Arlan Lewis, nearly 78 years old and hobbled by arthritis in his right hip, remembers feeling disoriented when a taxi dropped him in front of Sacramento’s Union Gospel Mission one afternoon last month.
He had just been discharged from Woodland Memorial Hospital, about 20 miles away, where he had spent more than a week undergoing psychiatric evaluations after sheriff’s deputies picked him up in Carmichael as a potential danger to himself or others.
Lewis, a former cook who recently had become homeless after his Social Security check no longer covered his rent, had not asked to be taken to the mission. Standing in an unfamiliar place where dozens of grizzled men were sprawled along the sidewalk waiting for one of the agency’s 60 shelter beds, he approached swing shift supervisor Bobby Chatman.
“I have a reservation,” Chatman recalled Lewis saying. Chatman said Lewis showed him his hospital paperwork, which directed he be sent to the mission. But the shelter had no bed for Lewis. It does not take reservations.
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“It doesn’t work that way here,” Chatman told Lewis. “We’re first come, first served.” He said no one from Woodland Memorial Hospital had called the shelter in advance. He also noted that Lewis had not undergone a tuberculosis test, a requirement for admission to the shelter, nor would his achy legs be able to navigate the building’s staircase to its dorm room.
With no identification, no phone and no family he could call, Lewis wandered the mission’s campus until late that night, when he sat in its “warming center” for a few hours, he said. In the morning, with the help of a sympathetic stranger, he made his way to Loaves & Fishes homeless services complex on North C Street, where staffers went to work to find him a board and care home.
He is safe now, having found a place to live in the Valley Hi neighborhood, he said. But he is baffled about the circumstances surrounding his discharge from the Woodland hospital, operated by Dignity Health.
“I was outside with this big, huge crowd of homeless people,” Lewis, tall and thin with expressive blue eyes and a missing-tooth smile, recalled on a recent afternoon. “It was a scary thing for someone my age. I didn’t know what to do. Why would they send me there when they didn’t even have a bed for me?”
Robin Oliver, vice president of communications for Dignity Health, declined to address Lewis’ case specifically. She issued a statement saying that Dignity is “committed to providing the basic needs of any patient identified as homeless.”
Lewis’ situation is hardly uncommon, said administrators of shelters and other nonprofit groups that serve homeless clients. They refer to the behavior as the “dumping” of patients who are poor or homeless, and said it is occurring with increasing frequency as the Sacramento region’s homelessness crisis deepens.
Local hospitals face a common dilemma as they cope with a growing number of homeless patients. Where do they send people who have no permanent address when they are ready to be released from care? Shelters can be an acceptable option, but only if prior arrangements are made for lodging and care, health specialists said. In many cases, shelter plans are never made or fall by the wayside, administrators and others said.
“Unfortunately, it happens all the time,” said George Kohrummel, assistant director of Friendship Park, the primary gathering place at Loaves & Fishes, which serves meals and provides a variety of other services to some 700 homeless men and women each weekday. At least once a week, a medical transport van, taxi, Lyft or Uber will drop off a newly discharged hospital patient to the complex, he said.
Sometimes, the patients are still in their hospital gowns and slippers, he said. Some are dropped off after Loaves has closed for the day, and arrive without needed wheelchairs, canes and prescriptions. Many are too frail to navigate the streets.
Loaves has no overnight beds, Kohrummel said. “If I see something like this happening, I’ll have the ambulance or the taxi take them right back to the hospital.” He is unsure what happens to them after that, he said.
Joan Burke, advocacy director for Loaves, said the system for serving an estimated 2,000 homeless people in Sacramento County “is over-saturated. But hospitals have a moral and legal duty to discharge people to a suitable place.”
Brian Jensen, regional vice president of the Hospital Council of Northern and Central California, agreed. But if some people fall through the cracks, “it’s not for a lack of good intentions or effort,” he said.
California’s Health and Safety Code requires hospitals to have a discharge policy for all patients, including those who are homeless. Hospitals must make prior arrangements for patients, either with family, at a care home, or at another appropriate agency, the code says. But the task is easier said than done for health professionals dealing with people who have no place to live and may have mental illnesses and other complicated problems, said Jan Emerson-Shea, vice president of external affairs for the California Hospital Association.
“Hospitals try to do a ‘warm hand-off’ if possible,” Emerson-Shea said. “But if the person is homeless, who do the hospitals call? There are only so many shelter beds. It’s a huge problem in California.”
Sometimes, homeless patients insist on being taken to specific shelters or agencies, or simply released to the streets, she said. In some communities, such as Los Angeles, patients are sometimes dropped off on skid row “because that is, in fact, where the services exist in that area for homeless people.”
But the failure of some hospitals in L.A. to make prior arrangements for homeless patients has spurred a rash of lawsuits alleging “dumping” of poor people. In 2016, a Hawaiian Gardens hospital agreed to pay $450,000 to settle a lawsuit filed by the city for sending a homeless woman to skid row with no identification and wearing only paper pajamas. The settlement was part of a crackdown by the city attorney’s office on such practices.
The Sacramento City Attorney’s Office did not respond when contacted with questions about patient dumping and whether the city was investigating the issue.
Lewis said he became homeless about two months ago, after the rent on his apartment in Carmichael rose dramatically and he no longer was able to survive on his $1,500 monthly Social Security check. Before he was picked up by sheriff’s deputies in early December, he said, he slept behind a big-box store in the neighborhood. Sheriff’s deputies took him into custody on a psychiatric hold after they received a call about him knocking on doors and looking into windows. Lewis said he was seeking help after he had been mugged and robbed of his belongings.
Lewis said he had never been homeless before. He has been to prison for drug infractions, records show, but has had no significant brushes with the law in 20 years.
The Sacramento County Sheriff’s Department confirmed they detained him on Dec. 5 and took him to nearby Mercy San Juan medical center, where he said he was held for about a day before being taken by ambulance to another Dignity Health facility, Woodland Memorial Hospital, for further psychiatric evaluations. He was there about a week, he said, before he was told by hospital personnel that “my ride” was waiting for him outside. He was happy to leave the facility, he said, but never was told where he was going. When he entered the cab, the driver informed him he was being delivered to the Union Gospel Mission.
That evening he met a local homeless activist, Tom Armstrong, who notified Loaves & Fishes and others about Lewis’s plight. Loaves & Fishes staffers contacted various nonprofit groups and housing agencies, and the organizations managed to find a board and care home for Lewis within a day.
Oliver, of Dignity Health, said the hospital group helps patients who need transportation and lodging after they are released from inpatient care. Those plans are specific to each person, and “may include providing transportation and determining bed availability at shelters,” she said.
She noted that Dignity Health works with community partners to provide services to homeless people, including mental health outreach and interim care for those recently released from the hospital.
Officials at Sutter Health, which is considered a local leader in innovative programs for homeless people, said hospitals have an obligation to make sure all patients are released to a safe setting.
Sutter’s staffers prepare detailed “transition of care” plans for homeless patients who remain frail but are well enough for release from the hospital. The plan might include respite care at one of about three dozen beds at Volunteers of America and Salvation Army for recently released homeless patients, said Keri Thomas, vice president of external affairs for Sutter Health Valley Area. Depending upon their needs, patients can receive “wraparound” services including substance abuse treatment and help with finding housing and resolving insurance issues, Thomas said.
“The goal is to give them that warm hand-off instead of putting them in taxis,” she said. “It’s something our hospitals take very seriously.”
The respite beds are available to patients released from hospitals throughout the city, Thomas said. But they often are occupied, or patients refuse to accept them. If homeless patients want to be discharged elsewhere, “it is imperative” that hospitals contact the receiving agency to make arrangements, Thomas said.
Kaiser Permanente, another large hospital group in the area, said it employs similar practices. “While we can provide a patient with options regarding shelter when discharged, if the patient is deemed mentally stable and capable of making his or her own decisions, we must comply with the patient’s preferences,” said Sandy Sharon, senior vice president and area manager for Kaiser Permanente Sacramento.
Sometimes, patients decline help and “opt to leave on their own,” said UC Davis Medical Center spokeswoman Karen Finney. In such cases, a case manager or social worker will attempt to contact the wayward person “as long as there is a way to communicate” with him or her.
Wellspace Health, which oversees a network of clinics that provide health care for poor people, works with all of the area’s hospitals to ensure that homeless patients are discharged safely. CEO Jonathan Porteus said the collaborative system works well. “This is (bewildering) to me,” he said of the “dumping” allegations. “We have a robust mechanism for people who are homeless being discharged from hospitals, so I can’t imagine how this would happen.”
“There are lots of reasons that hospitals want to make sure that patients transition to a safe place,” Porteus said. Those include “a sense of what is the right thing to do, legal reasons, public relations reasons. I’m truly surprised that this would occur.”
Chatman at Union Gospel Mission, where Lewis wound up after his release from Woodland Memorial, said the shelter had no information about him before his arrival in the late afternoon of Dec. 11. “It put me in a tough place,” he said. “It kind of broke my heart that we couldn’t take him.”
Similar scenarios play out at the shelter “probably two or three times a month,” said Pastor Tim Lane, director of the mission. “We’ve had people come in by taxi in night clothes, telling us the hospital sent them here. Sometimes they’re in the middle of convalescing, and are in no position to be out on the streets.”
Michele Steeb, CEO at St. John’s Program for Real Change, recalled an incident in July in which a taxi delivered a homeless, mentally ill woman to the agency without advance planning. The woman arrived in pink pajamas carrying a Cabbage Patch doll and a diaper bag filled with baby bottles and other items for infants, Steeb recalled.
St. John’s, which runs a shelter and job preparation program for homeless women and children, is consistently full, and not equipped to treat severe mental illness, Steeb said.
When the woman arrived, “I approached the cab driver, and I asked, ‘Who ordered her here?’ ” Steeb said. “He showed me paperwork from the Stanislaus County Department of Behavioral Health.”
Steeb fired off a note to Sacramento County health authorities, with the subject line reading “Dept of Behavioral Health of Stan Cty dumped one of their clients on our doorstep today ... ” Sacramento County administrators said they would investigate.
Richard DeGette, director of the Stanislaus County agency where the woman’s paperwork showed she received care, told The Bee he was unable to talk about specific cases because of privacy concerns. But he emphasized that patients can choose their destinations once they are released from county care. “If an individual who is not on conservatorship requests to go somewhere else, they’re able to move freely to that location,” DeGette said. “If the individual decides to accept a taxi voucher from our agency, we will provide that.”
However, he said, “our goal is to maintain services within the county.”
Tara Cryderman, a therapist who works at St. John’s, said she evaluated the Stanislaus County patient shortly after her arrival.
The woman, who The Bee is not identifying by name, “was not able to have a conversation that was cohesive,” Cryderman said. “She was seeing things that weren’t there.” The woman told Cryderman that she had schizophrenia, and wanted to go to a psychiatric hospital, the therapist said. St. John’s helped her get admitted.
“It was a horrifying situation,” Steeb said. “This is not how we should be treating human beings.”
Kohrummel of Loaves & Fishes said he fears for the lives of some people who end up at the agency following hospital stays. “What are we going to do with someone who is not stable and they’re dropped off?” he said. “People like that can die from exposure out here.”
Sometimes, in desperation, Kohrummel said, he has taken people who are too ill or weak to be outside to a fire station on the Loaves campus. “I’ll tell the paramedics, ‘She’s having a hard time breathing,’ ” he said, knowing that the words are code for the need for emergency care. “She has to go back to the hospital.”
Forcing city paramedics and ambulances to transport homeless patients back and forth “is a poor use of taxpayer money,” Kohrummel acknowledged. “It’s a vicious cycle. But in some cases I feel I have no choice.”
Last month, said Kohrummel, a medical transport van pulled onto the Loaves campus with an elderly homeless woman who had just left a Sacramento hospital. She was missing a leg, he said, but “she had no wheelchair, no walker, no prosthetic. Yet she said the hospital instructed them to bring her here, and they were putting her out on the sidewalk.”
“I told the driver to turn around and return her to the hospital,” Kohrummel said. He said he could not recall which hospital had cared for her. “There are so many of these situations,” he said. “I lose track.”
Lewis said his brief time on the streets has made him even more grateful for a warm place to sleep. But he still has flashbacks about the nights when he was without shelter, ever wary of strange places and sounds.
“When you’re out there in the dark, you close your eyes but you never sleep,” he said. “It’s the scariest thing ever.”