Hospital dumping

January 18, 2008 3:58 PM

WTF, LA hospitals? "Gabino Olvera, 42, sued the Hollywood Presbyterian Medical Center for negligence and elder abuse after it discharged him in February 2007, took him across town in a van and left him in a soiled hospital gown without a wheelchair in the heart of the city's homeless area."
posted by Kirth Gerson (89 comments total)

But....but...with socialized medicine you'll have to wait 6 months to get medicine for a cold!
posted by nevercalm at 3:59 PM on January 18, 2008 [5 favorites]

"The Olvera case was one of about 50 reported incidents in the past 12 months of sick, confused and homeless patients being left by ambulances in the 50-block area of downtown Los Angeles thought to have the highest concentration of homeless people in the United States."
posted by Kirth Gerson at 4:03 PM on January 18, 2008

Contrast that with my (Canadian wife) receiving a letter informing her she hadn't renewed her health card in over two years. The penalty for this was $15, which included the cost of a new card and of course free health care.
posted by furtive at 4:04 PM on January 18, 2008 [3 favorites]

With privatize medicine, you immediately get medicine for the cold ! If you pay for it, cash prontissimo.

On the other hand if you have an insurance, I just notice you didn't tell us you had a yeast infection once when you was young, you sexy rascal. Sorry, but you didn't tell the whole truth to us, therefore insurance will not pay. Now this is the phone of my bro who sells caskets..just in case, you never know !
posted by elpapacito at 4:06 PM on January 18, 2008 [2 favorites]

The LA Times has done several stories about this; I could have sworn I saw 'em on Metafilter. But yeah, it's ongoing and pretty incredibly fucked up.
posted by klangklangston at 4:06 PM on January 18, 2008

I guess the next question is....how many of the homeless in the 50-block area of downtown used to be patients in LA hospitals?

And after that: when do we accept that market forces don't seem to be the best invisible hand to guide the healthcare industry?
posted by nevercalm at 4:09 PM on January 18, 2008

This ain't new.

Fucked up. Deeply, deeply fucked up.
posted by Happy Dave at 4:12 PM on January 18, 2008

This ain't new.

That article is nothing without the picture it was printed with.
posted by phaedon at 4:15 PM on January 18, 2008

It's better than making him walk all the way back to bumville.
posted by "Tex" Connor and the Wily Roundup Boys at 4:20 PM on January 18, 2008

you guys haven't seen "Sicko", have you
posted by matteo at 4:20 PM on January 18, 2008

when do we accept that market forces don't seem to be the best invisible hand to guide the healthcare industry?

In the US? Never. It's the biggest industry in the country. You'll never get that pig back in the sty.
posted by pracowity at 4:24 PM on January 18, 2008

"Tex" Connor and the Wily Roundup Boys writes "It's better than making him walk all the way back to bumville."

But considerably less good than neither making him walk all the way to bumville nor dumping him in bumsville.

I mean, killing someone is better than killing multiple people, but that's seldom used as a defense of murders.
posted by Bugbread at 4:29 PM on January 18, 2008 [2 favorites]

I guess the next question is....how many of the homeless in the 50-block area of downtown used to be patients in LA hospitals?

My guess? All of them.
posted by Cool Papa Bell at 4:30 PM on January 18, 2008

But considerably less good than neither making him walk all the way to bumville nor dumping him in bumsville.

What's your idea? Let him live in the hospital? That's not going to work. It's a hospital, not a homeless shelter.
posted by "Tex" Connor and the Wily Roundup Boys at 4:36 PM on January 18, 2008

What's your idea? Let him live in the hospital?

That's a false dilemma.

Instead of dumping him on the street somewhere near a homeless shelter and leaving him to crawl for safety, how about, say, taking him to a homeless shelter and seeing that he's settled in (or at least in the door) before driving off? That's just one more option, maybe not a great one, but one of many between letting him live in the hospital and dumping him on the street.
posted by pracowity at 4:42 PM on January 18, 2008

Instead of dumping him on the street somewhere near a homeless shelter and leaving him to crawl for safety, how about, say, taking him to a homeless shelter and seeing that he's settled in (or at least in the door) before driving off?

Hey, if that's really what you'd do if you had a mentally ill homeless person pushed into your care (maybe you came home and found him in your garage, say), you're certainly a better person than I am, and you should feel free to point the finger.
posted by "Tex" Connor and the Wily Roundup Boys at 4:47 PM on January 18, 2008

"I mean, killing someone is better than killing multiple people, but that's seldom used as a defense of murders."

I am so using this the next time I kill someone—"Ya honor, at least I didn't kill EVERYBODY. At least gimme that."
posted by klangklangston at 4:50 PM on January 18, 2008 [5 favorites]

About us.

CHA Hollywood Presbyterian Medical Center is a 434-bed acute-care facility that has been caring for the Hollywood community and surrounding areas since 1924. The hospital is committed to serving local multicultural communities with quality medical and nursing care. With more than 500 physicians representing virtually every specialty, CHA Hollywood Presbyterian Medical Center is ready to serve your medical needs and those of your loved ones and strives to distinguish itself as a leading healthcare provider, recognized for providing quality, innovative care in a compassionate manner.

In addition to CHA Hollywood Presbyterian Medical Center, the CHA Health Systems owns and operates four acute care hospitals with approximately 2,000 beds, two specialty clinics for Oriental medicine, a medical university and a cell and gene therapy research institute, all in Korea, as well as two infertility medical centers in the United States and Korea, including the CHA Fertility Center in Los Angeles.

You just don't get it, guys. CHA Medical Group needs to make back that 70 million dollars they spent buying HPMC. You think these guys are going to make that back from Hobo Nopay? No, sir. Tex is right, society doesn't owe this guy shit. Those ambulance guys are on the clock, they got time to dick around making sure this guy has actual clothes before they put him on the street? Not on my dime, fella. Their only obligation is to their shareholders. They're running a hospital, for god's sake, not a charity.
posted by absalom at 4:56 PM on January 18, 2008

"pushed into your care"?? This is a hospital. It's their job to have people pushed into their care, and their job to care for them, not just turf them out onto the street.
posted by twirlypen at 4:59 PM on January 18, 2008

And absalom, do you see why that makes privatized hospitals a bad idea? Hospitals should have an obligation to their patients, not to shareholders. Sure, I can see why it comes to this, but that isn't an excuse for leaving it that way.
posted by twirlypen at 5:01 PM on January 18, 2008 [1 favorite]

"pushed into your care"?? This is a hospital. It's their job to have people pushed into their care, and their job to care for them, not just turf them out onto the street.

It's their job to provide medical care, not to generally see to whatever needs anyone who wanders in might have.
posted by "Tex" Connor and the Wily Roundup Boys at 5:04 PM on January 18, 2008

"CHA Hollywood Presbyterian Medical Center is ready to serve your medical needs and those of your loved ones"

Provided you've got the do-re-me, boys.

"and strives to distinguish itself as a leading healthcare provider, recognized for providing quality, innovative care in a compassionate manner."

Just don't forget what we said about the do-re-me. No moolah, no compassion. Capische?
posted by PeterMcDermott at 5:09 PM on January 18, 2008

matteo writes "you guys haven't seen 'Sicko', have you"

Apparently not, as they missed my yeast infection -> insurer fux with you reference. But wtf , Michael said he didn't care about profitless file sharing, so there you go, get your copy of sicko . If you like , do the wise thing go finance the fatty guy buy or rent the dvd.
posted by elpapacito at 5:11 PM on January 18, 2008

I do believe absalom was engaging in a bit of black humor. As for Tex - that's just Tex being Tex.
posted by Kirth Gerson at 5:16 PM on January 18, 2008

Just don't forget what we said about the do-re-me. No moolah, no compassion. Capische?

I just want to clarify something. How much money do you typically spend each month buying health care for indigents, anyway? Or is that just an obligation of people aren't you?
posted by "Tex" Connor and the Wily Roundup Boys at 5:18 PM on January 18, 2008 [3 favorites]

Everyone likes to point a finger but no one is doing anything about it. USA insurance or Michael Moore's socialized method isn't the way either. Corruption is at every level.

It amazes me that when the Chicago fire happened, it took ONE year to get Chicago back on it's feet and is still growing (ok our transit system is fucking wacked). Yet look at what the governement did and "is" doing for Katrina victims. Does anyone really want the US government to take care of healthcare?I sure don't. I rather have my choices, pay, and deal. I think cost has to come down on a tiered level or have greater access to catestrophic healthcare coverage. Employers bailing on people is fucking bullshit. I actually work for one of these insurance people and I pay more than I did at any other employer (even though I have the same coverage). But when I get my EOB, I shut the fuck up because I rather pay $112 a month out of my paycheck than the $17k outpatient surgery bill for stupid septum surgery. I paid my $300 share in installments (that's how the billing came) and gladly said "thank you". How many idiots say "no" to employer provided healthcare because they can't budget their money? I nearly hit my husband over the head when he said "why do we even have it if it's a $1,600 deductible?" Because stupid, if I have to get a heart procedure and stay 5 days in the hospital, hellooooo bill of $65,000, that's why.

Sheesh!

"They told me to go to socialized medicine and I said, no, no, no."

Look at the evidence around you. American governement fucks things beyond words. I surely don't want them having control of my health and decisions.
posted by dasheekeejones at 5:22 PM on January 18, 2008 [2 favorites]

Yeah, who the fuck do we think doctors are, anyway? People who just fix people out of the kindness of their hearts? That's the dumbest thing I ever heard.

I swear to fulfill, to the best of my ability and judgment* patient's ability to pay, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

*rev: 1973
posted by absalom at 5:22 PM on January 18, 2008

Oh, fuck? Did I say patient? I meant client. Let's not misconstrue their relationship.
posted by absalom at 5:23 PM on January 18, 2008

As for Tex - that's just Tex being Tex.

Yeah, people like Tex explain the frisson of schadenfreude the rest of the world feels whenever we read about another member of the American middle class being financially ruined because their insurance has run out or they can't get any cover.

Stack 'em *all* up like so many bums in the alley, that's what I say. They've only got themselves to blame.
posted by PeterMcDermott at 5:25 PM on January 18, 2008

It's their job to provide medical care

It is. And throwing a helpless patient out the door like that is providing poor medical care. You can't dump a mentally ill paraplegic on the street ("Witnesses who came to Olvera's aid said they saw him dragging himself on the ground with hospital papers and documents clenched in his teeth...") and expect him to come to no harm. Someone needs to be fired.
posted by pracowity at 5:26 PM on January 18, 2008

I just want to clarify something. How much money do you typically spend each month buying health care for indigents, anyway?

Whatever proportion of my tax bill that it takes to ensure that everybody gets decent health care, Tex. Just like every other civilized country.
posted by PeterMcDermott at 5:27 PM on January 18, 2008 [6 favorites]

Nevercalm: when do we accept that market forces don't seem to be the best invisible hand to guide the healthcare industry?

Pracowity: In the US? Never. It's the biggest industry in the country. You'll never get that pig back in the sty.

Nonsense. You think universal health care just happened to be growing on the trees in Canada and the colonists found it there when they got off the boat? The Canadian health care system began in Saskatchewan in 1947. It hadn't been there before. It is possible for people to implement a social safety net where one didn't exist previously. There used to be one here, in fact.

It happened, and critically it happened when it happened, because a generation of people had seen the consequences of decades of laissez faire government by an investor class of robber barons.

Those people were your grandparents, and they didn't create Social Security, Medicare, welfare programs, labor relations law, anti-trust law, pure food and drug regulations, rural electrification programs, nationwide education standards, an interstate highway system, the United Nations and the Peace Corps, mining inspection laws, the civil rights movement, unemployment insurance, the minimum wage and the 40 hour work week, universal vaccination programs, the National Weather Service, national flood insurance, Fannie Mae... oh, come up with your own list, because they just a bigger kick out of following rules and paying taxes than we do.

They did it because they'd seen what happened when those things didn't exist and everything was left up to the invisible hand. What happened was destitution and suffering, environmental desolation, plague and death on a massive scale. And they wanted to be damn sure that didn't happen to their children and grandchildren. But of course they forgot the key rule of revolutions. The second generation doesn't get why it was necessary.

They left their descendants one hell of a legacy, one those descendants have been steadily chipping away at through a combination of laziness and greed ever since. You haven't seen the kind of hard crash your grandparents lived through. But you will. Maybe soon now. And when you do, when enough pigs have just wheezed and dropped dead in their tracks, then you'll put the rest of them back in the sty by whatever means necessary.
posted by Naberius at 5:29 PM on January 18, 2008 [52 favorites]

Tex,

You do realize that, if the story is true, the hospital violated federal (and perhaps state) law against patient dumping? This isn't just morally reprehensible, it's also illegal.

Go learn yourself about the Emergency Medical Treatment and Active Labor Act of 1986, aka EMTALA.
posted by saslett at 5:33 PM on January 18, 2008 [2 favorites]

"Those people were your grandparents, and they didn't create Social Security, Medicare, welfare programs, labor relations law, anti-trust law, pure food and drug regulations, rural electrification programs, nationwide education standards, an interstate highway system, the United Nations and the Peace Corps, mining inspection laws, the civil rights movement, unemployment insurance, the minimum wage and the 40 hour work week, universal vaccination programs, the National Weather Service, national flood insurance, Fannie Mae... oh, come up with your own list, because they just a bigger kick out of following rules and paying taxes than we do."

Well, yeah, but they had the Great Depression to point out the general danger of the economic Calvinism that Tex seems to be advancing here.
posted by klangklangston at 5:33 PM on January 18, 2008

How much money do you typically spend each month buying health care for indigents, anyway?

Answer = You're already spending money each month buying health care for indigents in the form of taxes. How do you think your local county hospital stays afloat?

Setting aside my typically libertarianism, personally, I think the hobo-dumping practice is beyond shameless. We used to have state-run institutions for the mentally ill and hopelessly drug-addicted (see Cuckoo's Nest, One Flew Over The), which, to be honest, most of the homeless are. But for a variety of reasons, (and it was more than just the money being spent), we thought that was a bad idea. Unfortunately, we didn't have a back-up plan, the numbers of homeless shot up, but nobody says much about the whole "institutionalize 'em" idea any more.
posted by Cool Papa Bell at 5:33 PM on January 18, 2008

Whatever proportion of my tax bill that it takes to ensure that everybody gets decent health care, Tex. Just like every other civilized country.

So you pay the amount you're required, by law, to pay. That's really quite generous. I can see why feel you have the moral high ground here.
posted by "Tex" Connor and the Wily Roundup Boys at 5:36 PM on January 18, 2008

Whoops. Second link should go to here.

Patient dumping has always been a problem. I suspect we'll only see more EMTALA suits as fewer and fewer people are able to get health insurance.
posted by saslett at 5:37 PM on January 18, 2008

I don't think anyone's saying that they are morally better, just that a system which requires everyone to pay and which provides medical care for everyone is better than a privatized one. It's not a question of generosity.
posted by twirlypen at 5:38 PM on January 18, 2008

"Does anyone really want the US government to take care of healthcare?I sure don't."

Big goverment's not the problem—bad government's the problem. If we didn't elect people who believe that big government is de facto bad government, the fallout from things like Katrina wouldn't be as terrible. The ineptitude of government is a Republican self-fulfilling prophecy, not a universal truth.
posted by klangklangston at 5:41 PM on January 18, 2008 [14 favorites]

I don't think anyone's saying that they are morally better, just that a system which requires everyone to pay and which provides medical care for everyone is better than a privatized one. It's not a question of generosity.

No, I think there are two distinct issues that are getting confused in this thread. There's the issue of whether Olvera's plight illustrates the need for some sort of publicly funded universal health care, and I think most people in this thread (including me) think it does.

Then there's the issue of whether in Olvera's actual situation, under the system we have (which isn't, as it turns out, publicly funded universal health care), the hospital was obligated to continue to provide care, medical and otherwise, for free. My objection is that few, if any, of the people in this thread that wanted the hospital to volunteer its resources to care for Olvera volunteer their resources to provide healthcare for indigents, so all the ranting seems a mite hypocritical, frankly.
posted by "Tex" Connor and the Wily Roundup Boys at 5:44 PM on January 18, 2008 [1 favorite]

It would be more hypocritical if we were hospitals, especially hospitals that committed to charity, yet illegally dumped indigents out onto the street.
posted by klangklangston at 5:48 PM on January 18, 2008

It would be more hypocritical if we were hospitals, especially hospitals that committed to charity, yet illegally dumped indigents out onto the street.

That might make you feel better, but it really makes very little sense. Any dollar is as good as any other for buying health care. However you make your money, you can spend it buying health care for indigents. Hospital dollars aren't at all special in that respect.
posted by "Tex" Connor and the Wily Roundup Boys at 5:52 PM on January 18, 2008

My objection is that few, if any, of the people in this thread that wanted the hospital to volunteer its resources to care for Olvera volunteer their resources to provide healthcare for indigents, so all the ranting seems a mite hypocritical, frankly.

You know, I wouldn't be surprised if a lot of people here do shell out money to provide medical care for "indigents." And I suspect that I'm not the only person here who isn't "indigent" solely because someone else is helping me pay my medical bills. In America, one of the ways to avoid absolute financial devastation if you get seriously ill is to have friends or relatives who can afford to help you out. If, presumably like Olvera, you don't have friends or relatives who can or will help you pay your medical bills, you end up dumped on the pavement on skid row. I'm not sure what to say to you if you really can't see the problem with that.
posted by craichead at 6:04 PM on January 18, 2008 [3 favorites]

I don't understand.
I've been discharged from a hospital in the past; I called a friend or rode a bus home.

When the Hospital discharges you, you are done. Giving that person a ride to another part of town was something they didn't have to do. They got in trouble because the person had no destination...so they left him at his "home:" the street.

I think it's inferred here that some kind of "after discharge" care was needed. I'm sure it was. But I don't think it's the hospitals job to provide clothes, meals, document storage, etc. after discharge.

I don't understand how giving someone a ride in an ambulance (presumably at no charge...) after a discharge is a problem. How is that "patient dumping?" Is it OK if they just take them to the exit door and say, "Bye, good luck!" ??? When I had a knee surgery and couldn't walk, they wheeled me to the curb and that's where their responsibility ended. They didn't let me take that wheelchair home (yep, I asked...), didn't give me anything else (cept a lot of bills in the mail).

If I have a health issue that isn't addressed and I shouldn't have been discharged, that's another issue. But this seems to be the hospital saying, "OK, we took care of your health issue. You are discharged. Well sorry we can't find you a job or clothes or food or shelter...I guess we can give you a ride back to the area you came from if you like..." and then someone saying "you owe me more than that...." ? Am I missing something?
posted by PhiBetaKappa at 6:13 PM on January 18, 2008

Tex: I pay one of the highest sales taxes in the country so that Cook County can offer basic medical care to whoever needs it. The academic medical center that I work at funds indigent care (and subsidizes medicaid, which reimburses at about 22% of cost) by charging more from people with private insurance, increasing insurance rates. Medical care includes psychiatric care, which we and the country provide in various ways. There is also a small army of social workers here who plug people into the relevant services. Dumping ill disabled people on the street with no clothes is not the way the civilized world works, which includes much of America.
posted by a robot made out of meat at 6:17 PM on January 18, 2008

I think you're right Tex, there are two issues. Yes, with the current system, they may have provided care and satisfied all the required criteria. Yes, they aren't tasked with the job of taking care of people after discharge.

That doesn't stop it being shocking. That doesn't make it right. The main issue isn't whether or not they did their job, it's that the definition of their job needs to change if it leads to cases like this.
posted by twirlypen at 6:19 PM on January 18, 2008

I'm not sure what to say to you if you really can't see the problem with that.

I don't know how I can make this any more clear. Pass a law or pay for it yourself. I'm perfectly happy with either option.

Just stop freaking out when other people don't choose to spend their money to buy something you want.
posted by "Tex" Connor and the Wily Roundup Boys at 6:20 PM on January 18, 2008 [1 favorite]

Am I missing something?

I dunno, a tiny fucking bit of compassion perhaps?
posted by [expletive deleted] at 6:21 PM on January 18, 2008 [1 favorite]

"Just stop freaking out when other people don't choose to spend their money to buy something you want."

This isn't a widescreen tv or a new pair of sunglasses. It's not about wanting something for ourselves. It's about agreeing that there are basic things that should be available to all people.
posted by twirlypen at 6:22 PM on January 18, 2008

It's not about wanting something for ourselves. It's about agreeing that there are basic things that should be available to all people.

Parasite! Rapture has no place for people like you.
posted by [expletive deleted] at 6:25 PM on January 18, 2008 [6 favorites]

Well, PBK, it's a little thing called "compassion" that seems to be something you're unfamiliar with. As in, there are homeless shelters where someone like Olvera could theoretically get some clothes, a place to sleep while he recovered, and a chair to sit on since he couldn't FUCKING WALK.

It would have taken a minimum of effort for the hospital to have some contacts at local shelters, or among social workers, or a local church, and to call them and ask if they can take Olvera there instead of the street corner. Not because he is "owed" in some financial way, but because he's a helpless human being without resources who doesn't deserve to be treated like dog shit.

May you never be that helpless and left in the hands of someone who thinks as you do. May you never be a sick old man crawling down the street in a hospital gown, humiliated and hurting and abandoned. Jesus.
posted by emjaybee at 6:27 PM on January 18, 2008 [1 favorite]

Tex: Maybe it is my Canadian upbringing but I find your perspective rather baffling. The main difficulty with health care is that anyone anywhere can become ill or injured and require intensive care; often the person has no control over it. Furthermore, almost nobody would be able to afford the full cost of this care if they had to pay for it all themselves. So, you pay taxes or premiums that go towards providing care for the sick, with the knowledge that if you ever need it, the system will be there to take care of you. In that sense, everyone is contributing their resources toward providing care for others. Even in the US this is true - where do you think your insurance premiums go every month?

You can draw a few conclusions about this system depending on your philosophy. You might conclude that people who put more money into the system are more deserving of care, and that people who have paid nothing or very little should get no care. This kind of makes sense as a reward for those who work hard to earn more money. But it's hardly fair to the working poor; cancer strikes with equal opportunity and it seems inhuman to care only for the rich.

But once you accept some kind of redisribution of income, using the pool of premiums to pay for the more expensire care, you are basically implying that people should be allowed to pay what they are able to, yet should receive the care that they need. I don't know how you could draw a line at the indigent and say they should receive no care because they pay nothing.

And of course the reason people are outraged and ranting is precisely because they believe their money should already be providing this care for the very poor and are upset that it is not. They want to pass a law. Maybe they'll succeed one day.
posted by PercussivePaul at 6:28 PM on January 18, 2008 [4 favorites]

It's about agreeing that there are basic things that should be available to all people.

Awesome. Mobilize, relentlessly punish Congress members who don't support you, and get your plan pushed through. If you can't make it happen, maybe your principles aren't as universal as you thought.

Alternatively, you and everyone who agrees with you could fund your plan privately.

Both are great options! Do you know what's not a great option? Shrieking at people who don't want to spend their money the way you want them to spend it.
posted by "Tex" Connor and the Wily Roundup Boys at 6:31 PM on January 18, 2008

"That might make you feel better, but it really makes very little sense. Any dollar is as good as any other for buying health care. However you make your money, you can spend it buying health care for indigents. Hospital dollars aren't at all special in that respect."

They are in that they've been committed to the mission of caring for people. They are, demonstrably, not.

Further, and this is for PhiBetaKappa as well, this is illegal. It's against the law here to dump patients, in part because by doing so it passes the burden of care onto other hospitals. I'm also amazed that they were willing to discharge you, PBK, without a ride—every single surgery I've had (though I haven't had many) has required that I have transportation as a condition of my discharge.

At the very fucking least, this callous treatment is unnecessary, and is born from laziness and a lack of human compassion. That alone is enough to inveigh against it.

ps for Tex—You didn't understand how I could call you a crypto-con? That you're presenting the dumping of patients as the best possible solution and blasting folks who disagree for "hypocrisy" counts for more with me than your vague support of universal health care.

Fundamentally, this is not something a civilized nation should tolerate, and the answer is likely to be large and structural, not a bunch of MeFites tossing a dollar in a pot to appease whatever bullshit moral purity is necessary to find this cruelty detestable.
posted by klangklangston at 6:32 PM on January 18, 2008 [2 favorites]

Well, for one they didn't give him his clothes back. And by soiled garments, i take it they didn't bother even talking to him or trying to contact someone to find out where he should go.

Since he was described as Mentally Ill and Paraplegic, one would assume he was not capable to be left on the curb, with no means of location. He was not just some homeless person, who could walk himself back to wherever he was going. He was found crawling on the street. How hard would it have been for the hospital to call around and find a shelter that could have picked him up, instead of deciding to drop him off within view of one. They did this so they could clear a bed of a non paying patient and put another one in.

PhiBetaKappa- I have no problem that you were left to your own devices to get home, since besides having a knee surgery, you didn't describe yourself as needing any other care for ongoing issues. So I assume you were financially and mentally able to coordinate your own transportation.
posted by mrzarquon at 6:34 PM on January 18, 2008

"Both are great options! Do you know what's not a great option? Shrieking at people who don't want to spend their money the way you want them to spend it."

Hey, you know what's an even worse option? Shrieking at people who do want to spend socially in order to fix a social problem! I mean, if you actually do care about these folks, and aren't just playing the ol' "Complaining on MeFi doesn't change things" card.
posted by klangklangston at 6:35 PM on January 18, 2008

ps for Tex—You didn't understand how I could call you a crypto-con? That you're presenting the dumping of patients as the best possible solution and blasting folks who disagree for "hypocrisy" counts for more with me than your vague support of universal health care.

I never said that it was the best possible solution.

Shrieking at people who do want to spend socially in order to fix a social problem!

I didn't do this.

klang, I'm really starting to wonder whether there's something odd going on with Metafilter that makes my posts show up very differently for you than they do for me.
posted by "Tex" Connor and the Wily Roundup Boys at 6:41 PM on January 18, 2008

Tex, can I ask why you wouldn't want to spend your money on this? Why you'd resist government provided health care, funded by tax payers? We've clearly hit an impasse, so I'd be interested in knowing a little more about where you're coming from with this. It's got to be a bit more than just "not my problem", right?
posted by twirlypen at 6:41 PM on January 18, 2008

And Tex, to clarify my position -- you've characterized this as something people may choose to spend their money on, but in my mind it is no different from me choosing to pay for your expensive chemotherapy treatments. I don't see the hypocrisy in being upset that the system we have now provides for one, but not the other.
posted by PercussivePaul at 6:45 PM on January 18, 2008

I'm not sure why we're so convinced that complaining on MeFi doesn't change things. By itself, complaining on MeFi isn't going to help the situation, but the only way that things change is if people point out the problem and offer possible solutions. Slowly but surely, the American population does seem to be coming over to the side that says that we need to do something about how we provide healthcare and other social services. That's only true because people are talking about the problem. Nothing is ever going to change if we shut up and cast our eyes down and accept our plight, the way Tex seems to want. "Whining" is the only way things get changed. And people who object to whining generally don't want real change.
posted by craichead at 6:47 PM on January 18, 2008 [1 favorite]

Tex, can I ask why you wouldn't want to spend your money on this? Why you'd resist government provided health care, funded by tax payers?

I said that I support "publicly funded universal health care," and I honestly don't see what this can be taken to mean except "government health care, funded by tax payers."

Let me clarify. I support publicly funded universal health care. By that, I mean that I support a law that would obligate the federal government to spend a certain amount of money to assure a basic standard of medical care for everyone found within the borders of the United States.

However, until such a system is put in place through a duly enacted law, I don't recognize a general obligation to buy other people health care. Some people seem to, and I'm suggesting that they are just as capable of buying other people health care as anyone else, so they should probably pony up.
posted by "Tex" Connor and the Wily Roundup Boys at 6:51 PM on January 18, 2008

"I never said that it was the best possible solution. "

Well, see, you keep saying that people need to either get together and get a law passed that funds this care, while ignoring the fact that there's been a law passed that prevents this patient dumping, which seems weird especially in the context of defending the hospital's not allocating their resources to comply with this law, and seemingly implicitly arguing against the lawsuit brought by the dumped patient. So, you seem to be arguing against the remedies already in place, while arguing that those remedies need to be legislated. If what's happening is already what should legally be happening, why does it seem (not just to me) that you keep trying to argue that it's somehow the job of everyone who thinks that the hospital violating both law and morality to care for these people?

Again, it seems to me that you're arguing for what the situation was prior to the passage of the legislation, and I can't imagine you arguing for something that you didn't think was the best possible solution.

And you shrieked as much as anyone else shrieked. Keep your rhetoric turned down if you don't like bein' called on it.
posted by klangklangston at 6:53 PM on January 18, 2008

"However, until such a system is put in place through a duly enacted law, I don't recognize a general obligation to buy other people health care. Some people seem to, and I'm suggesting that they are just as capable of buying other people health care as anyone else, so they should probably pony up."

That's kinda an amoral and counter-productive perspective there, Tex.
posted by klangklangston at 6:58 PM on January 18, 2008

Well, see, you keep saying that people need to either get together and get a law passed that funds this care, while ignoring the fact that there's been a law passed that prevents this patient dumping

Are you talking about EMTALA? My understanding is that this only applies to emergency care (hence the "E"). There's no indication in the article that Olvera was in need of emergency medical care.
posted by "Tex" Connor and the Wily Roundup Boys at 7:04 PM on January 18, 2008

"Kaiser admitted the woman on March 17, after she was brought in by ambulance, with a diagnosis of dementia. She had lived in a park and made money by collecting and recycling bottles and cans. When Kaiser discharged her after three days, she was described as “forgetful,” “disoriented,” and “non-talkative.” But her condition didn’t stop the personnel at Kaiser from sending her away in a taxi (without her clothes, about which she apparently inquired) to a location 16 miles away.

A local mission in the area took her in, but three days later, while in the bathroom, she lost consciousness, and sustained a head trauma when she fell. She was transported to Los Angeles County-USC Medical Center, where she was diagnosed with pneumonia, anemia, dementia, and a progressive brain dysfunction, and was hospitalized for at least 45 days."

I don't recognize a general obligation to buy other people health care.

Christ, man, you're already paying for it.

Kaiser didn't want to pay for her care, so they dumped her. She ended up at a publicly financed hospital for 45 days - so who ended up paying? Yeah. Not the private insurance company. Taxpayers. Taxpayers like Tex.

When hospitals dump patients - especially private hospitals - they push the cost into the public sector. You will pay: either your taxes will go up, or your services down, or both.

You can pay a little now, or a fuckload later. Your choices do not include not paying. Right now, the big hospital industry is ducking out on paying - paying for something they explicitly and deliberately have chosen to do (taking care of sick people). They are pushing the cost - which you did not explicitly sign up for - on to you. You have to pay for it because the industry won't. How does that make any fucking sense? Still all "whatever" about patient dumping?

A shared load is lighter load. How is that not obvious? I mean, that's how private insurance works, so why couldn't it be a publicly shared burden, as it is in places like Canada?
posted by rtha at 7:04 PM on January 18, 2008 [3 favorites]

This is a bit of an aside, but as a resident of British Columbia, I am required to pay the Medical Services Plan premium of $54 a month. If I made less money, like when I was a student, or worked for Intrawest (bastards), I was eligible for premium assistance. The indigent receive 100% assistance. What do British Columbians get for this? Universal care, for everyone, and it's pretty decent care too. That California, one of the richest and most liberal states in the union can't or won't do this for its citizens is appalling.
posted by [expletive deleted] at 7:09 PM on January 18, 2008

Christ, man, you're already paying for it.

I misspoke. I should've said "general obligation to voluntarily buy," but I thought it would've been clear from context. Obviously I recognize that tax money already goes to buy some people some health care.

A shared load is lighter load. How is that not obvious? I mean, that's how private insurance works, so why couldn't it be a publicly shared burden, as it is in places like Canada?

I've already repeatedly said that I support publicly funded universal health care. I don't think we really have a disagreement.
posted by "Tex" Connor and the Wily Roundup Boys at 7:11 PM on January 18, 2008

What does 'elder abuse' mean? The story says the guy is 42!
posted by woodblock100 at 7:40 PM on January 18, 2008

What does 'elder abuse' mean? The story says the guy is 42!

It means his lawyer is throwing everything he can think of at the defendant in the hope that something sticks.
posted by "Tex" Connor and the Wily Roundup Boys at 7:43 PM on January 18, 2008

Most hospitals have at least one social worker who, if competent, should have a list of resources at hand. These resources should include the public assistance provided by the state or llocal government and the private assistance provided by charitable foundations, churches, and entities like the Red Cross and the Salvation Army.

Most benevolence boards of churches have emergency funds that could have provided temporary assistance with lodging and food.

Somebody failed to do his/her job.
posted by francesca too at 7:44 PM on January 18, 2008

"Are you talking about EMTALA? My understanding is that this only applies to emergency care (hence the "E"). There's no indication in the article that Olvera was in need of emergency medical care."

Two things—First off, the charges around Olvera are based on state law, primarily unfair business practices and failure to provide adequate care. City prosecutors have filed. Second off, if you read the definition of "emergency," you'll see that leaving a paraplegic in a hospital gown with a colostomy bag could pretty clearly be read as "absence of immediate medical attention [that] could reasonably be expected to result in placing the individual's health … in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs."
posted by klangklangston at 7:49 PM on January 18, 2008

As for Tex - that's just Tex being Tex MPDSEA. FTFY.
posted by stet at 8:55 PM on January 18, 2008

i say we bundle tex up and leave him at fark
posted by pyramid termite at 9:03 PM on January 18, 2008 [1 favorite]

Even if the US had universal health care like Canada, they still couldn't let the homeless guy live at the hospital. They have to do something with him - they need those beds for the incoming sick patients. What if there is no room at the shelters? What if the shelters won't take him because he has a drug problem or can't care for himself? This isn't necessarily a health care problem, it's a homeless problem. What does Canada do with homeless patients after they've been discharged from the hospital?
posted by Oriole Adams at 9:10 PM on January 18, 2008

Canada gets them high and then marries them to a member of the same sex, making it a domestic issue.
posted by klangklangston at 9:12 PM on January 18, 2008 [1 favorite]

What does Canada do with homeless patients after they've been discharged from the hospital?

We send them on their way. If they're disabled in some way, they're given some means to offset the disability.

There was a major hue and cry not long ago over a patient who was discharged without the staff ensuring she knew where she was going, and with no follow-up. She ended up home via public transit, but it took a while and in a circuitous route because she wasn't 100% there. Heads rolled as a result, and rightfully so.

Current wait times for specialists in Canada aren't great, but they're improving. It used to be 18 months before you could see an orthopedist. Now it's 2-3 months, at least in British Columbia.

I've never been a fan of entirely privatized medicine. You still have to deal with fuckheads in the system like in universal health care but you also have to get a second mortgage on your house for the privilege.
posted by illiad at 10:46 PM on January 18, 2008

Tex: I said that I support "publicly funded universal health care," and I honestly don't see what this can be taken to mean except "government health care, funded by tax payers."

Come visit some European countries, for example the Netherlands. Government doesn't provide health care insurance and funding, private insurance companies do. All government does is set regulations on what health care is and what must be covered by the insurance companies. Some tax money goes to infrastructure, but it sure isn't "government health care, funded by tax payers."

Oh, and it works. A few waiting lines exist for a very short list of procedures, but we have a much, much lower cost per capita than the US, and we don't dump homeless people on the street.
posted by DreamerFi at 12:49 AM on January 19, 2008

I see I forgot to mention *everybody* is insured. One of those regulations.
posted by DreamerFi at 12:50 AM on January 19, 2008

So Tex, if I understand your position right, what you're saying is: we should go get universal health care passed and signed into law. But until we do, we shouldn't talk about it. And if I do talk about it beforehand and I'm not giving random poor and sick people money out of my own wallet, then I'm a hypocrite. Is that right?

First of all, if you're also in favor of universal health care, why don't you go and get it passed as law?

Second of all, do you really not see how unhelpful this is? Try answering every AskMe this way: "well, go get a law passed! Oh you can't? Well then I guess not everyone agrees with you. No sense complaining about it!"

Making a fuss about egregious cases like this is one way to push the agenda of universal health care. So getting it passed into law is what people are doing right now when they shriek about this case.

As others have mentioned, there already seem to be laws against what the hospital did. Step 1 is enforcing these laws better through public outrage, step 2 is to recognize that these sorts of laws will never be sufficient in practice as long as health care providors still conceive themselves as private for-profit businesses. There will always be corner-cutting when it comes to poor people.
posted by creasy boy at 1:05 AM on January 19, 2008

DreamerFi: broke people on welfare have health insurance in Germany, and it was my assumption that the government paid for this. Are you saying this comes out of the insurance companies' pocket?
posted by creasy boy at 1:08 AM on January 19, 2008

third-world country, third-world solution
posted by blacklite at 2:05 AM on January 19, 2008

rtha writes "Right now, the big hospital industry is ducking out on paying - paying for something they explicitly and deliberately have chosen to do (taking care of sick people). They are pushing the cost - which you did not explicitly sign up for - on to you. You have to pay for it because the industry won't. How does that make any fucking sense? "

Bingo, cost socialization, which is one of the rational choices avaiable to any company, whose purpose is often considered to be profit maximization , but that is a misconception as pointed out by many scholars, including in my experience those italian scholars who support the idea of company as a "wealth generator" whose purpose is to survive and keep on turning out profits, as constantly as possible.

The objective of profit maximization can be incompatible with that of making the company survive, but what possibly escaped (I didn't read all their literature) to these and other scholars is that , if the effects of the destruction of an economically sound company aren't directly paid by those who manage the said company, they may decide to fly it into the ground (make it fail) if that allows them to maximize their personal profit (Wall Street movie, anyone?)

Rumor has it that one of the richest companies in Italy, the ex-state monopolist Telecom Italia, with an immense real estate capital , most extended telephone network and a wealth of hired competencies, were "sold" (there are aspect that make this not stricly a full transfer of property) for a dime to private profiteers during the privatization fever. These infrastructures were paid by entirely by italians by dint of a fixed monthly amount, so called "canone" , which is what you paid to access the network whether you used it or not and which many italians still pay.

Today, telecom is heavily in debt , possibily to buy the consensus of bankers who definitely like to extract fat interests from an heavily indebted, but very soluble company.

This is anything, but capitalism in the romantic conception often popularized, the one of the austere hard working hat wearing director, slowly but steadily enriching himself and all the surroundings by offering new or less expensive goods, new job positions, new opportunity, generally being a net positive influence.
posted by elpapacito at 2:28 AM on January 19, 2008

Are you saying this comes out of the insurance companies' pocket?

No, it doesn't. Their insurance premium is paid for by the government, either directly or via the welfare checks.

Note that in a country of 16 million, there's currently about 330,000 people who get the minimum welfare standard called "Bijstand". And all of those 330,000 are insured.
posted by DreamerFi at 3:15 AM on January 19, 2008

I think the point Tex is trying to make in a somewhat roundabout way is that passing laws against dumping by hospitals as a public health policy makes about as much sense as solving the problem of hunger by passing a law that forbids restaurants from refusing to serve people simply because they can't pay. Yes, it will work, to some extent, but any smart restauranteur will do his best to encourage the indigent to head elsewhere.

Effectively, the United States does have universal health care: laws that forbid hospitals from refusing to treat people because they can't pay. We just have a strange way of funding it: it's funded by whoever is left holding the bag, and that entity is SOL.

Everyone's a part of the system. Those of us who pay our hospital bills are subsidizing those of us who don't.
posted by alexei at 4:42 AM on January 19, 2008

Big goverment's not the problem—bad government's the problem

Show me a government (ours or 3rd world) that isn't bad. When we give all the power to one entity--whether it be government or a corporation---expect crap. I just hope we can find a compromise between the two and provide a basic need. People should never have to choose between paying for their doctor bill or their mortgage.

That's it. I'm going to live in a tree in Tahiti. :)
posted by dasheekeejones at 5:34 AM on January 19, 2008

Effectively, the United States does have universal health care: laws that forbid hospitals from refusing to treat people because they can't pay. We just have a strange way of funding it: it's funded by whoever is left holding the bag, and that entity is SOL.

I think (hope) you're being facetious, but that is not universal health care. Quite a few health problems are 'non-emergency' until it's too late, or cause significant quality-of-life issues. (Significant as in, driving one to suicide, or other self- or other- destructive behavior - and not limited to mental health problems, either.) If you want to argue that those of us with critical but non-urgent health care needs aren't worth the system's time, go ahead - but what we have now is not universal by any rational meaning of the word.
posted by spaceman_spiff at 5:42 AM on January 19, 2008

Quite a few health problems are 'non-emergency' until it's too late,

One of the interesting side effects of the way we've got our health care regulated over here is that it is in the interest of the insurance companies to make sure everybody get the best possible first line health care. As a result, if you want to stop smoking, it pays to give your insurance company a call, odds are they have a program to help you stop, and the program is of course free. Another result I heard on the radio last week: they're starting a program in primary education to increase dental checkups.

They cannot deny health care to you, so they have to pay either way, and if it's cheaper to have a few checks upfront that prevent expensive care later on, that's what they'll do.

So, dear US friends, whatever the politicians promise you, make sure their plans result in a system where it is in the best interest of the insurance company to give you good care.
posted by DreamerFi at 6:25 AM on January 19, 2008

Oriole Adams is right that this isn't necessarily indicative of a healthcare problem, but a homelessness problem. And a general social services problem. Social workers everywhere are overloaded with cases, every American city is full of homeless people, we have issues with poverty and crime, and eventually all these interconnected problems end up in the emergency room. The fact that we don't help people before they wind up in the hospital costs us - in money, because emergency care is very expensive, in quality of life, and in credibility.

A reasonable social services system and decently funded mental health services that all talk to each other would take a huge load off emergency rooms - thus shortening the wait and lowering the bills for all the self-righteous "i can pay for my own care" folks.
posted by Mr Bunnsy at 7:00 AM on January 19, 2008

"Show me a government (ours or 3rd world) that isn't bad."

Frankly, the US government is pretty good, these last seven-and-change years aside. There's some corruption and bloat, but in general we're pretty good at both protecting civil liberties and individual rights. We could, of course, be better—I think Canada does a better job at taking care of social welfare, and has a better handle on some civil issues (gay marriage, drugs), but a worse handle on some things (free speech, particularly pornography). Sweden, Norway and Denmark all do a pretty decent job. Hell, most first world governments do, if you're not living in a libertarian fantasy land.

The friction, for me, comes from the basic expectation that we shouldn't just be pretty good, or not bad, but that America should have the absolute best government and society on earth. We can learn plenty from things tried in other countries, but I fundamentally believe that we should make every effort to lead, to make our citizens the happiest, most prosperous and most free in the world. That's why things like patient dumping piss me off—we should be better than that. That's a failure. It's not fucking Haiti, where Olvera would have probably never been heard from again (had he received any care at all), but we shouldn't be comparing ourselves with Haiti.

But to pretend that there aren't any governments that aren't bad governments is some sort of anarcho-fantasy bullshit that's only possible when you live in a place that has a good government.
posted by klangklangston at 12:50 PM on January 19, 2008 [1 favorite]