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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal align=center style='text-align:center'><span style='font-size:9.5pt'><img width=540 height=163 style='width:5.625in;height:1.6979in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_1" src="cid:image001.jpg@01D4B3DF.53505700" alt="cid:image003.jpg@01D413DA.65584930"></span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782content"><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal style='margin-top:7.5pt'><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#7F7F7F'>Jan. 24, 2019</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:red'>California Hospitals Strive To Comply With New Homeless Patient Laws, But Say Lack Of Resources Makes It Tough</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#0070C0'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal><a href="http://www.capradio.org/articles/2019/01/21/california-hospitals-strive-to-comply-new-homeless-patient-laws-but-say-lack-of-resources-makes-it-tough/"><span style='font-size:9.5pt;font-family:"Arial",sans-serif;color:#1155CC'>Capital Public Radio</span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:60.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Monday, January 21, 2019<o:p></o:p></span></p><p class=MsoNormal style='margin-right:60.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:75.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Earlier this month, Dr. Aimee Moulin at the UC Davis emergency department treated a homeless man who was experiencing some foot pain. It was raining, and the waiting room was crowded with car crash patients and flu cases.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:75.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:90.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>She did the usual exam and prescribed Ibuprofen. But with California’s SB 1152 in effect as of Jan. 1 she had to take extra steps, including teaming up with another staffer to check in with local shelters about available beds. It took a couple of hours.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:90.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:90.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>“It was just sort of hard finding all the resources to make the calls to all the shelters, then we couldn’t find a bed, and then figuring out transportation,” she said. “It just took a couple hours to finish up with all that, which would have been an otherwise very simple visit. We just don’t quite have the systems in place.”<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Physicians across the state are grappling with the new law, which requires hospitals to offer homeless patients a meal, clothing and other services before sending them to a residence or a social services provider that has agreed to take them. It was designed to address “patient dumping,” a phrase homeless advocates use to describe hospitals discharging patients to the streets without adequate planning.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>But hospitals say there’s been confusion about how to interpret and implement the law. Peggy Wheeler, Vice President of Rural Health and Governance for the California Hospital Association, which originally opposed the policy, said she’s been receiving “any number of questions” from members trying to comply.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>California requires hospitals to make arrangements for all departing patients, but most go home with a family member. Wheeler said emergency department staff already screen for homeless patients, and now it’s just a matter of documenting that resources were offered.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Under the new law, hospital staff must offer a ride to a desired location less than 30 miles or 30 minutes away. If the patient wants to return to a tent, a car or another location they call a residence, the hospital can send them there with a bus ticket or a ride-share service. If they have nowhere to go, the hospital must confirm a bed for them.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>This comes after media reports about patients who said they were sent to shelters that couldn't take them. In a survey from the Sacramento Regional Coalition to End Homelessness, service organizations reported patients arriving in hospital gowns, without wheelchairs or other supplies needed for recovery.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>There are other requirements, such as asking about vaccinations, infectious disease screenings, health insurance enrollment information and a follow-up care referrals.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>At UC Davis, Moulin said these extra tasks can increase waiting times, or result in hospitals holding patients longer than usual to avoid an unlawful discharge.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>“You would like to find a bed,” she said. “I’d love for people not to be homeless. We all want to provide the services, and it’s just hard when they’re not there.”<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Noel Kammermann, executive director of Sacramento homeless services agency Loaves and Fishes, said patients with ongoing medical needs present a challenge for shelters, which aren’t often equipped to treat these conditions.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Since the law took effect, he’s gotten a few calls from hospitals asking how to best coordinate a patient drop-off. But he said in an ideal world, homeless people recovering from illness or injury wouldn’t end up at the day program at all.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>“The best way to go about this is that you get people into housing and then you wrap services around them so they start going to a primary care physician instead of the emergency room,” Kammermann said. “This senate bill, it’s a step in the right direction for sure, because now hospitals are trying to do a much warmer handoff to wherever it is the patients are going … but it’s going to require a lot of coordination.”<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.7pt'><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>A separate part of the law, which kicks in July 1, requires hospitals to develop a written plan for homeless patients with the county behavioral health department and homeless service organizations, and to keep a homeless patient log. Some counties have addressed the problem by expanding “whole person care” programs, which give homeless people a warm, safe place to recover after a hospital visit.</span><span style='font-size:9.5pt'><o:p></o:p></span></p></div><p class=MsoNormal><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-size:9.5pt;font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-size:9.5pt;font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.5pt'> <o:p></o:p></span></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>Contact us at: </span><a href="mailto:calaaem.news.service1@gmail.com" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>calaaem.news.service1@gmail.com</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'><br><br>For more articles, visit our </span><a href="https://www.aaem.org/get-involved/chapter-divisions/calaaem/news-service" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>archives</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>. <br><br></span><a href="mailto:somcaaem@uci.edu" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a><a href="https://maillists.uci.edu/mailman/listinfo/calaaem" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#0070C0;text-decoration:none'> </span><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>unsubscribe</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2018. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span><span style='font-size:9.0pt'> </span><a href="http://www.calaaem.org/" target="_blank"><span style='font-size:9.0pt;font-family:"Verdana",sans-serif;color:#1155CC'>http://www.calaaem.org</span></a><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.</span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.5pt'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:9.0pt;font-family:"Verdana",sans-serif'>Follow CAL/AAEM on Facebook and Twitter and check out WestJEM:</span></b><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><a href="http://www.facebook.com/CALAAEM" target="_blank"><span style='font-size:9.5pt;color:black;text-decoration:none'><img border=0 width=40 height=40 style='width:.4166in;height:.4166in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_2" src="cid:image002.jpg@01D4B3DF.53505700" alt="cid:image002.jpg@01D0A9FD.796449A0"></span></a><span style='font-size:9.5pt'> </span><a href="https://twitter.com/CALAAEM" target="_blank"><span style='font-size:9.5pt;text-decoration:none'><img border=0 width=43 height=43 style='width:.4479in;height:.4479in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_3" src="cid:image003.jpg@01D4B3DF.53505700" alt="cid:image003.jpg@01D0A9FD.796449A0"></span></a><span style='font-size:9.5pt'> </span><a href="https://westjem.com/" target="_blank"><span style='font-size:9.5pt;text-decoration:none'><img border=0 width=160 height=43 style='width:1.6666in;height:.4479in' id="m_-7835614069456891615gmail-m_-8812551497387718317gmail-m_-680625089083050367m_-4761171347054414624m_3707413379897925782Picture_x0020_4" src="cid:image004.jpg@01D4B3DF.53505700" alt="cid:image004.jpg@01D0A9FD.796449A0"></span></a><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:9.5pt;color:black'> </span><span style='font-size:9.5pt'><o:p></o:p></span></p><p class=MsoNormal style='text-decoration-style:initial;text-decoration-color:initial'><span style='font-size:9.5pt'> <o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>