week 4 discussion

The Policy Advocacy Challenge Focuses on Hospital Dumping on Skid Row

The social issue of Policy Advocacy Challenge is that Los Angeles hospitals release homeless patients, frequently in medical gowns, confused or unable to walk, into the streets, without providing safe post-hospital care. A dementia and hypertension patient, Carol Ann Reyes, 62, was left on a curb by a taxi in just a hospital gown (Jansson, 2018). The practice is referred to as “patient dumping”, which has a preoccupation with cost cuts rather than patient dignity or safety.

Who is Defining the Issue?

            The problem is identified by hospital administrators as a resource allocation problem: beds need to be used for paying patients, and there are no beds available for homeless patients to go to, without insurance or an option to discharge. The hospitals' lawyers presented the events as not being “dumping” because it wasn't happening on purpose, but rather as unfortunate but inevitable consequences of an overburdened system. The problem, on the other hand, is perceived as an ethical failure and a breach of the patient's right to receive adequate care and to be discharged safely by frontline social workers, city attorneys and advocates.

What Values are Shown in this Definition?

The definition of the hospitals reflects values of fiscal efficiency, legal minimalism and institutional self-protection. There is more to be gained in being profitable than in being concerned about risk management, and more to be lost by being compassionate than by being profitable. An alternative definition grounded in social work values, however, keeps returning to human dignity, client self-determination, non-abandonment, and that ethical “do no harm” principle (National Association of Social Workers, 2021). In that sense, the hospitals missed their obligations to beneficence and justice by deliberately allowing people who are vulnerable to be placed in unsafe environments, as if that was acceptable.

What is not Included?

            The hospitals' definition leaves out of its scope any recognition of systemic racism, classism or the criminalization of poverty. It fails to recognize that homelessness is a structural problem that needs community solutions instead of blaming individual people. Implicit bias is also left out: if a patient has a mental illness, dementia or substance use disorder, they are dehumanized and no longer worthy of the usual discharge process. Last, the definition excludes the legal and moral obligation of hospitals to provide “medically necessary care” required by the Emergency Medical Treatment and Active Labor Act (EMTALA).

            Through the use of advanced practice skills (reframing, educating, brokering, collaborating, and building trust), social workers can transform patient dumping into an ethical and policy issue, educate hospital boards about legal requirements, broker safe discharge plans, join legal advocates, and build trust with homeless patients to document patient dumping. Reporting to external authorities like in this instance is direct policy advocacy, in which individual suffering becomes systemic.

 

 

References

Jansson, B. S. (2018). Becoming an effective policy advocate: From policy practice to social justice. In  www.cengage.com (8th ed.). https://www.cengage.com/c/empowerment-series-becoming-an-effective-policy-advocate-8e-jansson/9781305943353/

National Association of Social Workers. (2021).  Code of Ethics. Socialworkers.org; National Association of Social Workers. https://www.socialworkers.org/about/ethics/code-of-ethics