Making it illegal to leave people on the streets would attack just part of the problem, experts say.
By Richard Winton
Los Angeles Times
Copyright 2007 Los Angeles Times
All Rights Reserved
LOS ANGELES — Despite the public outrage over the dumping of homeless patients on Los Angeles’ skid row, there is growing debate about whether criminalizing the practice would solve the problem.
As the number of suspected dumping cases reached 55 last week, a state senator announced legislation that would make it a misdemeanor for hospitals to transport patients and leave them on the streets against their will.
But some legal experts question whether the law could be effective without a parallel effort to provide more shelter and services for chronically ill homeless patients who are well enough to leave the hospital but have no place for continuing medical services.
There are only about 40 “recuperative beds” available in L.A. for homeless people who need medical attention after being discharged from hospitals, officials said, and there is general agreement that’s not enough. The proposed law, legal experts say, might be vulnerable, because it seems to make hospitals alone responsible for finding care for these patients.
“It is more complicated than it first appears,” said Russ Korobkin, a UCLA law professor who teaches health law. “Requiring hospitals to be responsible for the patients and not leave them in the gutter is a first step. But you’ve got to have a second step of providing some government-funded beds for recovery.”
Otherwise, he and others said, the law essentially creates an “unfunded mandate” -- which could be challenged in court -- that hospitals must not only treat the sick but also find housing for them upon their release.
Another expert on health law, USC law professor Alex Capron, said the proposed legislation could leave a hospital on the hook for services that go well beyond how it provides treatment for homeless people.
“If someone lives in a one-room flophouse alone, would that even be an appropriate discharge under this law and to what extent would a hospital be responsible?” he asked.
The proposed legislation, by state Sen. Gil Cedillo (D-Los Angeles), would make it a misdemeanor for a hospital facility or worker to transport patients anywhere other than their residences without their informed consent. Individual offenders could be punished by up to two years in county jail and a fine of up to $1,000. Healthcare facilities could be fined up to $10,000.
Cedillo and others said the law would give city prosecutors better tools to prosecute hospitals for dumping. City Atty. Rocky Delgadillo has filed criminal charges against just one hospital, Kaiser Permanente, saying the dumping of a homeless woman on skid row in 2006 amounted to false imprisonment. That legal strategy, however, hasn’t been tested in court.
“We had great faith in hospitals’ commitment to their patients,” Delgadillo said. “We have great faith in the Hippocratic oath. We had great faith in people’s adherence to common decency. We hoped hospitals would adhere to those ideals. But it doesn’t appear so.
“These dumping incidents aren’t aberrations, and they certainly make it necessary for us to make a clear and powerful statement about what is appropriate behavior for the health community and anyone dealing with fellow members of society,” he added. But some question whether it makes sense to focus only on hospitals when they are just one piece of the puzzle.
Homeless services officials said there is not enough money for long-term housing of homeless people, especially those with medical conditions or mental problems.
L.A. civil rights attorney Carol Sobel questions the validity of a law that would make hospitals liable for how they treat the homeless while not extending that liability to other groups.
“This is the last person in a chain that has failed these indigent patients,” she said. “Where’s the county social worker? Where are the nursing homes? Where are the missions? Where’s the rest of the system that is supposed to care for these people? Why don’t the police criminally charge the mission that turns somebody away?”
Hospital officials argue that they are being singled out even though medical centers in Los Angeles County provide care for 18,000 homeless patients each year. They say it’s difficult to find places to send those who are well enough to leave the hospital but have no place to go where they can receive care.
But Delgadillo and others say that although hospitals often face a dilemma, there is no excuse for leaving patients on skid row if they have nowhere else to go. Earlier this month, a 54-year-old man in a soiled hospital gown, his colostomy bag still attached, was found crawling in the gutter after being dropped off outside a skid row park, far from homeless services.
Police say that as onlookers demanded help for the man, the driver of the van for Hollywood Presbyterian Medical Center applied makeup and perfume before driving off. The hospital said it is investigating but acknowledged that it didn’t follow its own release policies.
The Kaiser case involved a 63-year-old patient who was discharged early last year from Kaiser Permanente’s Bellflower medical center. A short time later, video at a downtown mission captured her stepping out of a taxi in a gown and socks and then wandering aimlessly down San Pedro Street. Kaiser has denied any wrongdoing, saying the woman was discharged by mistake. The hospital said it has revamped its release policies.
Delgadillo said that about 10 of the 55 dumping cases have the potential to lead to further action. He said dumping isn’t unique to skid row, adding, “We suspect it is happening in other parts of the city.”
Andy Bales, executive director of Los Angeles’ Union Rescue Mission, said hospitals make facilities for the homeless a social services safety net, dumping patients at the mission’s doorstep or in the lobby without even calling first.
But the mission doesn’t have the medical facilities for the people, leaving them nowhere to go.
The proposed law, he said, “will not only overcome indifference, but evil.”
Explaining legal issues
What would the proposed homeless dumping law do?
It would make it a misdemeanor for any hospital facility or worker to transport patients anywhere other than their residences without their informed consent. Individuals could be punished by up to two years in county jail and fined up to $1,000. Healthcare facilities could be fined up to $10,000.
The city attorney has filed charges against Kaiser Permanente for alleged dumping. What laws were allegedly violated?
Prosecutors said that taking a patient against her will to skid row from a hospital was criminal false imprisonment. But this type of prosecution hasn’t been tested in court. Kaiser was also charged under a state unfair business practices law that city prosecutors usually use against slumlords. The suit seeks a judge’s order to forbid all Kaiser medical facilities from dumping homeless patients on skid row and impose financial sanctions if they violate the order.
Has anyone been arrested for dumping?
No. The charges were against the hospital chain, not individuals. But the Los Angeles Police Department said last week that officers would arrest on suspicion of false imprisonment anyone whom authorities see dumping patients.
Are there federal sanctions possible against hospitals accused of dumping?
Federal investigators were trying to determine whether the hospitals have violated the Emergency Medical Treatment and Labor Act and Medicare Conditions of Participation. Those statutes deal with the way hospitals treat and discharge patients. If a hospital is found to be in violation, it could be subject to discipline and civil penalties, possibly putting its accreditation and Medicare funding at risk.
How many dumping cases is the city attorney investigating?
There are now 55. Prosecutors believe they have solid leads that could result in charges in about 10 of them.