It looked mighty suspicious when a patient with a “grave mental disability” from Pacifica Hospital of the Valley wound up on Skid Row in downtown Los Angeles, so the Sun Valley medical center agreed to pony up $500,000 and revise its discharge policies to mitigate it happening again.
But the hospital stopped short of admitting any wrongdoing, just as the 224-bed Beverly Hospital in Montebello did in January when it agreed to pay $250,000 in civil penalties and legal fees to make the issue go away.
Patient dumping of the homeless has gone on for a long time, but didn’t show up on the city’s radar until 2005 when surveillance cameras at the Union Rescue Mission on Skid Row showed mentally ill patients in hospital gowns being dropped off by all manner of conveyances, including an ambulance and police cars. One patient was maneuvering about with a visible colostomy bag.
They were coming from far and wide and the practice was defended at first by the medical institutions. The Los Angeles Times reported at the time that officials from Hollywood Presbyterian Medical Center, Kaiser Permanente West Los Angeles and Martin Luther King Jr./Drew Medical Center said it was necessary to drop their patients on Skid Row because it was the only place in Southern California with a concentration of patient social services like homeless shelters and drug and alcohol programs.
A debate ensued about whether the patients were fit for discharge and whether Skid Row was a good place to land. The Union Rescue Mission counted 11 discharged patients at their doorstep during a five-week period in 2005.
Kaiser Foundation Hospitals was the first to settle with Los Angeles in 2007, paying $500,000 to a charitable foundation and agreeing to work on rules for discharging homeless patients. A city press release quoted Kaiser regional president Dr. Benjamin Chu as noting, “This agreement is an example of what can happen when people of good will sit down together.”
The city has been sitting down with people of “good will” on a regular basis since then to try to curtail the practice. After the latest incident, City Attorney Mike Feuer announced that his office is negotiating (pdf) with the 170-member Hospital Association of Southern California over a model discharge policy that could be broadly applied.
L.A.’s homeless population was estimated to be more than 57,000 in November 2013. A lot of them are veterans. The Los Angeles Homeless Services Authority estimated in 2010 that 17,000 homeless patients were treated annually and 6,000 were admitted to Los Angeles County hospitals. The pre-Obamacare daily cost of treatment was said to be $1,241 a day.
Dumping homeless patients is a widespread practice, crosses state lines and is not always discouraged by the courts. Rawson-Neal Psychiatric Hospital in Las Vegas was accused of busing 500 patients to California between 2008 and 2013. U.S. District Judge tossed a federal class-action lawsuit in February brought on behalf of one patient, 48-year-old James Flavy Coy Brown, who was bused to Sacramento, where he knew no one and had no place to stay.
The judge said that was OK because, “There was no direct command from an individual bearing state coercive authority, nor threat of punishment if (Brown) did not travel to Sacramento.” They simply discharged Brown, bought him a bus ticket and facilitated his access to a Greyhound station. The rest was up to him.