HOMELESS PATIENT DUMPING

Rocky Delgadillo discusses his office's efforts to combat homeless patient dumping with journalist Anderson Cooper prior to an interview for CBS' "60 Minutes."

For years, many California healthcare providers have engaged in a practice known as "homeless patient dumping." This practice involves hospitals or other medical facilities discharging and transporting indigent patients to foreign neighborhoods without the patients' consent.

Homeless patient dumping is especially prevalent in the area of Los Angeles known as "Skid Row." As a result, in late 2005, the Los Angeles City Attorney's office launched an investigation into the practice. Since its inception, the investigation has been carried out in unique collaboration with the American Civil Liberties Union, the Public Counsel Law Center, Bet Tzedek, the Los Angeles Police Department and many homeless service providers.

In November 2006, the office filed both civil and criminal actions against Kaiser Permanente and Kaiser Foundation Hospitals for allegedly dumping Carol Reyes, a disoriented elderly woman, wearing little more than a hospital gown and socks onto the streets of Skid Row. The incident came light only because she was videotaped wandering in a daze in the middle of the street after a taxi hired by Kaiser allegedly drove her 16 miles from its Bellflower Hospital.

The evidence indicated that she was discharged while suffering from hypertension, pneumonia, and dementia, rushed into a taxi without her pants, to skid row without any arrangements being made for shelter, much less continued treatment.

Rocky Delgadillo announces that his office has secured a settlement with, and the establishment of best practices patient discharge protocols for, Kaiser Permanente of Southern California. Pictured (l to r): LAPD Commander (then-Captain) Andrew Smith, Chief of the City Attorney's Criminal and Special Litigation Branch Jeffrey B. Isaacs, the City Attorney, Kaiser Southern California President Dr. Benjamin Chu, and Deputy Mayor Dan Grunfeld (with the Public Counsel law firm at the time)

A few months later, in May of 2007, the City Attorney announced a landmark settlement agreement with Kaiser to establish first-of-their kind, court-ordered protocols for the discharge of homeless patients. The court order requires all Los Angeles County Kaiser hospitals to implement detailed protocols for the discharge of homeless patients; enjoin these hospitals from discharging homeless patients other than in accord with the protocols; require the hospitals to train personnel responsible for homeless patient discharge in the requirements of the protocols; and appoint Lourdes Baird, a former U.S. Attorney and retired US District Judge, as referee to monitor Kaiser's compliance with the order.

Kaiser was forced to pay $50,000 in investigative costs to the City Attorney's Office and, in connection with the settlement, Kaiser has agreed to contribute $500,000 to a charitable foundation. This money will be distributed by an independent committee to support: a) the development of an electronic database to provide Los Angeles County hospitals with current information regarding shelter bed availability; b) the creation of a free legal clinic in the Skid Row area to assist eligible homeless persons in obtaining healthcare benefits; and c) increase the number of recuperative beds available in the City.

DOWNLOAD THE SETTLEMENT AND DISCHARGE PROTOCOLS HERE.

A few short weeks after the Kaiser settlement, the office filed civil charges against Hollywood Presbyterian Medical Center (and its van company Empire Enterprises) and Methodist Hospital of Southern California, for their role in the dumping of homeless hospital patients on Skid Row.

The civil lawsuits each allege two claims under the California Business and Professions Code for unlawful and unfair business practices with respect to each hospital's treatment of homeless patients and both hospitals' failure to follow state law mandating appropriate discharge planning for all patients.

The case against Hollywood Presbyterian stems from two incidents, involving the improper discharge of Gabino Olvera, 47, a mentally impaired paraplegic homeless man, and Sergio Verdugo, 43, a detoxifying alcoholic homeless man, to the streets of Skid Row at the direction of Hollywood Presbyterian staff without consent or proper arrangements for their care.

On February 7, Mr. Olvera was transported by the Los Angeles Fire Department to the emergency department of Hollywood Presbyterian following an automobile accident. At 12:30 a.m. on the morning of February 8, Mr. Olvera was sent by ambulance to the Midnight Mission (Mission) in Skid Row without a wheel chair or other means of getting around. The Mission insisted that he be returned to the hospital because it lacked proper facilities to deal with him. Mr. Olvera was returned to the emergency room of the hospital where he remained for nine hours without being provided additional medical treatment or offered food or water by hospital staff.

Hollywood Presbyterian Medical Center eventually placed Mr. Olvera in a van owned by the hospital and driven by an employee of Empire Enterprises, instructing the driver to return Mr. Olvera to the Mission on Skid Row, again with no wheelchair or other means of getting about, despite having been told just hours earlier that the facility could not care for him in that condition. Mr. Olvera did not even make it to the Mission on this trip but was instead dumped in the gutter outside a small park blocks from the Mission and left to crawl away with his possessions in a bag clenched in his teeth. After bystanders called the LAPD and City Attorney's Office for assistance, Mr. Olvera was admitted to Los Angeles County/USC Medical Center for further treatment, having been determined to be gravely mentally disabled.

Mr. Olvera was not the first victim of alleged misconduct by the hospital. On October 17, 2006, Sergio Verdugo had been admitted to Hollywood Presbyterian suffering from abdominal pain, hypertension and symptoms of alcohol withdrawal. The following day, ambulance drivers were instructed to deliver Mr. Verdugo to the Union Rescue Mission (URM), on Skid Row, while strapped to a gurney. URM had not received notice that Mr. Verdugo was arriving and had no facilities for dealing with someone in his condition. Mr. Verdugo was returned to the emergency department of Hollywood Presbyterian and subsequently readmitted as an in-patient. According to the hospital, he left the hospital against medical advice the following day.

The case against Methodist Hospital of Southern California also relates to two incidents in which homeless individuals, Therese LaBossiere, 61, and Hector Salazar, 41, were dumped at URM on Skid Row.

In November 2006, Ms. LaBossiere spent 10 days as an inpatient at Methodist Hospital after being attacked by a mugger on the streets of Arcadia. While still in pain, incontinent and unable to walk without assistance, Ms. LaBossiere was told that she would be discharged from the hospital to a shelter in Skid Row where a 90-day stay had supposedly been arranged for her. Ms. LaBossiere was transported by taxi 22 miles to URM. The URM staff members were not aware of her situation or expecting her arrival, and informed her that the shelter does not offer guaranteed 90-day continuous stays to persons in her situation.

Notwithstanding her perilously weak condition, Ms. LaBossiere fled the area via bus - ending up in Pasadena where she remains.

Prior to the dumping of Ms LaBossiere, in December 2005 Mr. Salazar had been transported to Methodist Hospital emergency room following an assault in Arcadia. Mr. Salazar, a chronic alcoholic, had a blood alcohol level of 0.33% at the time of his arrival at the emergency room. At a point when he still had a blood alcohol level in excess of three times the legal limit for driving, and while still in distress from his injuries, Mr. Salazar was discharged from the hospital and transported to URM by taxi. Fire Department paramedics were later summoned after the URM staff determined that Mr. Salazar required further medical attention. Mr. Salazar was taken to Los Angeles County/USC Medical Center and admitted for additional treatment before being released.

Under existing law, hospitals in the State are required to have written discharge planning policies and processes requiring that appropriate arrangements are made for post-hospital care for those patients who are in need. Existing law also makes it a misdemeanor for a hospital to transfer a homeless patient from one county to another in order to receive supportive services without prior notice or authorization, but does not prevent a hospital from transferring a patient within one county against his or her wishes.

Rocky Delgadillo joins with Council Members Jan Perry and Bill Rosendahl, LAPD Commander Andrew Smith, Central City East Association Executive Director Estella Lopez and members of the California Nurses Association (CNA) to unveil a new municipal ordinance which would make homeless patient dumping a specific misdemeanor crime in the City of Los Angeles. Pictured (l to r): LAPD Commander Andrew Smith, CNA ordinance supporters , Council Member Jan Perry, the City Attorney, Council Member Bill Rosendahl, CNA ordinance supporter, and Estella Lopez

To close this loophole, Council Member Jan Perry teamed up with the City Attorney in late 2007 to introduce a motion to draft an ordinance that would make it a misdemeanor for hospitals or their agents to transport patients without written consent. On Friday, May 16, 2008, by a vote of 12-0, the Los Angeles City Council, led by Council Member Jan Perry and Council President Eric Garcetti, passed an ordinance making the nonconsensual post-discharge transportation of a patient a misdemeanor. For the first time, this measure will make it a specific crime for a hospital to dump its patients in the City of Los Angeles.

DOWNLOAD THE ORDINANCE HERE

"We hope that this settlement with Kaiser will remind us all of the precious value of the life of each and every human being," said Andy Bales, President of the Union Rescue Mission. "Today brings us that much closer to ensuring that not even one person will be abandoned on our streets."