California Hospitals Strive To Comply With New Homeless Patient Laws, But Say Lack Of Resources Makes It Tough

CALAAEM News Service at
Thu Jan 24 12:21:28 PST 2019


Jan. 24, 2019


California Hospitals Strive To Comply With New Homeless Patient Laws, But
Say Lack Of Resources Makes It Tough 


Capital Public Radio


Monday, January 21, 2019


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.


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.


"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."


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.


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.


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.


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.


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


There are other requirements, such as asking about vaccinations, infectious
disease screenings, health insurance enrollment information and a follow-up
care referrals.


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


"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."


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


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.


"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."


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.




Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service


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