Special Report: Discharged and Dumped

- LITTLE ROCK, AR - Silent surveillance footage speaks to a problem homeless shelters like the Salvation Army say they have been facing for years.

"When they're dumped in that manner it's a scramble," said Tina McFadden, Salvation Army Director of Social Services.

"We don't know they're being discharged here and they're dropped off. We may be full, with no bed available, where does that leave the client being dumped?"

Shelter staff say the patient in the surveillance video is from The Bridgeway. According to staff she was discharged and dropped off in the shelter's back alley unannounced. The patient, according to the shelter, was unaware of where her end destination would be.

The van drove off, and she walked in alone.

"I can just imagine how they feel. I'm dropped off, and I'm not even taken into the building. That could be worked on," said McFadden.

"They may have already endured either a traumatic medical or mental health treatment. That's not an ideal situation and that's why we ask to be called."

According to McFadden, the Salvation Army received no heads up from the facility that this patient, and another the same day, were headed their way. That left staff with no knowledge of their needs, conditions or expectations of continued care.

It's a scenario the majority of shelters and homeless day centers in Little Rock say they are familiar with. And according to the Little Rock Compassion Center's Director Reverend William Holloway, it isn't a new phenomenon.

"I think there should be something better than what we're doing," said Holloway. "I have been doing this for going on 16 years in Arkansas, and it has been going on. I worked at shelters in Minnesota before that, and it was going on."

The Arkansas Department of Health requires hospitals and other healthcare facilities to have discharge planning policies on the books.

St. Vincent Hospital, UAMS, Arkansas State Hospital and Baptist Health all provided written policies to FOX16. The policies all outline that planning for discharge begins at admission, and direct staff coordinating with patients about their care upon discharge.

Some list specific guidance for homeless patient care coordination. Arkansas State Hospital, for instance, lays out step by step plans for working with a homeless patient, including not transferring them to a homeless shelter until coordination with shelter staff has occurred.

St. Vincent's policy places those without housing into the high risk category for discharge planning, and it guides those patients' cases be referred to the Care Management Department.

The BridgeWay facility in North Little Rock was the only hospital of those we inquired with in Little Rock not to release its discharge planning policy. Staff told us that it considered the details in that policy proprietary information that spoke to the level of care The BridgeWay provided.

The BridgeWay's representatives had initially agreed to an interview, but when we raised questions regarding the patient in the surveillance footage, the facility declined to speak on camera or address the allegation, citing patient privacy. The BridgeWay's full letter for making that decision can be read here.

According to UAMS, it follows federal guidelines for discharge planning, assessing patients on an individual needs basis.

"We assess the discharge destination and if the destination is going to be appropriate for those after care needs," said Dr. Chris Cargile, Chief Medical Quality Officer at UAMS. "Usually, we would work with the patient to have an understanding of where they're going because, our best hope that they make sure there is a continuum of care after they're discharged."

According to Cargile, the hospital defers to a patient's previous housing scenario, contingent upon whether the continued care is beyond a patient's ability to address and the level of need the patient has.

"It very much depends on the individual it depends on the type of illness and the individual's capability to manage their care," Cargile said. "We assess the discharge destination and if the destination is going to be appropriate for those after care needs. If there is a need for a professional to be available to be delivering the care, then we make those arrangements."

According to Cargile, coordinating with a shelter by providing medical information is not the usual practice, due to federal regulations and the fact that a shelter would not be considered a facility that continued medical treatment would be administered.

"A homeless shelter is not a place we would transfer a patient for their care," Cargile said. "So, sending medical information would not only be ethically problematic but illegal to forward information that way. That would not be normal practice to send ahead patients' medical records or those kind of things it would violate a number of federal laws."

McFadden has worked in both hospital and homeless shelter settings, even coordinating with patients for discharge from facilities in the past. In her past experience, patients were consulted and asked to sign a Consent to Release form that would allow her to coordinate with shelters if that proved to be the destination where the patient would go.

"It's a simple process," McFadden said. "That does allow for the agencies to share pertinent information. And the decision to send a patient to a shelter was never something that came up at the end by surprise. There's a lot of work and consultation that goes into planning a patient's discharge."

As far as continued care, shelters we spoke with said patients often need critical prescriptions filled or administered without a way to pay for them or in some cases even knowing what those medications are.

"That's why we need to be coordinated with," McFadden said. "In some instances, these patients are on psychiatric medications that they can't just suddenly discontinue. But they may not be entirely sure of what all they're taking. We work with them to get as much information as we can, but they simply don't always know."

According to Holloway, he's seen several instances of patients arriving highly medicated, without staff having background knowledge of the person's condition, care plan or whether they're likely to be violent.

"They may be all right when they leave but they are certainly not all right when they arrive here. There are some cases where they've arrived and can't even feed themselves," he said. "They're scared too, and they could end up injuring somebody or themselves. But you don't know anything about them, so there's no way to anticipate how they might react."

A gap in communication, partnered with a lack of resources in funding and facilities is the crux of contention, according to UALR professor Carolyn Turturro. Turturro is co-chair of the Arkansas Homeless Coalition.

"The hospital can't take care of them anymore, but they're not really ready for the types of shelters that are available," she said.

"The shelters often do not have the funds available to fill their medications, and staff are generally not trained to address mental health conditions or medical issues."

The coalition is currently working with the City of Little Rock, and reaching out to hospitals, to address ongoing issues, including the homeless population with unmet needs that covers the mentally and medically ill.

"There's a crack there of people where those people who have just come out of the hospital just don't quite fit in," she said. "There is a need for a facility to bridge that gap. But the issue is going to be funding. Much of the affordable housing funding is already accounted for."

McFadden agreed that a facility to bridge the gap would help all institutions involved.

"Once they're done at the hospital they need a place to go where they can recuperate, continue taking medications, receive mental health assistance and work on their case plan from there," she said. "We have Day Resource Centers, but the need is really to great for what we have."

She also believes that all parties involved coming to the table would be a step in the right direction to keep patients out of a continuous revolving door of crisis and care.

The Arkansas Homeless Coalition and the Central Arkansas Team Care for the Homeless (CATCH) both hope to be able to work with hospitals, police officers, city and state officials to address what they describe as a statewide, and even nationwide, issue.

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