Got Protocols? 
Reshaping Hospital Discharge Planning
For The Homeless

In May of this year, Public Counsel, in collaboration with the ACLU of Southern California and the Los Angeles City Attorney’s Office, successfully negotiated a monumental settlement of one of the most notorious hospital dumping cases in recent years: the case of Carol Ann Reyes.    The terms of the settlement were significant in providing appropriate compensation to the victim, Ms. Reyes, whose videotaped figure wandering the streets of Skid Row in nothing more than a hospital gown will long be remembered as a defining image of the horrific practice.  Equally important to the settlement, however, were the comprehensive homeless discharge planning protocols that Public Counsel assisted in drafting and that the hospital responsible for Ms. Reyes’ injuries, Kaiser Foundation Hospitals, agreed to adopt in order to ensure that homeless patients never have to endure what Ms. Reyes went through.

The protocols, which Kaiser agreed to implement at all of its hospitals in Los Angeles County, include systematic processes for identifying homeless patients immediately upon admission so that appropriate discharge planning commences at the earliest possible stage.   Detailed procedures for documenting the mental status of the homeless patients so that their psychiatric condition and any identified mental disabilities are fully integrated into the discharge plan are also a key component of the new protocols.  

The discharge plan itself requires a full assessment by the treating physician and discharge planner of the post-discharge medical and social service needs, including the need for ongoing inpatient care, assistive care, food, shelter, substance abuse treatment, eligibility for government funded mental health services, and financial assistance.  The ultimate discharge plan must be fully documented and must be developed with the participation and agreement of the patient with all barriers to appropriate discharge fully addressed.   Any referral to a shelter that is part of the plan must be to a location that is capable of addressing the patient’s post-discharge needs, with the shelter acknowledging that the patient fits the shelter’s residency criteria prior to discharge from the hospital. 

One of the most critical features of the new protocols is the mandatory training for all hospital physicians, clinical staff, and social services and discharge planning personnel on key issues impacting homeless patient discharge.  Ongoing education on the mental and physical problems typically faced by homeless persons in Los Angeles County are just some of the subjects that are part of the required education of hospital employees. For example, the post-discharge care issues that distinguish the discharge planning for homeless persons from that of the general patient population; the nature, location and limitations of homeless shelters or services in other areas in Los Angeles County; and the nature and extent of the hazards facing the homeless in the Skid Row area.

According to David Daniels, Directing Attorney of the Homelessness Prevention Law Project at Public Counsel, “a key priority for Public Counsel in reaching settlement with Kaiser was not only getting Kaiser to agree to the necessary discharge processes to protect the homeless, but also getting them to apply the protocols throughout its vast system of medical centers in Los Angeles County.  A big goal of ours is to effect awareness and change in the hospital industry as a whole,” says Daniels.   “And with one of the largest HMO’s in the country agreeing to new practices for all of its area hospitals, we feel a substantial step has been taken towards changing the industry’s treatment of homeless patients.”

“Our ongoing work in representing other dumping victims has already revealed a willingness on the part of other area hospitals to follow Kaiser and adopt revised protocols specifically geared towards issues of homelessness,” says former Public Counsel President and CEO Dan Grunfeld. 

Carol Ann Reyes