The Ugly History of Downtown Patient ‘Dumping’

City Attorney Mike Feuer and District Attorney Jackie Lacey last week announced a coming summer summit with some local hospitals to address preventing the “dumping” of homeless patients. It’s a practice that has gone on for many years.

DTLA - In the distant future, if the human race somehow avoids being taken over by sentient robots, we’ll look back and question much about our society, including how the heck the “dumping” of homeless individuals in Downtown Los Angeles became so prolific. Then again, maybe the machines should be in charge — a long track record of failing to prevent this scourge makes you doubt humanity.

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Last week, City Attorney Mike Feuer held a press conference to announce the eighth settlement in five years of a patient dumping case, this time with a $550,000 payment from Silver Lake Medical Center. If an octopus smacked a tentacle to her head for each incident, she’d be out of fish-grabbers.

Another Case of Patient Dumping

The fact that patient dumping continues can prompt one to be skeptical about the world’s so-called progress: We’ve sent people to the moon, built cars that drive themselves and have created refrigerators that talk to smart phones, but we can’t figure out how to stop hospitals from dropping gravely ill people, sometimes in paper gowns, on the streets of Skid Row.

Almost as bad is that every significant step to halt patient dumping comes with qualifiers and is accessorized by sky-high government or lobbying hurdles. In each of the eight cases Feuer’s office has settled, there was a financial payment, but never once did an institution admit wrongdoing.

Then there was District Attorney Jackie Lacey’s response last week to a question about whether there could be statewide legislation that establishes serious criminal repercussions for hospitals that are caught patient dumping. Appearing alongside Feuer, she stated, “I do think creating a criminal penalty for this would be dead on arrival in Sacramento.”

The reasoning behind that DOA, just like everything else with patient dumping, is complicated. And the fact that it is so complicated when it should be simple is why we’re in this mess in the first place. Well, that plus the lingering remnants of the Great Recession, plus the housing crunch, plus the NIMBYism that accompanies responding to homelessness, and so on.

Big Settlement

The dumping of patients in Skid Row has probably been going on as long as there has been a Skid Row, and that’s decades and decades. In the late 1930s folk singer Woody Guthrie lived in the area and wrote the song “Skid Row Serenade.” He didn’t reference patient dumping, but he did sing the line, “The banker put me down on the Skid Row.” You know, the more things change…

For all intents and purposes, dumping burst into the mainstream in September 2005. That was when then-LAPD Central Division Capt. Andrew Smith was in Skid Row and witnessed a pair of Los Angeles Sheriff’s Department deputies pull up to a curb and take a handcuffed man out of the back of a cruiser. When Smith intervened he learned that the man had been picked up in Lakewood, 20 miles away, and there was no legitimate reason to bring him to Downtown, except to make him someone else’s problem.

A number of patient dumping cases followed, including a sickening February 2007 incident when a paraplegic man in a hospital gown, and carrying a colostomy bag, was removed from the back of a medical center van and left on a Skid Row curb in front of dozens of witnesses. Three months later then-City Atty. Rocky Delgadillo announced a settlement with Kaiser Permanente over a separate 2006 dumping incident; the hospital paid $500,000 to close a case in which a woman wearing only a hospital gown was sent by taxi to Skid Row.

Those cases gained extensive media attention, but if the goal was to deter future patient dumping, they were unsuccessful. In April 2009, Delgadillo announced that College Hospital, with facilities in Costa Mesa and Cerritos, would pay $1.6 million to settle a case in which as many as 150 psychiatric hospital patients — yes, the number is correct — were sent to Skid Row over a two-year period without arranging for sufficient care.

“In this City of Los Angeles, we will not stand idly by while society’s most vulnerable are dumped in the gutters of Skid Row,” Delgadillo said in a press release at the time. “Those who engage in this unconscionable practice will be held to account.”

The settlement required the hospital to adopt more efficient and comprehensive discharge policies for patients. But clearly, little has changed.

Man on a Mission

Feuer has aggressively pursued dumping. He says the eight settlements since he was elected in 2013 have resulted in penalties and other payments totaling more than $4 million. His office has established a hotline to report suspected dumping incidents — it’s (213) 978-8340; the numbers work out to OMG-LAPD (not really). 

The Man on the Front Lines Against Dumping

I’ve seen Feuer get openly angry announcing the settlements. His face darkens; he seethes. It’s part of his wide-ranging response to homelessness, and he’s been inventive in using the resources of his office to address the issue.

The Sound and the Feuer-y

Feuer has worked to help turn motels into housing for homeless individuals, and has hosted numerous “citation clinics” that allow indigent people to have tickets dismissed if they agree to pursue services that can help them get off the streets. Last fall he testily called for the city to hire a FEMA-style director to be put in charge of addressing homelessness, though at a recent Downtown luncheon hosted by the Los Angeles Current Affairs Forum, he indicated that progress has been made.

“There has been a sea change within the city in terms of the level of focus on the issue,” he said.

But the dumping endures, as Feuer and Lacey detailed the settlement with Silver Lake Medical Center that arose from a whistleblower’s tip. An investigation revealed that, in up to 750 instances (again, the number is correct), hospital patients signed documents giving approval to take them to the Union Rescue Mission or another facility, but hospital transportation records revealed that instead, the patients were deposited at Union Station or another bus or rail hub.

Feuer noted that Silver Lake Medical Center’s $550,000 payment does not include any penalties, an anomaly in these cases. Instead the hospital will fund efforts to help place and care for homeless patients. This is where things got interesting; Feuer described needing to “thread the needle,” to have a financial repercussion, but one that doesn’t imperil a hospital that is part of a “fragile” ecosystem treating homeless patients.

Is major change possible? It’s a good question, and Feuer and Lacey announced a coming summer summit in which they will partner with Cedars Sinai and the Martin Luther King, Jr. Community Hospital to discuss protocols all hospitals can put in place to prevent dumping. The goal is to have additional hospitals participate, but Feuer has been trying for years to proactively get medical facilities across L.A. to adopt practices that ensure proper after-care and a so-called “warm handoff” for homeless patients.

This sounds like a no-brainer, but whether for legal or other reasons, certain hospitals and trade associations resist. The situation gets extra tricky when dealing with some individuals, who maybe because they are mentally ill, or just don’t trust large institutions, give mixed messages as to what kind of post-hospital treatment they want, if any.

Then there’s the concept of criminalizing patient dumping, and though that sounds logical if you want to eradicate the practice, it is jammed with land mines. Lacey’s “dead on arrival” line refers to the furious lobbying that hospitals will do to prevent state legislation. 

There’s a history here — in 2007, a bill authored by then-State Senator (and current City Councilman) Gil Cedillo to criminalize dumping was ferociously fought by lobbyists. A Los Angeles Downtown News story at the time quoted a California Hospital Association spokesperson who said that hospitals could be in a bind, that they could lose Medicare payments if convicted of a criminal offense. So they fight.

Will anything significant ever change? One can hope, but it’s a safer bet that, sometime in the coming months, Feuer will have a ninth press conference to announce a dumping case. And months later, a 10th.

Ideally I’m wrong, and the summit brings a variety of institutions together. Maybe more beds and facilities will be found for indigent patients, and the lobbyists will be put out to pasture. 

Or maybe it’s just time to hand everything over to the machines.

regardie@downtownnews.com

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