A remedy for patient-dumping?

Steven Davis’ sojourn on Los Angeles’ skid row last year was brief but unusually fruitful. Davis, a 32-year-old schizophrenic, was dumped in front of the New Image Shelter last year by College Hospital in Costa Mesa, not long after being diagnosed as dangerously delusional and paranoid. He made his way eventually to California Hospital Medical Center, which tracked down his relatives in the area. The medical center then found a place for him in a “board and care” facility equipped to support the mentally ill. Davis’ experience prompted a yearlong investigation by the city attorney’s office, which culminated Wednesday in a court order that should deter hospitals from tossing others like him onto the streets. Just as important, the order could help hospitals manage the challenges that homeless patients with mental illnesses present.

The investigation uncovered evidence that vans dispatched by the College Hospital chain left as many as 150 mentally ill patients on skid row in the last two years. That kind of routine dumping has abated in the wake of crackdowns by the city attorney’s office and the City Council. Yet there is widespread agreement that, when it comes to patients such as Davis, the safety net is badly ripped. In particular, there’s no procedure for conveying mentally ill patients who are homeless, or whose families can’t care for them, from the hospitals that provide emergency help to the residential facilities that supply the day-to-day support. The situation is exacerbated by the shortage of board-and-care beds.

As a result, hospitals in Los Angeles County often discharge such patients to the Salvation Army shelter in Bell, where they can get help for a few days before being released to fend for themselves.

It’s unreasonable to expect hospitals to manage the long-term care of the mentally ill patients who land in their emergency rooms. Federal regulations require medical facilities to come up with a plan for follow-up care, but they don’t order hospitals to make sure their discharged patients actually receive it. That’s no excuse for dumping patients on the sidewalk in skid row. In addition to prohibiting College Hospital from dropping off homeless psychiatric patients in downtown Los Angeles, the court order gives the hospital’s owners and the city attorney a year to come up with a protocol for discharging such patients that will “take advantage of all available public and private resources” for housing and services. The point is to provide “a continuum of care” by plugging the hospitals into a well-coordinated network of state mental-health services, supportive housing facilities and other sources of outpatient care. Such a system is overdue for hospitals and patients alike.