Physician's assistant Brett Feldman does a checkup on his patient Gary Dela Cruz on the side of the road near his encampment in downtown Los Angeles on Nov. 18, 2022. Feldman is the director and co-founder of Street Medicine at the Keck School of Medicine at the University of Southern California.Photo by Larry Valenzuela for CalMatters

More Street Medicine Teams Tackle California’s Homeless Healthcare Crisis

Although they are eligible for full medical coverage under Medi-Cal, the program was not necessarily designed for the homeless. For example, Medi-Cal will pay for transportation to and from a doctor’s appointment, but it requires the patient to provide a fixed address and give the driver several weeks’ notice, which most homeless people don’t. are unable to organize.

Link between homelessness and health

Data on the health of homeless people is sparse, with no state agency and only a few counties tracking the information, but it’s clear that most of their deaths are preventable.

In Alameda and Marin counties, half result from acute or chronic health conditions such as cardiovascular disease, cancer or respiratory failure. In Orange County, these account for a quarter of deaths among the homeless. In Los Angeles County, heart disease is the second leading cause of death among homeless people, second only to overdoses.

Even overdose deaths are considered preventable – yet in San Francisco, overdoses cause 82% of deaths among unsheltered people.

“We commonly see conditions that you would see in a typical population, but they just aren’t treated; so uncontrollable high blood pressure, uncontrolled diabetes… also substance use in terms of opioids, we see a lot more of that than in the general population,” said Dr. Absalon Galat, Medical Director of the Department of Health Services of the LA County. Housing Center for Health.

The Galat team began their foray into street medicine with the goal of distributing COVID-19 vaccines, but team members quickly found they needed to do more. The county used COVID-19 relief funds to purchase mobile clinics, and CalAIM funding helped them hire 60 staff members.

In September, the county’s fleet of mobile clinics, with fully equipped exam rooms, began visiting areas where services are scarce. Smaller teams of clinicians and social workers roam the camps to follow up on patients, treat minor issues, and bring patients to the mobile clinic. There is some disagreement among street medicine providers over whether mobile clinics remove enough barriers, as they always require patients to go to a specific location, but Galat said his goal is to improve access, whether on foot or by car.

“People are dying every day,” Galat said. “So we have to try with what we know best in the medical field right now to limit the people who die.”

The link between homelessness and health is inextricable, said Dr. Michelle Schneidermann, director of the people-centered care team at the California Health Care Foundation, a nationwide health policy think tank. of State.

“Either one can lead to the other. A catastrophic health incident or a series of conditions can prevent someone from working, leading to poverty,” Schneidermann said. “We see this all the time, with health conditions precipitating homelessness, and vice versa.”

Take Danny Doran, 56, who visited the LA County Mobile Clinic in Whittier Narrows Park on a recent Thursday to pick up some insulin. He spent his career as a plumber and owned a house in Bishop. Three years ago he fell into a diabetic coma and was hospitalized for months. A friend Doran trusted to pay his bills while he was hospitalized emptied his bank account and disappeared – Doran has been homeless ever since. Several weeks ago he was beaten and robbed by another homeless man, who left him with a fractured skull and tremors in his hands.

“I guess I’m a little naive,” Doran said. “We’re all human and we’re prone to mistakes, you know? So I hate that someone has their money stolen like mine and ends up on the street like me.

At the mobile clinic, Doran said the staff doctor had agreed to be his primary care physician. His former GP stopped accepting Medi-Cal insurance, and Doran has not had regular access to insulin since.

“The doc here, she really has compassion for her patients. I’m glad our paths crossed,” Doran said.

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