skid Row, the roughly 50-block portion of downtown Los Angeles that encompasses a large swath of the city's homeless population. The woman, homeless and battling drug addiction, was wearing a hospital gown. Her only possession was a note with an 800 number and the definition of schizophrenia.
A van from Tri-City Regional Medical Center, now Gardens Regional Hospital in southern Los Angeles County, had driven more than 20 miles through gridlocked traffic to drop her off there, according to a lawsuit filed against the hospital last April. The case is expected to go to trial later this year.
This is the latest case in what city attorney Mike Feuer (who filed the suit on behalf of the city of Los Angeles) has called "patient dumping" by area hospitals. Instead of arranging for a post-treatment plan, hospitals discard the chronically ill and homeless back to the street, where they are swallowed up by the black hole that is Skid Row. Advocates for the homeless say this has been going on for some 20 years, but Feuer has only recently started aggressively suing hospitals. In the past three years, four Los Angeles hospitals have settled on the allegations of patient dumping, the settlements totaling over $2 million.
Feuer is currently seeking an injunction against Gardens Regional, which would compel the hospital to provide proper discharge and aftercare plans for patients rather than abandoning them, like the 38-year-old woman found on Skid Row. The hospital could also face additional civil penalties up to $2,500 for each violation.
"In my opinion, they should hold onto a patient until there is a warm hand-off." — Andy Bales
In 2007, a paraplegic man was found crawling around Skid Row, clenching a bag of belongings with his teeth. A hospital had apparently dumped him onto the streets without a wheelchair. The scene unfolded in front of multiple witnesses, who in turn contacted both the media and police. Hollywood Presbyterian Medical Center paid $1 million to settle that case.
Reverend Andy Bales, the CEO of Union Rescue Mission, a shelter located in Skid Row, said the problem of patient dumping got so bad that the shelter set up a video camera to capture footage of it.
In this pending case, the woman eventually found Union Rescue Mission. She was allegedly dumped by the hospital after being discharged without a follow-up plan on eight separate occasions.
Throughout 2013 and 2014, the woman—who was allegedly suicidal and at risk for tuberculosis—was given minimal treatment at the hospital for her diabetes, and nothing to deal with her mental health issues, the suit alleges.
On one of the days she was out on the street, the woman checked into the hospital and reported hearing voices in her head, having been off her medication for two weeks. But, according to the lawsuit, no mental health help was provided and there was no follow-up scheduled with her primary care physician.
The city also says the Union Rescue Mission reported the incident to a case worker at Gardens Regional, who admitted that she had not followed protocol.
For years, Gardens Regional has dealt with homeless and mentally ill patients. The hospital is located in Hawaiian Gardens, an incorporated city just south of Los Angeles, where nearly 30 percent of the population lives in poverty, according to US Census Bureau statistics. Gardens Regional is only authorized to discharge patients to places like nursing homes or permanent affordable housing, according to policy.
Failure to do so, as in the recent alleged cases of patient dumping on Skid Row, is considered a crime under Los Angeles city law, which states: "A health facility may not transport or cause a patient to be transported to a location other than the patient's residence without written consent, except when the patient is transferred to another health facility following bona fide procedures in accordance with another provision of law."
Bales, of Union Rescue Mission, said the recent lawsuit leaves out important questions about intermediary resources for homeless people who are discharged from hospitals.
"While I admire Mike Feuer's aggressiveness, the truth is that the new approach to address homelessness is to move all the resources toward permanent supportive housing," he told VICE. "There's always gonna have to be an in-between shelter or rescue mission or agency that is gonna take someone in from the hospital."
More than 2,400 shelter beds have disappeared in Los Angeles, a city that holds one of the world's largest transient homeless populations, with over 80,000 people without a place to sleep on any given night.
The lack of funding for homelessness and shelter also puts hospitals in a squeeze.
"They get exasperated and impatient, but in my opinion, they should hold onto a patient until there is a warm hand-off," said Bales, who said he often receives word of homeless walking around downtown in hospital gowns.
The patient dumping case is expected to go to trial by the end of the year. The law firms representing the hospital—Perkins Coie and Selvin & Weiner, which had served as counsel until this month, and Lewis Brisbois Bisgaard & Smith, which is now defending the hospital—did not respond to multiple requests for comment.
Bales said he doesn't know how the woman detailed in the lawsuit is doing today.
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