California Homeless Discharge Law

Started by GeneralVeers
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GeneralVeers

GeneralVeers

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This couldn't happen to a better state! (well maybe New York)

In California, as of July, hospitals can't discharge homeless people to the street, or just send them in a taxi to a shelter. They will be required to document that the patient was fed, clothed, and had a safe place of discharge, as well as any appropriate medications prior to discharge. The state has provided no additional funding to find these people a place to go.

This can only end well!

www.healthleadersmedia.com

California Imposes More Rules on Homeless Patient Discharges

Hospitals had opposed the measure, arguing that they do not 'dump patients.'
www.healthleadersmedia.com www.healthleadersmedia.com
journals.lww.com

News: California Law Setting Discharge Rules for Homeless... : Emergency Medicine News

An abstract is unavailable.
journals.lww.com journals.lww.com
 
Probably a bunch of right wing nuts wrote this law thinking they could buy off Social Justice with mere trinkets. At the very minimum hospitals should be required to give these valued self-pay homeless customers a college degree and a lifetime pension upon discharge as well. I think anything short of that is pretty racist and sexist and probably a whole bunch of other double-plus-ungood words too. I mean if you don't get housing and a pension what's even the freakin' point of going to the hospital in the first place??

Consider me offended.
 
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southerndoc said:
This + Medicare For All + EMTALA = great times for hospitals!
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When a bunch voter’s kids with asthma, granmmas with copd and mvcs with broken arms sit in a lobby for 2 days because the rooms are full of homeless guys 3wks into their wait for for a shelter, it will go away

Or maybe every hospital builds a shelter, d/c to shelter. Then the shelter (who technically isn’t under the same rules) kicks them out in 24hrs
 
Hospitals will become de facto homeless shelters. This is already the case in NYC, where the homeless sit on the floor for weeks to months awaiting emergency Medicaid and emergency housing. Insane.

Medicine is becoming ridiculous.
 
miacomet said:
Hospitals will become de facto homeless shelters. This is already the case in NYC, where the homeless sit on the floor for weeks to months awaiting emergency Medicaid and emergency housing. Insane.

Medicine is becoming ridiculous.
Click to expand...

Same at our big county facility down here in Miami. Our IM service routinely has 50+ percent of the census as either homeless or currently residing in a shelter.
 
miacomet said:
Hospitals will become de facto homeless shelters. This is already the case in NYC, where the homeless sit on the floor for weeks to months awaiting emergency Medicaid and emergency housing. Insane.

Medicine is becoming ridiculous.
Click to expand...

I suspect this might be what they have to do. Hospitals band together and essentially create a giant centralized warehouse. If you allow no smoking, and no re-entry most of the homeless wouldn't stay long.
 
I work in CA. This law wouldn't bother me that much if it were for discharged INPATIENT patients, but it's for all.

Written by an Ophthalmologist / State Senator who was appalled when he saw homeless people discharged from the hospital without clothing (they were in hospital gowns), living under bridges and without their medicine.

I'd say in the winter time we went from having, on average, 2-3 homeless borders in our ER every night to about 5. hasn't made a huge impact yet.

But overall agreed it's a terrible law
 
turkeyjerky said:
This isn't socialism--this is gross misallocation of resources, a classic problem of late stage capitalism
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In a random internet forum such as this one, we can easily laugh and ridicule nonsensical statements like the one above and dismiss them out of hand for the inanity that they are.

The terrifying thing about the world outside of the isolated ghetto the "free internet" has been reduced to is that the left controls literally every microphone and those microphones are continually blasting insane inversions of reality unto the population at maximum volume with nothing to challenge them. The mass media, the entertainment industry, the universities, every large institution involved in shaping the public's perception of the world is controlled by the Left and continually pumps this inverted poison into the minds of impressionable people.

Turkeyjerkey can repeat his absurd interpretation of reality however many times he wants but he won't get anywhere here on SDN because his microphone is no bigger than anyone else's. Out there, when you have the NYT, CNN, MSNBC, CNBC, etc blasting drivel 24/7, well, we're screwed.
 
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www.whitecoatinvestor.com

12 Reasons California Is a Terrible Place for Doctors to Build Wealth | White Coat Investor

Just how difficult is it for a physician to build wealth while living in California? Here are 12 reasons the economic costs may be too high to call it home.
www.whitecoatinvestor.com www.whitecoatinvestor.com

Just finished reading this WCI article from over on the med student forums... looks like it's due for an addendum.

"
# 12 Crazy Legislature/Laws
The California legislature is not known to be a particularly physician friendly body.
"
 
Scribe4Life said:
www.whitecoatinvestor.com

12 Reasons California Is a Terrible Place for Doctors to Build Wealth | White Coat Investor

Just how difficult is it for a physician to build wealth while living in California? Here are 12 reasons the economic costs may be too high to call it home.
www.whitecoatinvestor.com www.whitecoatinvestor.com

Just finished reading this WCI article from over on the med student forums... looks like it's due for an addendum.

"
# 12 Crazy Legislature/Laws
The California legislature is not known to be a particularly physician friendly body.
"
Click to expand...

It's truly a crazy place, but I completely support California enacting every costly, insane proposal like high-speed rail, welfare benefits for illegals, Medicaid for all, sanctuary state, etc....as a lesson to the nation at large of the folly of the programs.

The only reason they are free to pursue this insanity and haven't gone bankrupt yet is Silicon Valley and the taxes generated by those companies. It's ironic that free(ish) market capitalism is propping up the socialist state. Just wait until the next downturn, and watch as California collapses. They had better hope that many of these companies don't get wise and move on to greener, cheaper pastures like NV, TX, or FL.
 
GeneralVeers said:
The only reason they are free to pursue this insanity and haven't gone bankrupt yet is Silicon Valley and the taxes generated by those companies. It's ironic that free(ish) market capitalism is propping up the socialist state. Just wait until the next downturn, and watch as California collapses. They had better hope that many of these companies don't get wise and move on to greener, cheaper pastures like NV, TX, or FL.
Click to expand...

Silicon valley is one of the reasons why California has a 21B budget SURPLUS this year!
 
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Booze Aldrin said:
In a random internet forum such as this one, we can easily laugh and ridicule nonsensical statements like the one above and dismiss them out of hand for the inanity that they are.

The terrifying thing about the world outside of the isolated ghetto the "free internet" has been reduced to is that the left controls literally every microphone and those microphones are continually blasting insane inversions of reality unto the population at maximum volume with nothing to challenge them. The mass media, the entertainment industry, the universities, every large institution involved in shaping the public's perception of the world is controlled by the Left and continually pumps this inverted poison into the minds of impressionable people.

Turkeyjerkey can repeat his absurd interpretation of reality however many times he wants but he won't get anywhere here on SDN because his microphone is no bigger than anyone else's. Out there, when you have the NYT, CNN, MSNBC, CNBC, etc blasting drivel 24/7, well, we're screwed.
Click to expand...

You post a lot of inane ramblings, but at least I slightly agree with you about the leftist lean on society at large lately. No more than that and not to the degree you say, but a lean.
 
GeneralVeers said:
I suspect this might be what they have to do. Hospitals band together and essentially create a giant centralized warehouse. If you allow no smoking, and no re-entry most of the homeless wouldn't stay long.
Click to expand...

They’ll call 911 and come back to the ED again.

This really incentivized abuse of ambulance services and the ED. Now you can’t be discharged without food, clothes, meds, and a place to go.

The hospitals will come up with a work around. Say, create a discharge/hold room for pending social issues. If they leave the room, they are considered to have left against medical/social advice, and be trespassed from the property. They cannot enter the ED unless anMSE determines they have an emergent medical condition.

I also think using the MSE to send people out will become more used. Does the bill address the hospital’s requirement if a MSE determines they have no emergent medical condition? Are they still required to provide the above social items?
 
Perrin said:
I also think using the MSE to send people out will become more used. Does the bill address the hospital’s requirement if a MSE determines they have no emergent medical condition? Are they still required to provide the above social items?
Click to expand...

It doesn't specify. Essentially once on hospital property the hospital "owns" them and can't discharge without meeting the guidelines stipulated by the bill. Once the homeless find out about this, things are going to get very interesting in CA. It'll be like a scene from the walking dead as every homeless, drug addict, and meth head descends in waves on the hospitals.
 
Yeah, but there's a workaround. Oh, you've been MSE'd and have no emergent medical condition. You're welcome to wait in the lobby until there are literally no other patients, and then you can be seen. If you leave prior to that, you'll need a new MSE.
 
miacomet said:
Hospitals will become de facto homeless shelters. This is already the case in NYC, where the homeless sit on the floor for weeks to months awaiting emergency Medicaid and emergency housing. Insane.

Medicine is becoming ridiculous.
Click to expand...

Sadly this is the case at many inner city hospitals.

Night shifts at my hospital are routinely 50%+ homeless especially during the winter months.
 
Dr.McNinja said:
Yeah, but there's a workaround. Oh, you've been MSE'd and have no emergent medical condition. You're welcome to wait in the lobby until there are literally no other patients, and then you can be seen. If you leave prior to that, you'll need a new MSE.
Click to expand...

Unfortunately many ER docs are too scared to MSE anyone let alone someone living on the street with chronic medical problems. The patients aren't stupid either and know how to say the right things. Oh the rash or cough only bought me an hour and a sandwich yesterday lets spice things up today with chest pain, arm numbness, or vision loss.
 
alpinism said:
Unfortunately many ER docs are too scared to MSE anyone let alone someone living on the street with chronic medical problems. The patients aren't stupid either and know how to say the right things. Oh the rash or cough only bought me an hour and a sandwich yesterday lets spice things up today with chest pain, arm numbness, or vision loss.
Click to expand...

You have to be careful with this. If an abdominal "cramps" with nausea, vomiting, and diarrhea ends up having appendicitis, then you've committed an EMTALA violation. You'd be surprised at what CMS views as EMTALA violations. It's not just the unstable/sick people. Undiagnosed/untreated appendicitis is a violation. As is not ordering a head CT quick enough for a headache in the waiting room who turns out to have a SAH.

When the lady from our local CMS came to give us a talk on EMTALA, I could've used a nitro and a Xanax. Seriously, it was that bad what they view as EMTALA violations. Even calling to ask for a transfer, you review the films (from a sister hospital), and tell them they don't need transfer because you would discharge that patient if seen primarily? EMTALA violation. If they ever request a transfer, the only acceptable answers are "yes, we'll take it" or "no, we do not have capacity to safely treat the patient at this time."
 
Veil said:
You post a lot of inane ramblings, but at least I slightly agree with you about the leftist lean on society at large lately. No more than that and not to the degree you say, but a lean.
Click to expand...

What is the leftist lean/control of society I always hear about? Last time I checked the conservative party in politics control the executive, the judiciary, and the senate (so 3 out of 4 branches of federal government), the majority of state governorships, including the majority of state trifectas (control of governorship, state senate, and state house of reps).

Furthermore the most popularly watched news media station in the country by a considerable margin (Fox News) is famous for a hard right bias. The most popular cable news show is hosted by a Sean Hannity (again a well known 'leftist').
 
I'm also delighted that this garbage unfunded mandate isn't happening in a state I work in. We need more cautionary tales of what happens when *****s who have no relevent experience treating patients get to dictate health policy.

I worked at a non-profit that served the homeless. In my experience, people who are homeless often come in three flavors:

1) people who are recently out of work or unable to work (due to childcare issues, disability, etc) but would happily work to get off the streets

2) people too impaired to escape being homeless (drug, alcohol, psych issues) but otherwise actually wish to work

3) people who wish to be homeless rather than work (and they may also happen to have drug, alcohol, psych issues)

I suspect the group who would primarily abuse this CA law would mostly be the third group and some of the 2nd.

If I was a CA hospital I would require these "patients" awaiting social dispo be required to assist the hospital custodial staff as part of their treatment plans. At least then you could achieve a functional improvement in the lives of these patients.
 
Perrin said:
I also think using the MSE to send people out will become more used. Does the bill address the hospital’s requirement if a MSE determines they have no emergent medical condition? Are they still required to provide the above social items?
Click to expand...

It’s for all “discharged” patients. Homeless person comes in because his lipoma is painful. You discharge him because he has no EMC. Thusly he falls under this statute.
 
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The Knife & Gun Club said:
Wow that is one remarkably short sighted piece of legislation.

What the hell do you do in a city like San Fran that has a gigantic homeless population and no shelters for them to go to? Just let them all live in the hospital?
Click to expand...
California has some of the highest taxes in the nation and where does the money go?
Not to helping the homeless and certainly into the pockets of the politicians. The Democrats promise Utopia, raise your taxes to punitive levels, social problems metastasize, the money disappears and their brilliant rescue plan is to dump the problem on emergency rooms?

100% appalling.
0% surprising.
 
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RoyBasch said:
the executive, the judiciary, and the senate (so 3 out of 4 branches of federal government)
Click to expand...
Increase my civics knowledge, if you will. As I was educated in elementary school going forward, and right from the US Constitution, there are 3 branches of government. What is the 4th?
 
Birdstrike said:
California has some of the highest taxes in the nation and where does the money go?
Not to helping the homeless and certainly into the pockets of the politicians. The Democrats promise Utopia, raise your taxes to punitive levels, social problems metastasize, the money disappears and their brilliant rescue plan is to dump the problem on emergency rooms?

100% appalling.
0% surprising.
Click to expand...

A huge amount goes to pension plans like CALPERS. These incredibly generous pensions fund employees well over six figures in retirement. By state law they can't be changed retroactively or amended. The rest goes taking care of the hordes of dependents. California has 25% of all the homeless, and 30% of all the welfare recipients in the country. That's not to mention all the illegals getting driver's license, schooling and social services, while paying nothing directly back in income taxes.

As I said, the only thing keeping the company afloat is Silicon Valley.
 
California has always been a desirable place to live. People will come here regardless of income taxes, amount of crime, number of illegals, etc. It's beautiful here and there are fun cities. People have been saying forever that the high income taxes will drive out the weathy, and they keep on coming in and staying here, year after year after year.

California Budget Allocation:
budget-figure-1-1.png


~ 55% just to education. And our system ain't that good
 
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While this is relevant to medicine, it's less relevant to EM based on the political nature. Thus, moving to Topics in Healthcare.
 
GeneralVeers said:
A huge amount goes to pension plans like CALPERS. These incredibly generous pensions fund employees well over six figures in retirement. By state law they can't be changed retroactively or amended. The rest goes taking care of the hordes of dependents. California has 25% of all the homeless, and 30% of all the welfare recipients in the country. That's not to mention all the illegals getting driver's license, schooling and social services, while paying nothing directly back in income taxes.

As I said, the only thing keeping the company afloat is Silicon Valley.
Click to expand...
Sounds like quite a mess.
 
thegenius said:
California has always been a desirable place to live. People will come here regardless of income taxes, amount of crime, number of illegals, etc. It's beautiful here and there are fun cities. People have been saying forever that the high income taxes will drive out the weathy, and they keep on coming in and staying here, year after year after year.

California Budget Allocation:
budget-figure-1-1.png


~ 55% just to education. And our system ain't that good
Click to expand...
I think the wealthy come as you say due to good jobs and weather. The only reason the state is successful it’s the nature side of it. The government is awful and the polar opposite version of terrible that the state of West Virginia is.

IE both are equal amounts of suck just hanging off the opposite ends of the earth
 
Birdstrike said:
California has some of the highest taxes in the nation and where does the money go?
Not to helping the homeless and certainly into the pockets of the politicians. The Democrats promise Utopia, raise your taxes to punitive levels, social problems metastasize, the money disappears and their brilliant rescue plan is to dump the problem on emergency rooms?

100% appalling.
0% surprising.
Click to expand...

I love it how Californians always bash the Midwest and south yet their state is no better ran than ours and they pay more in taxes.

Can’t even change your water heater settings without a plumber. Such a scam of a state
 
GeneralVeers said:
This couldn't happen to a better state! (well maybe New York)

In California, as of July, hospitals can't discharge homeless people to the street, or just send them in a taxi to a shelter. They will be required to document that the patient was fed, clothed, and had a safe place of discharge, as well as any appropriate medications prior to discharge. The state has provided no additional funding to find these people a place to go.

This can only end well!

www.healthleadersmedia.com

California Imposes More Rules on Homeless Patient Discharges

Hospitals had opposed the measure, arguing that they do not 'dump patients.'
www.healthleadersmedia.com www.healthleadersmedia.com
journals.lww.com

News: California Law Setting Discharge Rules for Homeless... : Emergency Medicine News

An abstract is unavailable.
journals.lww.com journals.lww.com
Click to expand...


Love how the government puts out laws without money to back it or sweat from their shoulders. If Bernie sanders won president this would be in every state
 
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Cheeni17 said:
I love it how Californians always bash the Midwest and south yet their state is no better ran than ours and they pay more in taxes.

Can’t even change your water heater settings without a plumber. Such a scam of a state
Click to expand...
If I'm paying the highest taxes in the country, I don't want to have to download a snapcrap app to help me navigate the treacherous, winding road between piles of human feces. At least include snapcrap when I register my license plate. That's the least they could do.

And trust me, this problem can be solved very quickly. If the homeless tent cities set up shop in the politicians front yards, the problem would get fixed so fast, your head would spin.

'SnapCrap' app invites San Francisco residents to report poop on city streets
 
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It's odd to me how excited people from other states get when talking about California. Why do you care so much?

I can't tell if NYC or CA gets outsiders more worked up over nothing (ie the complainers don't live in either).

HH
 
Hamhock said:
It's odd to me how excited people from other states get when talking about California. Why do you care so much?

I can't tell if NYC or CA gets outsiders more worked up over nothing (ie the complainers don't live in either).

HH
Click to expand...
Because if we let go as is other states might think it’s a good idea and follow suit
 
Hamhock said:
It's odd to me how excited people from other states get when talking about California. Why do you care so much?

I can't tell if NYC or CA gets outsiders more worked up over nothing (ie the complainers don't live in either).

HH
Click to expand...

I love how they also never complain about the Federal Government taking tax dollars from Californians and sending it to the same states that complain the loudest. CALIFORNIA IS SOCIALISTIC AND SOCIALISM IS BAD... (now please give us more money from the Federal Government so that we don't have to pull up our boot straps fund our own state government).

Yes, this plan is stupid, but there's a reason it's "California Dreaming" and not "Alabama Dreaming." That's not even commenting on states like Texas, where the most cherished place in Texan history is where a bunch of Mexicans killed a bunch of illegal immigrants.
 
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