Saturday, December 4th 2010
I woke up this morning exhausted from working a 65 hour week and didn’t want to get out of bed.  It was raining outside and I couldn’t help but think of the vulnerable guests that we had to put out at the bus stop this morning when our temporary winter shelter programs shut down for the day.  One man in particular came to mind and I began to weep.  Let me share with you the unsettling story of how I met James B.

This past Wednesday, December 1st, Union Rescue Missions’ affiliate, Eimago, opened four new winter shelter programs throughout the County with 620 new beds available for people who want to get in out of the cold this winter.  It’s our busiest week of the year, but we look forward to it all year long. It was a beautiful night for the most part…albeit bittersweet.  Our new team did a fantastic job setting up things at the National Guard Armories and everything was running smoothly until about 6:30 pm when James B. was dropped off in the parking lot at the National Guard Armory in West LA by the VA Hospital.

Our Program Manager was called out to the parking lot by someone who said there was a man screaming for help.  James B. was dropped off by a Yellow Cab in the parking lot in a wheelchair with all of his belongings, medical equipment, a urine bottle, in VA hospital pants with a medical slipper on his foot.  He recently had his toes amputated on his left foot and had been at the VA Hospital for a couple of months because infection had spread throughout his body.

When our Program Manager found Mr. B in the parking lot he was asked how he got to the shelter, and if he had requested to be brought there.  He said “no, he didn’t know about the shelter but his social worker put him in a cab and sent him there.  She talked to the cab driver and sent Mr. B off telling him he was going to a cold weather shelter for the night”.  He didn’t know where he was going but they told him he had to be discharged.

James B. is a 72 year-old former Navy Intelligence Officer, diabetic, with paranoid schizophrenia.  He can not ambulate completely on his own to get in and out of his bed or to and from the bathroom and shower.  He was unable to find or manage his medication on his own or change his bandages and tend to his sutures.  Our staff got Mr. B inside, gave him some food and coffee and made sure he was comfortable.  His back was causing him a lot of pain and he just wanted to lie down so the staff got him to a cot.

So I’m just curious…anyone else besides me have a problem with this picture so far?

When I got the call I spoke with Mr. B over the phone.  I told him that this shelter was not an appropriate situation for his immediate needs and I wanted to help him get to a place where he could receive the attention he needed and deserved.  After talking with him for several minutes and gathering information, he told me “you say you want to help me, everyone says they want to help me, but you are not here. I can’t see your face, your eyes or your body language so how do I know you really want to help me.”  I responded with, “you are absolutely right Mr. B, I am getting in my car right now.  It will take me 30 minutes or more to get there, but I will be there…because you deserve that.”

Since he was sent by the hospital in a vulnerable position and did not give his consent, I instructed our Program Manager to call the LAPD for a report on a hospital dumping, which is a violation of the law in Los Angeles.  The police showed up about 9:15 and I arrived at the shelter shortly thereafter.  I explained to the police officers that Mr. B was not in any position to be at a temporary winter shelter program, for many reasons.  He had to have his bandages changed daily; he could not get up and down to go to the bathroom regularly so he had an open urine bottle beside his cot to relieve himself which could spill and be a hazard to others in this open dormitory setting; he obviously had some mental instability; we had nowhere to send him in the morning at 6:00am; and he was agitated and shaky because he could not find his medication, which he had not taken all day, along with his insulin.  The police officers were familiar with the hospital dumping ordinance because of years of media attention, but had never handled one before.  They were extremely nice and horrified that the VA Hospital would do this to one of their own, and they took a detailed report.

Mr. B said he was not told that the winter shelter programs are just temporary and closed down at 6:00am. He was distraught about where he would go.  I told him that the busses pick our guests up at the Armory at 6:00am and drop them off at a pretty secluded area on Exposition and asked if he had somewhere to go from there or someone he could call.  Clearly there was no discharge planning thought through by his social worker and it is incomprehensible for our staff to leave him out on the street in a wheelchair with huge bags of stuff that he was unable to transport.  What in the world were they thinking?

So I went over to the VA Hospital and arrived at about 11:00pm.  I spoke with the Administrative Officer of the Day (AOD) and the Nursing Supervisor.  Everyone there was very familiar with Mr. B and after reading through his discharge notes, they agreed that the winter shelter program was not an appropriate placement for him.  After talking with them and reading through the case notes it was apparent to me that the social worker became frustrated with him and finally told him that he was out of options and she was “sending him to a new cold weather shelter that had just opened up.” So she put him in a cab and sent him off – forcing someone else to figure out where he would go the following morning.

It seems that Mr. B can be a bit cantankerous and his social worker had been trying to place him for a few days.  He refused her placement options saying he did not want to go downtown or to any of the other shelters she offered, for various safety reasons.  They failed to tell me at the time that he was paranoid schizophrenic – and of course he didn’t want to go to Skid Row.  I also found out later that he had a sister who they should have been working with to assign conservatorship.  Why weren’t they working on a board and care or permanent supportive housing where he could get the ongoing support he needs, instead of an overnight emergency shelter?  Cantankerous, hard to place, or not…when is it ever okay to dump an elderly veteran with mental illness and serious health problems in a parking lot with all of his belongings and leave him there?

The Administrative Officer of the Day agreed to have Mr. B picked up the following morning at 6:00am when their transportation crew came on shift, to transport him back to the VA Hospital.  She said they would work on a proper placement where he could get care for his bandages, etc.  They were pleasant but I told them I was not completely satisfied with their corrective action plan because we were very concerned about Mr. B’s health since he had no medication or insulin, which puts him at risk and our staff in a very precarious position.  What if something happened to him in the night? They had no way to pick him up until the following morning and if he had health problems we were to call 911. Period.

I was sure that after I came storming in there like a pit bull at 11 o’clock at night, the VA Administration would begin circling their wagons and developing a damage control strategy.  They should have picked him up immediately that night after I started using language like “hospital dumping”, “criminal”, “elder abuse”, etc.  So of course I got a call the following day from the social worker, her supervisor, and the attending physician who all tried to explain to me why they left Mr. B in the parking lot. They knew he had problems with medication management, being able to fully ambulate by himself, showering, changing his bandages, etc and they had been working with him over a period of about a week to make sure these issues were resolved.  Clearly they were not.

I asked this “social worker” if she knew that Mr. B would have to leave at 6:00am and would be dropped off by a bus in an isolated area, far from his services with all of his belongings and asked her what she expected him to do from there.  She did know the hours of operation and said Mr. B told her he could take care of himself.  Well of course he did…he’s a Navy veteran who was filled with anger, pride and frustration.  But when a mentally ill man in a wheelchair with all of his belongings tells me that he can take care of himself, I know well enough that is probably not the case and he is going to need some assistance.  Did she really think it was appropriate to leave this sick man on the street corner in a wheelchair with a walker and several bags to carry?  I explained to her that our staff were trained better and would never leave someone like that, so she placed us in a very uncomfortable position sending him to us late at night with no time to make arrangements for the following morning. I also explained that the winter shelter programs have very limited staff with two people in the morning to get 150 people on the bus, pass out lunches, put away all equipment, supplies and cots in the storage container, clean kitchens and bathrooms, restock supplies, etc and we have to be out of there by 8:00am.  There is no way we can take care of a guest with such serious health issues through all of that, and give him the care and attention that he deserves.

I listened to their story, and then they listened to my diatribe…and they had nothing else to say.

Hospital dumping incidents like this occur several times during the winter shelter season and it appears we are off to a bad start this year.  Some hospitals wear out the other shelters around town during the other 9 months of the year, and apparently can’t wait until the temporary winter shelters open up so they have a place to send people who are taking up a bed and need to be discharged.  Yesterday we received four calls from hospitals looking to refer patients.  At least they called and followed the proper protocol to find out if this was an appropriate placement.

So we have called in some of our faithful public servants, including Councilman Bill Rosendahl and City Attorney Carmen Trutanich, to send a very clear message to hospitals in Los Angeles that the winter shelter programs can not and will not be used as a dumping ground for patients that they cannot otherwise place.  This criminal investigation has only just begun.

Please pray for Mr. B and the hundreds of other vulnerable men and women who get dropped off on street corners and go unnoticed.  Pray that hospital administrators around the nation will train their teams on appropriate discharge planning. Pray for our veterans who oftentimes do not get the respect they deserve.  My outrage has turned to sadness today and so I got up this morning, exhausted as I was, to give it all I’ve got.  Mr. B is worthy of my very best and I’m going to see that he gets everything he deserves.