‘The ball was dropped, and there was no accountability’
Days after her double mastectomy surgery late last month, Lara Woods still had drainage tubes dangling from her chest when a ride-share car delivered her from UC Davis Medical Center to the Salvation Army building near downtown Sacramento.
Woods, fighting a second bout of potentially deadly breast cancer, had been told by a UC Davis social worker that a respite bed was awaiting her at the homeless shelter upon her discharge that day, she said. But when she arrived, staffers told her that no prior accommodations had been made for her, and the agency’s beds were all occupied.
She ended up walking to a friend’s house nearby, she said. The friend helped her retrieve her car, and that’s where Woods slept that night. Weeks later, she continues to live out of her Kia.
To homeless advocates, Woods was a victim of what’s known as “patient dumping,” or the discharge of poor people from hospitals and other health care providers to shelters or the streets without advance planning.
The Salvation Army did not return calls Tuesday asking for comment on the matter. UC Davis declined to address the specifics of the Woods case, citing patient privacy, but spokesman Charles Casey said the hospital system makes every effort to secure housing for homeless patients upon discharge.
“UC Davis Medical Center and its care teams are deeply committed to the health and well-being of every patient we see and treat, regardless of the patient’s background or circumstances,” he said in a statement.
Data released this week by a nonprofit advocacy group, the Sacramento Regional Coalition to End Homelessness, suggest that the practice of sending patients to shelters without advance notification is not uncommon.
The organization recently surveyed agencies that serve the poor in the Sacramento area about whether homeless people recently had been dropped off at their organizations – by ambulance, cab or ride share – immediately following discharge from a health care provider and without prior notification. The results were startling, said executive director Bob Erlenbusch.
Thirteen of 20 service providers responded to a poll asking about the practice, Erlenbusch said. Seven of the 13 agencies answered that recently released patients had been delivered to their campuses. One agency reported the practice occurring two or three times a week, and three facilities said it happens about once a week. One said it occurs about every other week, and two estimated that it happens once or twice a year.
In most cases, the agencies said, patients were wearing hospital gowns upon arrival. Many arrived in wheelchairs or on walkers. Some had open wounds.
The facilities or agencies discharging patients included major hospital groups in the Sacramento area and government organizations, according to the survey respondents.
Erlenbusch launched the survey in response to a Bee story about Arlan Lewis, 78, who was discharged in December from a Woodland Hospital to the Union Gospel Mission in Sacramento, which turned him away because he did not qualify for a bed there. The results of the new poll “paint a horrifying picture of homeless patient dumping,” he said.
“Our report underscores that this is a systemic issue for our community, and not a few isolated incidents by a few ‘bad actors,’” Erlenbusch said.
Stephen Watters of First Step Communities, a nonprofit group that among other things runs the winter sanctuary shelter, in which people are transported to rotating churches to have meals and sleep, said the practice “seems to be happening more and more” in Sacramento.
“I am not in any way callous,” Watters said, “but I’m to the point that I’m not shocked anymore because these things happen so often.”
Watters said the staff has learned to be on high alert when a vehicle pulls up to drop someone off. “We try to go in and see who is coming to us, who is sending them and what is going on,” he said. “Are we the right place for them to be?”
In many cases the answer is no, he said. Recently, a ride share service deposited a discharged hospital patient “who could barely stand, much less walk,” and therefore was not a candidate for the sanctuary program, Watters said.
“Almost once a day, I hear from a hospital asking if we can take someone,” Watters said. “That’s OK. We just need a heads up to understand whether the person can succeed in our environment.”
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, placing them either with family, at a care home or at another appropriate agency, the code says. But in a recent interview with The Bee, an official with the California Hospital Association said the task is sometimes difficult for health professionals dealing with people who have no place to live. The problem can be compounded if a patient has mental health issues.
Erlenbusch said he understands the pressures on medical discharge planners who may have few housing options for men and women who are homeless and recovering from injuries and illnesses. But, he said, “it remains immoral and unconscionable to release homeless people to recuperate, sometimes from major surgery, on the streets.”
He said he will be asking the city and county to respond with strict enforcement of laws designed to prevent illegal “patient dumping,” including hefty fines and possible jail sentences for those responsible.
Mayor Darrell Steinberg, who has made Sacramento’s growing homelessness crisis a centerpiece of his administration, said what happened to Woods “should not be the standard in our community. It’s just not acceptable.”
He said government leaders should review existing laws and hold hospitals accountable for improperly discharging poor people. “These stories should be used as a catalyst for change,” he said.
“The ultimate answer to this very complex problem is, of course, more housing for people who need it, and a system that is seamless” in helping people who are without stable housing and recovering from serious medical problems, Steinberg said.
Woods, who said she has been homeless off and on for the past decade because of various issues including health challenges, generally praised UC Davis and its doctors and nurses for the cancer care she has received since 2015. “But I question the actions of the people who discharged me” in January, she said. “This is about accountability.”
Her medical records, which she provided to The Bee, show that Woods was discharged from UC Davis on Jan. 22, four days after undergoing mastectomies on each of her breasts. Her discharge papers urge her to “keep wound clean, dry and intact,” and to use small pumps attached to tubes in her chest to drain fluids from the surgical area. Her papers also included a list of agencies that provide meals and shelters to homeless people.
Woods said she left UC Davis in a ride-share car called by the hospital. The car took her to the Salvation Army, but she was turned away, she said.
With no place to go, in pain from her surgery and with her drainage tubes still in place, Woods walked over to Quinn Cottages, a nearby homeless services agency, and sought help from a friend who lives at the facility.
“When I saw her and heard her story, I was sick to my stomach,” said Sarah Allen, a Quinn Cottages staffer. “I thought, ‘This is a complete failure. How could she be in this position, given the intensity of her surgery?’”
Two days after her arrival at Quinn Cottages, while spending “scary” nights in her car outside the building, Woods was taken by ambulance back to UC Davis with cardiac symptoms, she said. Her medical condition stabilized. When she told hospital workers about her situation, they pitched in and secured a hotel room for her for a week, she said.
She spent a couple of days with a daughter who lives in Corning, but wants to live in Sacramento where she soon will undergo chemotherapy, she said. During the day, she has been meeting with housing advocates. She has taken showers at her friend’s apartment at Quinn Cottages, and sleeps in her Kia.
Woods said she is on track to get housing in the near future, and has hopes of once again working as a neighborhood advocate or as an ambassador for cancer prevention. Next month, she is scheduled to return to UC Davis for 18 weeks of infusions of cancer-fighting drugs.
“I have had a very hard life,” Woods said. “Right now, I’m just trying to survive and trying to make the next half of my life as good as it can possibly be. But the fact is, I’m living in my car. At the moment there are no other options for me.”