A homeless man was discharged from the ER to a homeless shelter, where he died 12 hours later:

Monitor reporter Sarah Leibowitz was at the shelter when the 66-year-old Arsenault arrived. Its volunteers and residents were shocked at his condition. He was in hospital pajamas. He could not sit or stand and at times appeared unaware of his surroundings. He died 12 hours after a taxi dropped him off.

In this collapsing, cost-shifting semblance of a health care system, patients are being discharged sicker every year. They are released before they can walk, feed themselves or go to the bathroom without assistance. Some have no home or family, no money and no way to qualify for intermediate care.

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  • Anonymous

    This is a sad but true statement: My hospital would collapse if we didn’t treat homeless patients differently. We are a city hospital, have a 10 hour waiting room time, and patients languish in the ER for days waiting for beds. If a homeless patient has a “high risk” complaint (chest pain, abd pain) we usually discharge them to make room for the patients with “next of kin” who will sue. That’s not to say homeless people don’t have families who will come out of the woodwork to sue when they die. (Who usually haven’t spoken to them in 10 years). It’s just very unlikely. Every patient I see is a roll of the dice, a homeless guy is less likely to come up snake eyes. I know I’ll get slammed for this, bur the health care system has completely collapsed in my area, and this is our only way to continue functioning. IF anyone who works in an ER with 10-20 hour waits has a better idea, let me know.

  • Anonymous

    I don’t understand…why don’t you treat the homeless the same…just let them wait in the er for beds upstairs, when your er gets full, you get the head of the er to close the er, all other incoming are diverted to other er’s, why would you put yourself at risk? Am I missing something?

  • Anonymous

    We never go on diversion. We have such a large homeless population it would cause the system to completely collapse to admit them all. As it is, around 15% of patients who sign in to my ER leave without being seen. Additionally, so many homeless people sign into our ER for secondary gain issues (to get a meal, to get out of the cold, to watch TV) it’s impossible to tell who’s really having chest pain and who’s just looking for a bed and a meal. They used to let the homeless just hang out in our waiting room and watch TV, biw if they don’t sign in they kick them out, so they sign in. Again, not being cynical, just stating the facts. Nothing against the homeless, it’s just that they don’t have advocates, so they get overlooked in favor of those who do.

  • Anonymous

    “it would cause the system to completely collapse to admit them all”

    So what? You want to risk malpractice to save “the system”. Where I work we admit the people who need to be admitted. I think all of us remember as residents coming in in the morning and getting assigned the homeless person that hadn’t taken a bath in months/years, when you walked into the room the stench would cause you to vomit…the nurse or aide would scrub them down and the next day…smells like a baby! why are you practicing differently?

  • Anonymous

    I do not understand why MDs either have to ad a substandard label everyone or attach some percentage formula to them. I am not generaling about the profession just most of the ones that post here.

  • Anonymous

    Where I live people do not get turned away from the ER if they are homeless. EVEN IF THEY DON’T NEED MEDICAL CARE. The top floor of our hosp. is devoted to non ill homeless patients who have checked into the ER. They stay there until some other arrangements have been made for them, through SS or whatever.. I can’t imagine a health system that would put a potential heart attack, that is homeless to boot, back out on the street. In this country we actually do practice “Wait until they are down and then KICK.”

  • gasman

    And the people at the shelter were so shocked at his condition they did nothing until they noticed he was dead.

    Then in hindsight and to assuage their own guilt, they decide that someone else erred in sending him to the shelter. Somehow their foreknowlege of his condition prior to death without action is forgiven.

  • Anonymous

    “The top floor of our hosp. is devoted to non ill homeless patients who have checked into the ER. They stay there until some other arrangements have been made for them, through SS or whatever.”

    Do you practice in America? I knew I would get slammed for the homeless double standard. But it’s not me doing this practice, it’s the entire system. You’re lying if you tell me you treat homeless people exactly the same as the businessman with a Rolex. Again, I’m not saying I do this purposely, it’s another consequence of our sick, malpractice fearing healthcare system. There are five thousand homeless people in the shelter 5 blocks away. Admit them all?

  • Anonymous

    What the doc is doing above by discharging homeless drunks is no different then docs who change specialty to get out of high risks, Like OB’s who become solely Gyns, or docs who move from high malpractice risk states to low risk states. In any case, it’s risk avoidance and it’s what we all try to do to avoid the sodomites. Has anyone here actually been sued by the family of a homeless drunk?

  • Anonymous

    The first anonymous is a liar. Consistently.

  • Anonymous

    “Admit them all?”

    Yes! Why are you trying to fix the healthcare system and risking malpractice to do that? If you admit the patient, then it becomes somebody else’s problem…the bedboard administrator, the er administrator, the nursing supervisor…why is this your problem? You just make the decision to admit or not…no one can stop you from admitting a patient…granted , the patient might sit in the er or a hallway for days…but your covered.

  • Anonymous

    If I admit them, and we have no beds, it’s often my job to get on the phone and “sell” them to other hospitals. You people just don’t get it. You need to spend a week working in an ER with a 5000 person Homeless shelter down the street. I still haven’t heard from anyone who’s actually been sued by the family of a homeless person. And again, it’s not just me, it’s an unwritten rule of my and other) entire hospitals.

  • Anonymous

    what are you talking about? Every hospital has this problem! But we don’t discharge drunks with chest pain! Just wait until the next day, when all the BS admissions are discharged then you ship the patients upstairs, you have to coordinate with them medical housestaff!

  • Anonymous

    “But we don’t discharge drunks with chest pain!”

    You admit patients who come in almost every day (especially cold or rainy days) and say they have chest pain, have had clean coronary caths, and when you tell them they’re discharged for their chest pain they say, “OK, I’m suicidal then!” That’s what I deal with every day. When I discharge them, they’re only going across the street to stand in the road with their drinking buddies and beg for change. They can always come back if their pain gets worse, and I can do another EKG.

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