Patient dumping tale is all too familiar

While I understand that the plight of the homeless is a sad social issue that we face here in the L.A. area, what is the answer really? If a homeless individual calls 911 from a payphone located on the street, is taken to a local E.R. and is triaged, medically screened and given the necessary treatment (per EMTALA guidelines) and then discharged, what is the hospital to do? Should they let the individual take up residence in the hospital? If the hospital calls a cab company on behalf of the patient and the patient instructs the driver to drop them off at "skid row," why then is the hospital blamed for patient dumping? I think before the hospitals come up with solutions for this social problem, perhaps our local government should address the homeless issue in L.A. County.

I am the author of Inevitable Incompetence, Soaring Medical Costs, Dangerous Medical Care. I practiced neurosurgery at El Camino Hospital in Mt View, CA for 25+ years. We had social service personnel who worked to place discharged patients properly. They worked diligently to provide proper post-discharge venues for my patients regarless of their social and economic status. Kaiser has manifest its continuing incopetence in another recognizable area. Dumping patiets on skid row is a manifestation of Kaiser's focus on cheap, inappropriate and dangerous health care.

I am an ER nurse, and there are many times when we accept the responsibility for paying for a cab to take a discharged homeless person to a shelter, then discover the patient told the driver to let them out at another location. Sometimes the patient is discharged in hospital clothing and socks, as the homeless shelter we have sent them to assured us there would be clothing available to the patient upon arrival. Usually, they arrive in clothing that is almost always soiled and unserviceable. We do not stockpile clothing for dressing these folks - there is not enough room. All available room is being used to let the intoxicated sleep off their drunk because some citizen decided they didn't want that dirty person lying on the street in front of their store/home, called the police, the person complains of pain, the ambulance is called, and now they are our responsibility. Usually, they are 'regulars' with chronic complaints (which are worked up every time they come in, at our expense), and we can't send them out until they are sober enough to walk safely. The cab driver has no responsibility to escort the fare into the shelter - so if the patient decides to wander off, it's now our problem that we 'dumped' the patient. Seems the ERs can't win here. We're damned if we don't take the patient (EMTALA), and we're damned if we take the trouble to get a shelter to accept the patient and the patient decides to wander off or have the cab driver let them out on skid row. Or, the patient gives us an address on skid row, so the cab takes them there and lets them out. (They must give us an address to go to, or we cannot pay for the cab). And, because we have so many beds being taken by intoxicated homeless people sleeping off their drunks, we have no beds left for people with medical problems, exacerbating the already overcrowded ER problem. So, what are we to do now? I spend many hours on overtime while we board patients in the ER overnight who cannot go to a regular hospital bed because there are none available on the floor, either because there aren't enough nurses to staff the floor, or because the beds are all full. We cannot admit every patient who presents intoxicated or practicing 'better living through chemistry' in order to get them off the street. Our social workers work like mad to find housing for these folks when we discharge them, and then the next day, they're back in the ER, drunk again, screaming for food.

So, all you people out there condemning the ER for not caring, what are we supposed to do? We have little to no funding for these people, it costs us money in terms of keeping staff available 24/7 and having the equipment and supplies ready to treat whatever comes in, doing all the lab work to ensure there's not another problem going on under the intoxication/overdose, etc. Tell us how to take better care of these people without having to dig deeper into our empty pockets. Tell us how to keep the patient in the shelter after we get them there, so we don't get slammed for dumping yet another patient on the street. Help us find solutions, rather than condemning us for believing the patient when they promise to go to the shelter we have made arrangements for. Give us better options for these folks.