Two days before Valentine’s Day, Santiago Tarver collapsed at a homeless women’s center in Los Angeles’s Skid Row. He lay on the ground convulsing as staff members called an ambulance, which took Tarver to a public hospital about three miles away.
“I didn’t expect to see him for a couple days,” said Spencer Coats, a medical social worker at the women’s center.
But just a couple of hours later, Tarver, a transgender 28-year-old, was back. Although he was still disoriented from the medication he’d been given, Tarver said the hospital had given him bus tokens and sent him home to his tent amid feces, discarded syringes and trash.
Homelessness is surging in many parts of the US, including by more than one-fifth in Los Angeles last year, and hospitals are struggling to shoulder the burden. In some cases, like Tarver’s, advocates complain of what they call “patient dumping” – when homeless patients are discharged not to shelters or temporary housing but to the streets, where it can be impossible to follow a treatment plan and there is a higher likelihood that they’ll fall ill again.
In 2017, a widely publicized video showed a patient being dumped from her wheelchair at a Washington DC bus stop and left on the ground. An executive at a Baltimore hospital apologized earlier this year after a patient was found on a street in midwinter in only a hospital gown and socks. And a state psychiatric hospital in Nevada was alleged to have bussed hundreds of patients around the country.
In Skid Row, social workers say they have seen mothers dropped at shelters holding newborns.
Homelessness undoubtedly poses challenges to hospitals: Americans living in poverty are among their most common patients. A 2014 study found that 74 homeless “super users” visited one US emergency room more than 800 times over the course of one year.
A survey at the LAC+USC medical center found that more than 20 people essentially lived on the hospital grounds.
“Hospitals are being used for meeting basic needs,” said Kalpana Ramiah, director of Essential Hospitals Institute, a hospitals’ association. “I don’t think hospitals see it as a burden – I think they’re looking at what role they can play.”
Even so, because many homeless patients have minimal health insurance, there’s no financial incentive to keep them hospitalized and do the kind of expensive tests more monied patients might undergo.
“The vibe is almost: ‘Let’s get rid of this patient who we’re not making money off of,’” said Coats. “Which isn’t their fault – they have to keep the lights on.”
Tarver was just three pounds when he was born, said his foster mother, Susan Simpson. “I kind of made a deal with God,” Simpson said. “I said, ‘whatever you do, don’t let one die on me. I won’t be able to handle that.’”
Tarver was in and out of the hospital as a baby, fighting to gain weight, and his epilepsy went long misdiagnosed. Doctors put him on a powerful medication that made him practically catatonic at school.
A stroke in 2015 left half his body temporarily paralyzed, and he walks with a leg brace. He has absence seizures daily and frequent convulsive seizures, making it dangerous for him to drive, and virtually impossible for him to work. Tarver said he did not really have anyone he could rely on, except a service dog, Bagheera, trained to detect seizures.
“He casually mentions that if he’s not [at the women’s center] in the morning,” said Coats, “it’s because he had a seizure in his tent by himself.”
In response to questions about Tarver’s case, the LAC+USC medical center said it couldn’t answer any questions about patients due to privacy laws.
“However,” the emailed statement said, “our hospital’s policy is to offer homeless and other vulnerable patients linkages to support services.” The hospital “follows an established discharge planning policy and always strives to ensure that patients are offered assistance,” it said.
A note in his medical file said Tarver was “offered admission given multiple seizures … but prefers to go home.” But Tarver has no memory of being offered admission, and given the choice between recovering in the hospital and a tent, he can’t imagine he would have chosen the latter.
Plus, Tarver said, after multiple seizures in quick succession, he wasn’t in a mental state to make that kind of decision. “There’s no way they should’ve sent me home,” he said.
“It’s almost like they don’t want to deal with them,” said Luna Covarrubias-Klein, a clinical social worker at the Downtown Women’s Center, where Coats works and Tarver had his seizure.
There are no reliable statistics on how many homeless patients are improperly discharged from hospitals in Los Angeles. Skid Row’s fame as a dumping ground for unwanted patients emerged about a decade ago, with stories like that of the 150 Orange County psychiatric patients dropped off on shelter doorsteps.
A series of high-profile lawsuits followed, resulting in millions in settlements paid by offending hospitals, and a Los Angeles city ordinance was passed banning hospitals from transporting patients anywhere except their homes or other health facilities without their written consent. The office of the Los Angeles city attorney, Mike Feuer, also developed a discharge protocol that some hospitals have adopted, which emphasizes linking homeless patients with shelter.
Hospitals across the country, meanwhile, have poured millions into funding housing programs for “frequent flyer” homeless patients.
“Society as a whole needs to grapple with the paucity of beds in the recuperative bed world, the shelter world – every world,” said Feuer. “I think we’ve made great inroads, but no one should say that we’ve solved this problem here.”
Tarver recently moved out of his tent and into transitional housing nearby, and is scheduled to get an implant intended to control his seizures. But the sheer number of homeless Angelenos – there are almost 60,000 people on any given night across the county and fewer than 20,000 shelter beds – suggests many will continue to leave hospitals without a clear destination.
“Hospitals just weren’t designed to do this stuff,” Coats said. “It wasn’t supposed to be a place where you end homelessness. And that’s kind of what they’re having to do right now.”