If You're Homeless And Without Insurance In LA, Your Next Stop After The ER Is Skid Row

MayorBob.

Posted to Etcetera on Mon Nov 20, 2006 at 01:24:38 PM EST (promoted by port1080). RSS.

Patient dumping is a technique some hospitals use to divert insurance-challenged patients away from their highly profitable emergency rooms and services. Essentially, it's a case of "no room at the inn" at the nice, shiny for profit medical center here, so you shuffle the patient off to the run-down, less shiny hospital over there. Upon discharge from whatever medical facility, patients ought to expect some sort of release to an environment where their physical safety doesn't immediately become an issue. In what has become a major scandal it seems that a nasty variation of patient dumping has emerged in Los Angeles - sending patients directly from the emergency room or hospital to the mean streets of the city's skid row. For the first time, a major hospital chain has been formally charged for this practice.

LA City Attorney Rocky Delgadillo filed civil and criminal charges (pdf doc) against Kaiser Permanente. The criminal charges involve the treatment of a 63-year-old woman, suffering from dementia, who was discharged from a Kaiser hospital and allowed to wander skid row in her hospital gown. The civil charges were brought for Kaiser's violations of the California Business and Professions Code for its treatment of homeless patients and failure to properly follow state law regarding patient discharge planning. According to Delgadillo:

"We seek to end the inhumane and illegal practice. We believe this is the right action to take and it speaks to this region's values. We are in the right place at the right time to hold Kaiser accountable."

Kaiser responded with shock at being charged. Kaiser spokesperson Diana Bonta said she "can't understand" why the charges were brought. She said "as soon as we heard about it" they began changes in their policies as well as a dialogue with the city attorney office. She also indicated that Kaiser had begun "working with" homeless agencies. But, some facts might strike at the heart of Bonta's statement that Kaiser began doing the right thing "as soon as" they heard about the skid row dumping. It turns out that several months lapsed from the incident, which is the basis of the criminal complaint, and any actions taken by Kaiser. Added to this is the fact that prosecutors have been investigating skid row dumping over many months, involving as many as ten hospitals, leading to at least 15 potential cases.

Although some people accuse Delgadillo of grandstanding, some legal experts believe his choice in filing both criminal and civil complaints, while "creative lawyering," might be successful. The exact same tactic was used to go after slumlords. Successful criminal conviction would involve Kaiser Permanente being placed on probation which would restrict some of their medical practices and could adversely affect their bond ratings as well as ratings by medical associations. Civil penalties call for a fine of at least (US)$2,500 for each infraction. But, because the cases have drawn the attention of the ACLU, it seems likely that further civil (and potentially more expensive) charges may be pressed.

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Tags: edited by Port1080, Los Angeles, patient dumping, homeless, medical insurance, lawsuit, crime, written by MayorBob (all tags)

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17	Tequila in his heartbeat his veins burned gasoline Steve Urkel. Wed Nov 22, 2006 at 12:45:37 AM EST 4.50 (funny, funny)

At least they didn't drop this poor woman off at the brutal hell hole known as the UCLA library.

17

Re: Tequila in his heartbeat his veins burned gaso

Lou.

Wed Nov 22, 2006 at 09:16:24 AM EST

none

Well Gord, we know your trying to be funny. However, given that the woman probably doesn't have a bruins card, and she is too far gone to be able to follow directions, you have a point. Maybe the hospital has a heart after all?

It's the end of the world as we know it, and I feel fine

3	The gerrymander/wetkarma axis of skepticism wetkarma. Mon Nov 20, 2006 at 05:18:15 PM EST 4.00

Allow me to build on a few points that gerrymander has raised.

Why is this reported as a "63 yr old woman" and not as a "63 year old homeless woman". I mean I ask the TnT lefties among us, doesn't the word "homeless" change the entire context of the case? And why does the LA Times bury that little factual nugget multiple paragraphs into the story.

Second, where should Kaiser have let the woman off? In theory prosecutors seem to be arguing (or alluding) that she should have been left at a public park in Gardena. Would'nt Kaiser then be liable for contributing to loitering and vagrancy?

Why isn't United Rescue Mission (the people who took her in) being sued as well? After all it was in their care that the lady
"lost consciousness in the bathroom of URM, falling and suffering head trauma."

It seems in terms of damages, URM caused more harm to the lady than Kaiser. Yet Kaiser is the one being sued.

Hm what is the key difference between Kaiser Permanent and United Resource Mission I wonder.

Memory is a strange bell, jubilee and knell.

4 3	Re: The Thalia Line of Reality Thalia. Mon Nov 20, 2006 at 05:44:15 PM EST 5.00 (brilliant)

Wait, I know. Kaiser is the one that lost her clothes, and released her onto the street, wearing a hospital gown, no shoes, no ID, and no money? WTF is that? She may have been homeless, but that doesn't mean she (1) didn't have anyplace else to go, or (2) it was acceptable to rush her out the door without any of her stuff to leave her on the streets. That's pretty fucked up. Even those of us who don't suffer from dementia and aren't homeless would have a hard time getting home from an unfamiliar area, wearing only slippers and a hospital gown, with no ID or money.

There is just no way that is acceptable behavior.

Thalia

7 3	Re: The gerrymander/wetkarma axis of skepticism Smash Hit Tom. Mon Nov 20, 2006 at 07:06:51 PM EST 4.50 (astute, astute)

Would'nt(sic) Kaiser then be liable for contributing to loitering and vagrancy?

Uh, no. Stupid. And URM is responsible for her losing consciousness because... Look, I understand, you're a conservative troll on a liberal site. But not every fucking little goddamned thing that ever happened comes in a nice neat ideological package that means from a leftist view it's ok, and from a rightist view it's the worst thing EVAR, or vice versa. This is just common human decency. Do you really have to take the devil's advocate position here?

19 3	come on, brother jbou. Wed Nov 22, 2006 at 02:37:54 PM EST 4.00

I want the least of our people taken care of. Kaiser should not have just dumped her off, it isn't right, I don't care if she is homeless or whatever, give the lady some help, and get her a room. Kaiser made how much money last year? I think they can spare a bed. This is just another nail in the coffin of the for profit health care industry, I feel a wave of popular support for a universal single payer health care system coming, and it won't be pretty for these insurance companies, they should have done better while they had the chance.

Sincerely yours,

Your commie brother.

19

Re: come on, brother

wetkarma.

Wed Nov 22, 2006 at 06:16:39 PM EST

4.00

Kaiser should not have just dumped her off, it isn't right, I don't care if she is homeless or whatever, give the lady some help, and get her a room

Kaiser made 1billion in profits last year. This compared to 1.4billion in 2004. I.E. The company saw profits drop 38%.

Still 1 billion is a pretty big pie and surely the company could have afforded a room for one homeless person. Except why this particular homeless person? Why not all of them?

Average hospital stay costs is $6k per day. Lets say they follow the practicies of the mission where the lady was later taken in, slipped, and hurt herself -- they host her for 3 days. Thats 18k for one crazy homeless lady.

So basically Kaiser could pay for 55 thousand homeless people out of its vast fat wallet, before it ran out of money. For 3 days.

But wait..there are 361,000 homeless people. In California alone.

So tell me again Jbou about how Kaiser can afford to give the old lady a place to stay?

Memory is a strange bell, jubilee and knell.

5 3	Re: The Thalia Line of Reality Thalia. Mon Nov 20, 2006 at 05:44:43 PM EST none

There is just no way that is acceptable behavior.

Thalia

22 3	Homeless nmiguy. Fri Nov 24, 2006 at 10:52:01 AM EST none

So they get a derranged homeless person and they have finished providing her care, what do they do with her? No one to claim her, no home for her? It is a good question. Patient dumping is obviously wrong, but the hospital does face a problem that needs a good solution, and there is likely a cost associated to that as well.

1	Another 'BS Meter Needle Red Zone Moment' MayorBob. Mon Nov 20, 2006 at 04:21:16 PM EST none

When I read Ms. Bonta's statement I thought, "yeah, right you didn't realize that taking a patient suffering from dementia and releasing them onto the streets of a part of town they didn't live in in their Depends and hospital gown was a problem while you were doing it." I hope Ms. Bonta doesn't really have that deed to the Brooklyn Bridge.

Illegitimi non carborundum.

2 1	Part of town? gerrymander. Mon Nov 20, 2006 at 04:54:10 PM EST none

Bonta is homeless. By one reading, Kaiser Permanente arranged for private transportation to a homeless shelter. I can see problems for the hospital arising from treatment before discharging her (losing her clothes, for example) and from having incomplete procedures for patient transfer. But is the hospital obligated to discover what neighborhood a homeless person haunts and return them there? If said neighborhood has no homeless facilities, what should a hospital do about it's patient transfer procedure? If the patient lies or dissembles ("I came from Jupiter"), what then?

14 2	A Challenge just for Gerrymander & Wetkarma Thalia. Tue Nov 21, 2006 at 02:52:26 PM EST 5.00

Why do you assume that someone who is homeless has nowhere to go? That tends not to be true for most homeless. They do not have permanent residences, but most homeless people have relatives, friends, or just shelters where they reside normally. Just because you do not have a permanent abode doesn't mean that you can be dropped anywhere in the city (and LA is huge!) because after all "you're just homeless" so one spot is as good as another. I find your callousness quite disturbing.

Try this challenge sometime. Have someone drop you off, from a locked van so you can't see where they took you, in an unfamiliar to you part of the city. Preferably a rather bad part (skid row isn't exactly the business district). I'll be nice, you can wear real shoes instead of hospital socks, because the streets are filthy. You can even wear clothes that completely cover your ass, instead of a hospital gown. No one wants to invite violence here. Now, find your way home, with no clue where you are, no possessions, no money, no working payphones (ever try to find a working payphone in the wrong part of town? It doesn't exist). You won't find a cabbie either. I guess you'll just have to walk. Did I mention that Los Angeles is huge? Hope your drop off was somewhere relatively near where you want to get.

Thalia

14

Re: A Challenge just for Gerrymander and Wetkarma

gerrymander.

Tue Nov 21, 2006 at 05:43:46 PM EST

none

Thalia, it's not that I expect a homeless person has nowhere to go. Rather, I question the assumptions implicit in this lawsuit, that a) hospitals are legally obligated to act as transportation providers to homeless patients no longer requiring medical care, and b) a shelter is not the preferred method to continue care for the homeless after discharge from a hospital.

In both cases, I think society has come a great way towards improving the lot of the homeless, and I believe those changes would make things worse. I don't want hospitals to become bus services any more than they must to provide care. I also don't think dropping a homeless person at a familiar street is an improvement over an unfamiliar shelter. We can pick over the particulars where Kaiser Permanente failed, but their general post-treatment plan seems to have been "send this person to a shelter, which is equipped to help them over a longer term," which I approve of.

As for the challenge, I'm not sure what that would prove. If I found myself with my wits but in an unfamiliar area, my first act would be to find a way to communicate with someone who could help: flag down a police car, borrow a phone to call a family member/friend, and so on. But then, I have any number of resources a homeless person might not, not the least of which includes my wits.

15

Re: A Challenge just for Gerrymander and Wetkarma

Thalia.

Tue Nov 21, 2006 at 06:03:31 PM EST

none

Good luck borrowing a phone, or for that matter finding a cop, on skid row. You should visit it sometime. Then you might feel differently about people being left there in nothing but a freaking hospital gown & socks.

Kaiser does not have to be a taxi service. But if they choose to transport people the least they can do is (1) make sure they transport them to the correct location, (2) with all their stuff, and (3) appropriately dressed. Seriously the concept of randomly dropping someone off at a shelter they had never been at, in a hospital gown just blows my mind.

Thalia

21 2	Re: Part of town? 3fingerspointback. Wed Nov 22, 2006 at 06:35:45 PM EST 4.00 (informative)

By one reading, Kaiser Permanente arranged for private transportation to a homeless shelter.

They put her in a taxi and told the driver to take her to skid row. At the very best, that's private transportation towards a homeless shelter. And whatever weird policies these hospitals have in place, they certainly aren't executed very well, given that one patient who was dropped off on skid row turned out not to be homeless at all--his family was never even notified of his discharge. So Thalia's hypothetical below could very well be made a reality the next time you're sick in LA.

I'm not moved to let Kaiser off the hook for half-assedly implementing a humane gesture that leaves people worse off than simply leaving them directly outside the hospital doors. At least in that case, better coordination with humanitarian orgs can be made.

(is 3fingerspointback)

6 2	Gerry. MayorBob. Mon Nov 20, 2006 at 06:57:30 PM EST none

Bonta is homeless? Who'd have thunk that? She's the Kaiser Permanente vice president who had all these convenient excuses about what the company did or didn't do just "as soon as" they found out what was actually happening. You would think a person raking that sort of serious coin could afford a home. Oh, but you did get her mixed up with Ms. Reyes, the 63-year-old victim, didn't you? That's all right, I'm sure if you hustle on down to the nearest emergency room they'll probably have some medication for that sort of thing.

Illegitimi non carborundum.

10 6	Re: Gerry. gerrymander. Tue Nov 21, 2006 at 10:46:30 AM EST none

My apologies; I did get the names mixed up. After a search and replace to correct, however, I still think the questions are valid.

10

Re: Gerry.

MayorBob.

Tue Nov 21, 2006 at 12:04:35 PM EST

5.00 (astute)

You're correct, the questions are valid. But, these patients are transported from somewhere by someone in authority (eg, paramedics or police). One would think that a hospital would take at least the smallest steps to find out where the patient came from in an attempt to return them there, rather than just driving them down to skid row and dropping them off like a piece of human garbage.

Illegitimi non carborundum.

11

Re: Gerry.

gerrymander.

Tue Nov 21, 2006 at 12:23:07 PM EST

4.00

One would think that a hospital would take at least the smallest steps to find out where the patient came from in an attempt to return them there

Sure, they could, but would that help? Reyes (got it right this time) was ultimately diagnosed with dementia, which by definition impairs cognitive ability. Knowing where the cops picked her up doesn't necessarily ascertain if she would be best served if dropped back there -- she might have wandered to there in the same way she wandered outside Union Rescue Mission.

Expanding beyond this particular case, isn't it better for a hospital to arrange for discharged homeless patients to be further assisted at a homeless shelter, instead of being dropped off at various locales around the city (which almost certainly would still include some shabby areas)?

8	Re: If You're Homeless And Without Insurance In LA ms sue. Mon Nov 20, 2006 at 07:12:29 PM EST none

Kaiser's Bonta said the hospital group was committed to treating homeless patients with respect and care

I'm curious as to how Kaiser has any homeless patients as clients. Does anyone know?

9 8	Re: If You're Homeless And Without Insurance In LA Thalia. Mon Nov 20, 2006 at 10:02:09 PM EST 5.00 (informative)

The cops drop them off, or they're delivered by ambulance mostly. Kaiser, like most other large hospitals, has an emergency room that is required to treat all patients, whether or not they can afford treatment. And cops often take vagrants to the hospital if they show signs of a medical condition.

Thalia

12	Re: If You're Homeless And Without Insurance In LA Lou. Tue Nov 21, 2006 at 12:08:53 PM EST none

rather than just driving them down to skid row and dropping them off like a piece of human garbage.

Too true, MB. At least those scumwads who abandon their unwanted pets usually leave them in a place where the bewildered animal will get fed. You'd think the authorities would be at least as smart.

It's the end of the world as we know it, and I feel fine

This story: 24 comments (5 from subqueue)

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MayorBob.

Posted to Etcetera on Mon Nov 20, 2006 at 01:24:38 PM EST (promoted by port1080). RSS.

Tequila in his heartbeat his veins burned gasoline

Steve Urkel.

Wed Nov 22, 2006 at 12:45:37 AM EST

4.50 (funny, funny)

17

Re: Tequila in his heartbeat his veins burned gaso

Lou.

Wed Nov 22, 2006 at 09:16:24 AM EST

The gerrymander/wetkarma axis of skepticism

wetkarma.

Mon Nov 20, 2006 at 05:18:15 PM EST

3

Re: The Thalia Line of Reality

Thalia.

Mon Nov 20, 2006 at 05:44:15 PM EST

5.00 (brilliant)

3

Re: The gerrymander/wetkarma axis of skepticism

Smash Hit Tom.

Mon Nov 20, 2006 at 07:06:51 PM EST

4.50 (astute, astute)

3

come on, brother

jbou.

Wed Nov 22, 2006 at 02:37:54 PM EST

19

Re: come on, brother

wetkarma.

Wed Nov 22, 2006 at 06:16:39 PM EST

3

Re: The Thalia Line of Reality

Thalia.

Mon Nov 20, 2006 at 05:44:43 PM EST

3

Homeless

nmiguy.

Fri Nov 24, 2006 at 10:52:01 AM EST

Another 'BS Meter Needle Red Zone Moment'

MayorBob.

Mon Nov 20, 2006 at 04:21:16 PM EST

1

Part of town?

gerrymander.

Mon Nov 20, 2006 at 04:54:10 PM EST

2

A Challenge just for Gerrymander & Wetkarma

Thalia.

Tue Nov 21, 2006 at 02:52:26 PM EST

14

Re: A Challenge just for Gerrymander and Wetkarma

gerrymander.

Tue Nov 21, 2006 at 05:43:46 PM EST

15

Re: A Challenge just for Gerrymander and Wetkarma

Thalia.

Tue Nov 21, 2006 at 06:03:31 PM EST

2

Re: Part of town?

3fingerspointback.

Wed Nov 22, 2006 at 06:35:45 PM EST

4.00 (informative)

2

Gerry.

MayorBob.

Mon Nov 20, 2006 at 06:57:30 PM EST

6

Re: Gerry.

gerrymander.

Tue Nov 21, 2006 at 10:46:30 AM EST

10

Re: Gerry.

MayorBob.

Tue Nov 21, 2006 at 12:04:35 PM EST

5.00 (astute)

11

Re: Gerry.

gerrymander.

Tue Nov 21, 2006 at 12:23:07 PM EST