No Place to Heal

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SUNDAY A

www.bakersfield.com

LOCALLY OWNED SINCE 1897 $1.50

UGUST 26, 2007

KERNELS OF KORN INSIGHT, G1

ADVENTURE AWAITS AT OCEANO DUNES, H1

KERN PARENTS SPEND THOUSANDS ON LAVISH ‘SWEET 16’ PARTIES, G1

H O M E L E S S PAT I E N T S
LOIS HENRY ON MISSING WOMEN IN POLITICS, B1
KERN GOVERNMENT

Real estate

Price drops expected nationwide
First measured decline may further contract the market
BY DAVID LEONHARDT AND VIKAS BAJAJ
N.Y. Times News Service

Union members agree to strike
Kern’s general employees voted overwhelmingly to dismiss the latest contract proposal by the county and strike Saturday evening, officials from the Service Employees International Union said. Contract negotiations with the some 6,000 county employees represented by the union fell apart Wednesday. Page B1
HENRY A. BARRIOS / THE CALIFORNIAN

Cheryln Williams takes a peek down the road. Partially paralyzed from a stroke and suffering from other ailments, Williams relies on others to help her through the day.

WAR IN IRAQ

Surge helping in some areas
The “surge” of U.S. troops has succeeded in bringing violence in Baghdad down from peak levels, but the death toll from sectarian attacks around the country is running nearly double the pace from a year ago, according to reports released Saturday. At least some of the recent bloodshed can be traced to militant fighters that drifted into northern Iraq after fleeing U.S.-led offensives. Page A18

Shelters often ill-equipped to provide care after discharge
BY EMILY HAGEDORN
Californian staff writer e-mail: ehagedorn@bakersfield.com

NO PLACE TO HEAL


he median price of American homes is expected to fall this year for the first time since federal housing agencies began keeping statistics in 1950. Economists say the decline, which could be foreshadowed in a widely followed government price index to be released this week, will probably be modest — from 1 percent to 2 percent — but could continue in 2008 and 2009. Rather than being limited to the once-booming Northeast and California, price declines are also occurring in cities like Chicago, Minneapolis and Houston, where the increases of the last decade were modest by comparison. The reversal is particularly striking because many government officials and housing-industry executives had said that a nationwide decline would never happen, even though prices had fallen in some coastal areas as recently as the early 1990s. In Bakersfield, as of June, the median home price –– the price at which half the homes sold for more and half sold for less –– was Please turn to HOUSING / A3

T

Pesticides

C

TECHNOLOGY

Cell phone calls slow 911 system
Thousands of Californians trying to report crimes in progress or dangerous emergency situations are facing lengthy waits to reach 911 dispatchers because a tenfold jump in cell phone calls has overwhelmed critical parts of the state’s system. Page A5

heryln Williams stares out at a road she can barely see. Sitting in her wheelchair on a porch at the Bakersfield Homeless Center, Williams, who is diabetic, explains how a friend helps test her blood sugar because she can’t see the test strip. Her left hand, gnarled from a stroke, can’t work the machine. Showering, even eating, all require the help of others. The shelter doesn’t like to take in people like Williams. It isn’t equipped to handle their needs, employees say. But Bakersfield doesn’t have any other places for people like Williams to go to. She’s too poor to pay for a board-andcare facility. She isn’t sick enough to stay in a hospital. She’s too sick for the only respite care center for the homeless in town because she’s in a wheelchair. And, at 49, she’s too young for most skilled nursing homes.
Please turn to PATIENTS / A4

I couldn’t stop crying. I had never been in a homeless shelter before.”
— Cheryln Williams

Drifts down, but activists still skeptical
BY STACEY SHEPARD
Californian staff writer e-mail: sshepard@bakersfield.com

T

BAKERSFIELD.COM
Check out The Pulse, reporter Emily Hagedorn’s blog on health and medicine on Bakersfield.com. You can find it at people.bakersfield.com/blogs/ehagedorn.

he number of pesticide drifts and people sickened by them have steadily declined in Kern County in recent years. In 2002 and 2003, more than 550 people were sickened from seven drift episodes. Since then, the number has gone to 18 sickened in one incident last year, according to preliminary numbers from the state Department of Pesticide Regulation. The agriculture industry said progress is due to an industry-led initiative to fix the problem through a program called Spray Safe. “The concept is to get growers more involved in each other’s business,” said Kern Drift Prevention Coalition Chairman Dale Nicol, who also works for pest control manufacturer Syngenta. Started in April 2006, the program is based Please turn to DRIFT / A3

INDEX
Books . . . . . . . . . .G6 Classifieds . . . . . . .D1 Crossword . . .D3, G3 Eye Street . . . . . . .G1 Funerals . . . . . . . . .B2 Horoscope . . . . . .G3 Jobs . . . . . . . . . . . . .E1 Local news . . . . . . .B1 Movies . . . . . . . . . .G2 Opinion . . . . . . . . B10 Real Estate . . . . . . .F1 Sports . . . . . . . . . .C1 Television . . . . . . .G7 Travel . . . . . . . . . . .H1 Weather . . . . . . .A22

WEATHER

94 Low 73
High

COMING W E D N E S D AY

Air quality: Unhealthy, 97 Complete weather, A22

CALL US
Subscriber services: 392-5777 or 1-800-953-5353 To report a news tip: 395-7384 or 1-800-540-0646
Designers are turning away from ’60s-inspired mod fashions and pushing a new, polished look that borrows from the 1940s. Read Wednesday’s Eye Street and have a fashionable fall.

A4 THE BAKERSFIELD CALIFORNIAN

HOMELESS PATIENTS KMC CEO Paul Hensler thinks that estimate is a little steep. Hospital records indicate about three patients a day are being kept due to discharge difficulties, he said. But still, that’s about $1.6 million a year for “Jell-O days” that may or may not be paid for by the patient or insurance. “The bottom line is that KMC is a receptacle for a lot of underfunded, uninsured and homeless people,” Martin said. “What do you do with people who have had their medical and surgical care but don’t have a safe place to go afterward?” A day at Bakersfield Memorial and Mercy hospitals also costs $1,500, hospital executives said. Mercy doesn’t get many homeless patients, but when they do, it can take a couple days to discharge them, said Sandy Barker Doucette, Mercy’s marketing and communications manager. At Memorial, four to five homeless patients are admitted a month and sometimes it can take two weeks to a month or more to place them, said Paul Chavarria, social work supervisor at Memorial. “It’s a given we won’t see that money back,” said Ken Keller, Memorial’s vice president for physician and business development. “That’s just a cost of doing business that we understand as a not-for-profit facility.” San Joaquin Community Hospital may see four or five homeless patients a week who end up staying about a week extra due to placement difficulties, said Jeanie Rucks, a registered nurse and case manager. On average, this costs $2,013 per patient per day. Representatives from Bakersfield Heart Hospital would not return calls for comment SOMETHING NEEDS TO BE DONE The hitch comes in finding an agency or program to pay for these patients, KMC’s Riar said. It can take up to three months to be approved for Medi-Cal. Even so, many nursing facilities won’t take Medi-Cal due to low reimbursement rates, she said. Many homeless people also have mental or substance abuse problems that make them hard to place. Some board-and-care homes — which usually don’t offer skilled nursing care — take homeless patients, but usually they must be plugged into a county program. California Board & Care, on Brundage Lane, took homeless patients when it opened in 1997, but had problems with payment and patients left before they were well, said owner Mohammad Bhatti. Now patients must be referred from KMC or Kern County Mental Health and have a case manager who oversees their care. Several facilities, including several board-and-cares and shelters, require patients be able to walk. “We run a rescue mission. We’re not a nursing facility,” said Rev. Dan Gorman, executive director of the rescue mission. Most people agreed that something needs to be done. “I know everyone is saying we’re going to be paying a whole lot (to create a service),” Gorman said. “But we’re paying a whole lot anyway.”

SUNDAY, AUGUST 26, 2007

PATIENTS: ‘Dumping’ denied
Continued from A1 Williams sits alone on the porch; her one good hand picks at the black tape on her wheelchair’s left armrest. She looks out toward the cars that zip by on East Truxtun Avenue. “I was just brought to a place where I felt unwanted,” she says. “But I have no where else to go.” HOMELESS DUMPING? Williams, her Social Security payments in limbo, was forced to move out of her apartment in late June and went to the only place she thought she could get a bed — a hospital. Her blood sugar was high; she called 911 to bring her to San Joaquin Community Hospital. It was the last call she made before calling AT&T to turn off her phone. San Joaquin admitted her for the night, and then a taxi drove her to the homeless center the next day, June 20, she said. “I couldn’t stop crying,” Williams said. “I had never been in a homeless shelter before.” Just because a hospital takes patients to a homeless shelter doesn’t mean they were dumped, said Debbie Hankins, San Joaquin’s vice president of nursing. Hospital social workers kept Williams overnight to secure housing, and the homeless shelter agreed to take her. “We always make sure our patients have a place to go,” Hankins said. “Our No. 1 priority is patient safety.” Crisis managers at the homeless shelter and Bakersfield Rescue Mission, however, said unannounced taxis dropping off newlydischarged patients are a common sight. Kern Medical Center dropped off a 75-year-old man “in 30degree weather in nothing but a nightgown and wheelchair,” said Ray Smith, director of the mission’s crisis program. If they can, the mission’s employees will catch the cab and have the driver bring the patient back to the hospital, he said. “They get really pissed because they didn’t get paid to do this,” Smith said. “But we’re not set up to take care of those people.” TRANSFERS VS. DUMPING Leaving a stable patient at a homeless shelter in the county without prior consent from the patient or shelter is legal. The law requires that Medicareaccepting hospitals stabilize patients, regardless of ability to pay. Each hospital must have a written discharge plan, requiring safe after-hospital arrangements and that each patient be informed, orally or in writing, of continuing care requirements. Hospitals also aren’t allowed to transfer homeless patients out of the county to another medical or social service agency without

POSSIBLE SOLUTIONS:
Bakersfield has 10 respite beds through Clinica Sierra Vista set aside for Kern’s roughly 900-person homeless population. Homeless people can come to Clinica’s homeless respite program housed in a small green home at the Griffin’s Gate soberliving facility on Monterey Street to recuperate from illness and injury, said Marie Wall, program coordinator for Clinica’s homeless health services. And at roughly $37 per bed per day, the price is a far cry from the other hospitals’ hefty rates. But the center is rarely at capacity, Wall said. “We are very seldom full because the people (who want to go there) are so deathly ill,” she said. “To come here, they have to be able to get out of the building if there’s a fire ... ambulatory and relatively self-sufficient.” Wall would like to see her program get more funding, so it can hire more staff to care for sicker patients. Several solutions are being kicked around to fill in this gap. LARGE, STANDALONE FACILITY Many homeless people and health advocates say Bakersfield needs a larger facility, maybe a program that could offer rehabilitation and take people who are wheelchair-bound and dependent. “We need something that offers that intervention care,” said the Rev. Dan Gorman, executive director of the Bakersfield Rescue Mission. “That’s the hole we have.” Greater Bakersfield Legal Assistance, as part of Mayor Harvey Hall’s 45-member Homeless Collaborative, has been working on a project to assess how hospitals discharge the homeless, working with discharge managers to make the transitions smoother. GBLA’s solution: A 30-bed transitional facility that could handle more complex health needs, like monitoring IVs and dressing wounds, as well as people who are physically disabled, said Roy Malahowski, a GBLA attorney. GBLA doesn’t know how much a facility like that would cost. They plan to submit a proposal to Hall within the next month in response to his call to end homelessness in Bakersfield by 2016, said Estela Casas, GBLA’s executive director. Hall said he hasn’t heard about the facility but realizes that health care is a big factor in ending homelessness. “I don’t think hospitals should be held exclusively liable when cities that do have the resources have been dropping the ball,” said Michael Cousineau, associate professor and the director of the Center for Community Health Studies at the University of Southern California Keck School of Medicine. “That’s where it should start.” HOSPITAL-ATTACHED FACILITY KMC CEO Paul Hensler has toyed with the idea of a skilled nursing facility that could “provide the appropriate care for $200 or $300 instead of $1,500.” But KMC doesn’t have any capacity to take this on, and after crunching numbers, the need isn’t there, he said. Mercy has a 40-bed transitional facility. But it doesn’t have a Medi-Cal contract, and “that’s not the place where we would look to place them (the homeless),” said Sandy Barker Doucette, Mercy’s marketing and communications manager. “It’s hard to just yell at the hospitals,” Gorman said. “Are we asking the hospitals to do what the federal, state, county and city governments should be doing?” BEDS IN A LOCAL SHELTER Representatives from the Bakersfield Homeless Center and the rescue mission have said they would like to see beds attached to their facilities that could take on some of the sicker patients. “I think humanely we need a place,” said Diana Campbell-Rice, associate director of the homeless center. “If people don’t feel good, they can’t work. If kids don’t feel good, they can’t learn.” The rescue mission is partnering with several local doctors to build a clinic on the mission’s grounds, Gorman said. Maybe some beds in that facility could be used for long-term care if the mission hired more medical staff. “I couldn’t justify setting up a whole wing to do this service,” he said. “But it has to be addressed.”

Victoria Gibson, 49, feels blessed to be at Clinica Sierra Vista’s homeless respite on Monterey Street. After being released from the hospital, she had nowhere to go until she went to the respite house.



I was just brought to a place where I felt unwanted. But I have nowhere else to go.”
— Cheryln Williams

notice or consent from the patient or facility. But if the transfer is in county borders, it’s OK in the legal sense. (Senate Bill 275, which is currently in the Assembly, is trying to change that.) KMC is usually the worst about leaving patients, but considering they typically get more of these people, this isn’t a surprise, the homeless crisis managers said. KMC does not drop patients off against their will, said Toni Smith, director of patient care service. If the homeless person is being treated on an inpatient basis, the hospital works to find housing, which is sometimes the homeless shelters, she said. They call the shelters before bringing the patient and only do so if the patient is stable. If the homeless person was treated in the emergency room and wasn’t admitted, KMC will sometimes give them a taxi voucher, but they choose where to go next, she said. “We don’t force people to go there,” Smith said. “We would never do that.” TOO ILL FOR THE SHELTER Spokespeople for all local hospitals deny dumping patients on homeless shelters’ door steps. Greater Bakersfield Legal Assistance has been working on a project to assess how hospitals discharge the homeless, hoping to make the transitions smoother. The program was launched with a $74,200 grant from Bakersfield’s Kaiser Permanente after Kaiser’s Bellflower Medical Center near Los Angeles was singled out in the area’s patient dumping scandal. “This cannot be viewed as just a

Cheryln Williams struggles to read after losing most of her vision. problem with KMC,” said Estela Casas, GBLA’s executive director. “Every hospital is dealing with this and the poor and the homeless are not going to be going away.” KMC and other local hospitals are getting better about calling before bringing a patient to the shelters, but the homeless center still gets some they aren’t equipped to handle, said Jason Meek, crisis services supervisor at the center. “I don’t want to say it’s a dump job, but we get several people who are extremely physically limited,” he said. HOTEL KMC In response to the recent patient dumping scandal in Los Angeles, the Legislature passed a law requiring hospitals to convene regionally and discuss discharge plans for the homeless and come up with a plan by Jan. 1. In the meantime, discharge planners are begging, bargaining and pushing respite centers, skilled nursing facilities, board-and-care homes, rehab facilities and homeless shelters to take their patients, they said. “Sometimes they do go back to the homeless shelters,” said Manjeet Riar, supervisor of KMC’s care management department. “We don’t like to do that, but we don’t have any alternative.” Many Bakersfield hospitals say they regularly keep homeless patients several weeks or months because there’s nowhere else for them to go. One homeless person, a 60something man who came to KMC for a colostomy in February, ended up staying for six months because no recovery program would take him and KMC didn’t want to leave him on the sidewalk, said Dr. Maureen Martin, chairwoman of the surgery department. At about $1,500 a day, his fivemonth-three-week stay past when he could have been discharged cost county taxpayers $256,500, as well as a bed for a more critical patient, she said. In the end, the man was approved for Medi-Cal, but the county is going to have to fight to get some of that back. PAYING THE ‘JELL-O’ FREIGHT Martin puts the number of beds occupied by people who could be discharged at roughly 22 beds at any given time. These also include people who are uninsured and underinsured, not just homeless.

Though she is free to come and go as she pleases, Cheryln Williams says, “Sometimes I feel I’m in jail.”

HENRY A. BARRIOS / THE CALIFORNIAN

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