January 14, 2015
LA Times: Skid row doctor's care includes finding patients a homeLos Angeles Times | Gale Holland
J oan Morton was pencil-thin and hollow-cheeked when Dr. Susan Partovi found her sleeping on skid row, with what Morton said were lingering pneumonia and HIV complications.
Partovi, a longtime skid row "backpack" doctor, said she could get Morton a permanent place to live — an offer she said she hadn't received in nearly three decades on the streets.
"Only once I lived inside with my ex-husband," said Morton, 43.
Partovi's overture was part of an $18-million Los Angeles County program called Housing for Health, which some experts call the nation's most promising initiative to end homelessness. The program uses county Department of Health Services money to subsidize rents for the very sick among the county's 39,000 homeless people.
"It's a really wise use of public resources," said Matthew Dougherty, director of national initiatives for the U.S. Interagency Council on Homeless in Washington. "I'm not aware of anything else being done at this scale."
Studies have demonstrated that providing housing to ailing homeless people saves public funds by keeping them out of ambulances, emergency rooms and jails.
A single year's medical and mental health costs for the county's sickest homeless people — including those treated while in jail — dropped to $16,000 after they obtained housing from $59,000, according to a 2013 report by the Economic Roundtable, a Los Angeles research organization.
Last year, the Board of Supervisors authorized $14 million in health services money, augmented by $4 million from the Conrad N. Hilton Foundation, to house 500 people not only on skid row but also in duplexes and apartments in Culver City, West Hollywood and the Antelope Valley. An additional 1,000 placements are planned this year.
Similar programs have been tried in San Francisco and elsewhere, but none so broad. Street outreach teams similar to Partovi's are planned in every part of the county, and officials have pledged to transform the misery and degradation that have ruled skid row's streets for decades.
￼The housing comes with counseling and various therapies as part of an effort to give homeless people a place to live while treating their mental illness and addictions. In the past, homeless people often had to be on good behavior at shelters or in transitional housing to earn an apartment. Many landed back on the streets, leading some to conclude they wanted to be homeless.
Marc Trotz, director of Housing for Health, said it was plausible that Morton had never been offered a permanent home. And that's what homeless people want, he said.
"The vast majority, way into 90%, really want housing," Trotz said. "OK, there may be a few people really hard to reach, but that will be a great day when all we have are those last remaining people."
Partovi, 47, has worked in homeless medicine for 12 years. The daughter of a schoolteacher and a Jewish Iranian immigrant engineer, Partovi grew up in Brentwood. She converted to Christianity in high school and began volunteering in Tijuana through her church.
For five years, she spent every Saturday in a bare-bones Tijuana clinic treating conditions that included leprosy.
"From a medical standpoint, I was completely hooked," she said.
Over the fall, she walked skid row with the city-county Operation Healthy Streets team, which patrols the district and offers aid during bimonthly street cleanings. Partovi dressed casually — the only signs of her profession were a badge and a stethoscope around her neck.
"Knock knock," she announced herself outside a worn blue tent. "We have a couple of medical doctors here."
In her backpack she carried a blood pressure cuff, blood sugar tester, wound care supplies and scabies medication. She described her bedside manner as collegial, not paternalistic. Even after several brushes with MRSA, an antibiotic-resistant bug prevalent on skid row, she wore no gloves or mask.
"You accept where people are at, asking them to guide you how they want to be cared for," Partovi said.
When she found someone truly sick —- and there were many — she walked them to the county's new Star Clinic, Housing for Health's headquarters at Maple Avenue and East 5th Street. Or she took them to the Healthy Streets "hub," the patio of a shelter at Crocker and East 6th streets, where they could sign up for a drug detoxification bed, Medi-Cal or welfare benefits.
A 24-year-old man named John, who suffered from seizures and spinal problems, accompanied her to the hub in his stocking feet. He said he'd been robbed in his sleep of everything, including his shoes.
An outreach worker gave the homeless man the shoes off his feet. John stepped away to smoke, then
￼began jittering about frantically and talking to himself.
"It's just a little bit of spice," he said, referring to a synthetic weed popular on skid row.
"If they're going to smoke a joint, to get them into housing, OK," Partovi said. "We're part of this movement of doing whatever it takes to get people off the streets."
Other homeless people were so ill she referred them to a county health services department recuperative care center that recently opened in Compton.
Partovi's work went well beyond exams and referrals. When one patient refused to put back on his dirty pants, she made sure he got another pair. Weeks later, she was calling the hospital, trying to get him a spinal tap.
"Sometimes I'm my own nurse, my own social worker," Partovi said. "If you don't have family to take care of you, who's going to do it?"
Morton almost left as soon as she got to the hub. She wanted ice cream. Rocky road. Now.
An outreach worker went across the street and brought back a serving of cookies and cream, and she stayed put.
"It doesn't happen in one day. It's building a rapport," Partovi said. "The first time I met Joan on Wall Street, I left a card. Maybe on the seventh or 10th visit they build up the trust."
A woman using a wheelchair arrived at the hub in a voluminous, plush cape. Her gauze-wrapped calves were grotesquely swollen. She said she slept outside in her chair because the shelter was too cold.
Outreach workers attempted to get the woman to the recuperative care center. She couldn't climb into the van by herself, and they were afraid of dropping her.
"I'll strap her in myself if I have to," said Partovi, who managed to get her into the vehicle.
Despite Partovi's herculean efforts, not every placement has stuck. At the recuperative care center, the woman refused to sleep in a bed, even with eight blankets, and eventually left complaining of the cold, nurses said.
But the bulk of the patients have remained in housing, including Morton. During a recent visit, she was enjoying a pack of chocolate wafers and looking forward to having a place of her own.
"They got me housing," Morton said, "which is what I need."