Treating and Streeting Vulnerable Patients – Inhumane and Ineffective
By: John Landefeld, MD MS
Healing is hard work for patients and clinicians, and leaving the hospital can be just the beginning of a long and complicated recovery process. As a physician, I care for many marginally-housed or homeless patients who struggle with managing antibiotics, wound care, physical therapy, or necessary follow-up appointments after they leave the hospital. Yet most hospitals discharge patients as soon as they are ‘medically clear’: when the wound is stitched, burn is treated, or heart stabilized after cardiac arrest. Homeless patients who still need care are often discharged to the streets or to waiting lines at shelters. A recent survey by the SF Homeless Coalition found that more than half of shelters reported hospitals routinely dropped off discharged patients who were still wearing hospital gowns, had open wounds, or injuries that were not fully treated. Some patients even had IV’s in their arms! Many of these people were confused, still in crisis, or in need of counseling.
The painful experience of my recent patient, Mr. “F”, illustrates this disturbing and increasingly common situation. Mr. “F”, a San Francisco native, is homeless. Due in part to the harsh reality of his life on the street, he developed a severe skin infection that required hospitalization, where I first met and cared for him. After several days, he no longer required IV antibiotics and had stabilized, but still needed several more days of oral antibiotics. To the health care system the hospital had done its job, and he was to be discharged in an all-too-familiar manner for many of our marginally-housed patients; dropped off to a line waiting for a jam-packed shelter, hoping to secure an open bed for the night.
Mr. “F.” was scheduled to be released into a torrential rainstorm. He confided that he was terrified of leaving the hospital so soon after a serious illness, with only-just-healing skin wounds, to wait outside, drenched, in hope of securing a bed or spot on a floor. The “system” was unsympathetic. One senior staff member suggested that Mr. “F.” be given trash bags to wear as rain gear. Luckily, a social worker was able to find him a raincoat, but he still had to leave the hospital in a storm, without a guarantee of a place to sleep or a secure follow-up plan.
Fortunately, lawmakers are doing something to help health care facilities and their patients navigate the post-hospital transition.
Legislators will soon vote on SB-1152, a bill that requires an explicit planning process for discharge of marginally-housed patients. The bill ensures that basic human needs are met before discharge and provides a straight-forward protocol for hospital staffs who care every day for patients in these heart-breaking situations.
Join me in letting your state representative know that SB-1152 will go a long way to alleviate the preventable pain, suffering, and lack of dignity that homeless patients experience every day in hospitals and shelters around the state. Find your representative at findyourrep.legislature.ca.gov/.
– John Landefeld is a physician living and working in San Francisco.