Opinion

Homeless patients discharged to the streets? Hospitals can do better. Here’s how

Lara Woods, shown here in her car in Sacramento on Tuesday, February 13, 2018, said she was “dumped” to the streets after undergoing double mastectomy surgery at UC Davis Cancer Center. Lara Woods was homeless when she underwent a double mastectomy at UC Davis Cancer Center. The hospital put her in a cab just days after her surgery, she said, and sent her to Salvation Army, which had no bed for her. She was forced to live in her car. Homeless services agencies regularly see fragile people discharged by health care agencies to the streets.
Lara Woods, shown here in her car in Sacramento on Tuesday, February 13, 2018, said she was “dumped” to the streets after undergoing double mastectomy surgery at UC Davis Cancer Center. Lara Woods was homeless when she underwent a double mastectomy at UC Davis Cancer Center. The hospital put her in a cab just days after her surgery, she said, and sent her to Salvation Army, which had no bed for her. She was forced to live in her car. Homeless services agencies regularly see fragile people discharged by health care agencies to the streets. rbenton@sacbee.com

My wife and I are experienced physicians now practicing in the Sacramento area. Swearing The Hippocratic Oath reaffirmed our commitment to serving our patients, preventing disease whenever possible, and actively addressing a patient’s life circumstances as they often impact health.

It is my deep belief that this oath applies to all patients, including the most vulnerable I see often at our local clinic – people experiencing homelessness.

My colleagues and I see firsthand the vast challenges these patients face. Not only does lacking stable housing contribute negatively to health, but it presents a major roadblock to recovery after leaving the hospital.

The current practice is for patients to be moved from facilities as soon as they are deemed “medically clear,” but being cleared to leave the hospital is not the same as being healed.

Often, discharged patients are dropped off at homeless facilities by ambulance or Uber or Lyft, many still in hospital gowns. It’s not unheard of for patients to have open wounds or injuries that still need care, or a course of antibiotics to take.

Being discharged to the streets without a plan not only hinders recovery, but often makes the health issues worse, resulting in readmission to the hospital, or worse.

One patient in my primary care panel was hospitalized with a skin infection of his leg. After receiving intravenous medication for two days, he was discharged on oral antibiotics and instructed to keep his leg elevated and clean. These instructions were almost impossible for someone without stable housing and consistent bathing facilities.

He soon returned to my clinic. His infection had spread, and he was quickly readmitted to the hospital for prolonged inpatient treatment, a costly and unnecessary outcome that might have been prevented with better discharge planning.

Medical professionals dedicate their life to improving the health of patients. While hospitals and health care workers alone will not solve homelessness, we can play a part to ensure that patients are discharged with dignity and connected to the services they need.

The California Pan-Ethnic Health Network is sponsoring Senate Bill 1152, introduced by Sen. Ed Hernandez, D-Azusa. This bill will establish a uniform discharge planning process that takes into account the unique needs of homeless patients. This bill will equip hospital staff with a way to take actionable steps to help achieve the best possible health outcomes for our homeless patients – ensuring they are referred to shelters, properly clothed, and equipped for ongoing care.

As part of a medical staff routinely faced with the heartbreaking task of releasing patients to an uncertain future, I urge you to join me in asking state lawmakers to pass SB 1152. A straightforward protocol for transitional care will result in a more efficient use of state and county health resources. It is also a compassionate solution both for patients and those of us who have sworn an oath to do no harm.

Sharad Jain, M.D. is a general internist at the Sacramento County Clinic. Reach him at sharadsf@gmail.com.

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