Patient Dumping Probe Widens in Los Angeles

The Los Angeles city attorney's office is investigating whether a Hollywood hospital violated multiple laws when it attempted to leave a paraplegic man on a gurney at the Midnight Mission -- hours before he was left in a skid row gutter, officials said Monday.

A video, filmed by security cameras at the Midnight Mission early Thursday, shows two workers from Hollywood Presbyterian arriving by ambulance and trying to wheel the man, who is strapped down to the gurney, into the mission courtyard. They are confronted by security guards, who, according to mission officials, asked about the man's follow-up care.

After about a minute and a half, the video shows the workers wheeling the man back to the ambulance; a mission official said late last week that the ambulance attendants decided to return the man to the hospital.

The video widens the probe into what happened to the man, who witnesses said was later left in a gutter by the driver of a van hired by the hospital. As of late Monday, he was a patient at County-USC Medical Center.

Jeffrey B. Isaacs, head of the Los Angeles city attorney's criminal and special litigation branch, said he believes that the attempt to drop the man off by ambulance at the mission represents a violation of federal law because the patient did not meet basic discharge requirements.

"You cannot transfer a patient to an institution like the Midnight Mission," Isaacs said. "This seems to be a transfer, not a discharge. Based on initial information, he was in no shape to give any authorization."

It would be up to the federal government to decide whether the conduct violated the federal Emergency Medical Transfer and Active Labor Act. That law requires hospitals to screen and stabilize all patients, and penalizes them for releasing or transferring patients who are medically unstable.

But the city attorney's office could sue under a state law dealing with unfair business practices, which has been used in the past to prosecute alleged slumlords. The law allows a corporation to be sued for unscrupulous behavior. It also allows the government to ask a judge to issue an order forbidding a corporation to take certain actions. If the corporation violates the court order, it can be fined.

The city attorney's office filed charges late last year against Kaiser Permanente in connection with a homeless dumping case, using that same law.

The case last week drew international attention after the hospital-hired van left the 41-year-old man near skid row's Gladys Park. The van driver allegedly ignored the cries of onlookers to help the man and instead proceeded to apply makeup and perfume before driving off, leaving him crawling through a gutter in a soiled hospital gown and with a broken colostomy bag.

Dan Springer, a spokesman for Hollywood Presbyterian, said the hospital finds the incident "extremely troubling and regrettable. The fact is, we would never condone leaving an individual at a location without his consent," he said.

Springer would not comment on the Midnight Mission video. But he said that the hospital, which is conducting an internal investigation into the matter, is taking a number of immediate steps "so it's clear to everyone that we are addressing the situation and take it seriously."

The hospital will conduct further training for its staff and discharge personnel regarding the special needs of homeless people and how to refer them to service providers. It will augment the social-worker and case-management staff to supplement off-hours placement of homeless patients, although exact staff numbers were not available Monday. And it is "reassessing communications and coordination with social service providers," Springer said.

For many people who work in downtown's skid row, the incident last week provoked important questions about how hospitals should treat homeless patients upon their discharge. There are few places for chronically ill homeless patients to go after they leave hospitals -- and little funding for their care.

"It's one thing to need shelter beds," said Rebecca Isaacs, executive director of the Los Angeles Homeless Services Authority. "It's another to have medical needs."

Government insurance pays hospitals to care for homeless people when they are sick, but there is no such safety net when they have recovered enough to leave the hospital but still are not able to care for themselves.

"The fundamental irony here is that health insurance, whether Medicaid or Medi-Cal, will pay for you to be in the hospital -- $1,000, $2,000 a day -- just to get you better," said University of Pennsylvania professor Dennis Culhane, who has studied homeless dumping. "But then you will be discharged to the street, and they won't pay for housing, even though those patients get readmitted more quickly and stay in the hospital longer."

In the last year, downtown service providers have worked with healthcare facilities to create a universal referral form to be used by hospitals trying to discharge homeless patients to appropriate care. Many have said they now take more homeless patients from hospitals, especially when the patients need relatively modest follow-up care.

But for those who have more serious follow-up needs, there aren't a lot of choices.

The JWCH Institute downtown can accommodate a few dozen people released recently from hospitals, giving them private rooms, meals and support case services. Twenty of those beds are funded by the Los Angeles Homeless Services Authority.

Isaacs said planning before patients are discharged from hospitals is "crucial." But she acknowledged that more needs to be done.

"All of these people who fall through the cracks just kind of expose what we don't have in place," she said.

For some healthcare providers, the additional scrutiny they have been under since the Los Angeles city attorney's office notified hospitals more than a year ago that they were potential targets of a dumping investigation is just another strain on an already burdened healthcare system.

Brian Johnston, an emergency room doctor and a member of the California Medical Assn.'s board of trustees, said he thinks public officials have used the "dumping debate" to draw attention away from their own responsibility in the matter.

"They have made it a hospital or medical issue," Johnston said. "I don't think it's the primary mission of our hospitals to provide shelter for the homeless. When homeless people are ill, we admit them and we take care of them.... But I don't think we should be responsible for finding them shelter."

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