Unhoused People Rarely See A Doctor. The Street Medicine Bill May Change That.
Last year, nearly 23% of the roughly 1,300 people experiencing homelessness who died in Los Angeles passed away from underlying health issues. But even for unhoused people who have insurance, 73% have never seen a health provider, according to the Street Medicine Institute.
Gerald Tartt, aka Seed Sire Seed TG, who has been unhoused since 2018, said getting to the LAC + USC Medical Center to see a doctor is difficult.
“Man, you gotta catch maybe two or three buses to get there sometimes,” he said, adding he has missed a lot of appointments traveling from downtown Los Angeles. Seed said he last visited the emergency room earlier this year.
“I was pissing out blood,” Seed said. “And it took so long … I’m not gonna be sitting there for no eight-hour shift … like going to a job just to see a doctor?”
Seed was worried about being gone so long and having his belongings stolen.
“If [health providers] can come out and see the people on the street more, yes, it would be a better way,” he said.
AB 369, a street medicine bill introduced by Sydney Kamlager, the senator for California’s 30th district, hopes to remove barriers for unhoused people, in part, by allowing care to be provided outside the walls of traditional medical clinics. That would include health care provided on the streets, shelter-based care and services for people living in transitional housing.
Kamlager said the bill underscores the need for the healthcare industry to understand how much flexibility is required to help people who are unhoused.
It is a crisis that folks are unhoused and it's a reality that a lot of folks who are unhoused are also sick and in need of medical care just like anyone else.
“This is a bill about humanity and about saving Californians,” Kamlager said as she recently accompanied a group of health professionals who were providing street care to people experiencing homelessness. “It is a crisis that folks are unhoused and it's a reality that a lot of folks who are unhoused are also sick and in need of medical care just like anyone else, right?”
Street Medicine In Action
Doug, who declined to give his last name, lives in a tent overlooking a freeway in downtown Los Angeles while trying to manage his diabetes and high-blood pressure. He said the last time he was inside a hospital was three years ago. Brett Feldman, a physician’s assistant and director of street medicine for the Keck School of Medicine at the University of Southern California, and Feldman’s wife, Corrine, also a physician’s assistant, are Doug’s current health providers.
“I see them like twice a week, every week,” said Doug, as Brett Feldman treated a wound on his arm. “They come out like clockwork every week and refill my meds, check my blood pressure, make sure I’m doing the right things, and listen to my heart.”
After wrapping Doug’s wound in gauze, Feldman checked Doug’s blood pressure and gave him a passing 110 over 80, adding it was the best Doug’s pressure had been in a really long time.
“Street medicine recognizes that people experiencing homelessness can’t access healthcare the way the rest of us do,” said Feldman, adding that his team also looks at other programs such as California’s Health Homes Program, which helps unhoused people.
The California Department of Health Care Services started the Medi-Cal Health Homes Program in 2018 to serve eligible Medi-Cal beneficiaries with complex needs and chronic conditions. Feldman said a 2020 study from UCLA that evaluated the program showed that of everyone who qualified, 13% were successfully signed up, but only 3.5% were experiencing homelessness.
“It just underscores the difficulty of really caring for these people from inside four walls,” he said.
Doug said street medicine has been a “blessing” in his life.
“Without them, I probably wouldn't take any medications, I wouldn't be conscious of my high blood pressure or my diabetes, and I'd be in the hospital every month,” Doug said. “I’d get infections I didn’t know I had, and all kinds of bad stuff.”
Street medicine teams such as Feldman’s also meet people in transitional housing, including Project Roomkey, a joint effort by the state, county and Los Angeles Homeless Services Authority (LAHSA), to put unhoused people in hotel and motel rooms.
Louis, a 52-year-old man who struggles with drug addiction, lives at a Project Roomkey motel and has been a patient of Feldman’s for three years. On this day, the team was there to check abscesses, a collection of pus buildup within tissue on both of Louis’ legs.
Feldman said the best way to treat Louis’ abscess would be to go to the hospital, but Louis said he was reluctant because of his past experience with hospitals.
“You want to know what they’re going to end up doing?” Louis said. “Open me up in places that I don't need to be opened … and an hour later, they come to the room and say now you can go. I’m like, 'I can’t even walk! Y'all just opened my leg up!' But they don’t care.”
Feldman’s team was able to secure housing for Louis, but said after trying methadone and rehabilitation clinics, getting Louis to stick with the treatment has been difficult.
“I brought this on myself,” said Louis, referring to the abscesses on his legs due to drug use, but added he was grateful for the street medicine team that regularly comes to treat his wounds and change his gauze.
Feldman said California is a hotbed for street medicine and he's involved because it’s the right thing to do, even if he and other provides aren’t being reimbursed by Medi-Cal, California’s Medicaid program that serves low-income people.
According to the Street Medicine Institute, street medicine has been shown to reduce expensive hospital admissions by two-thirds, but Medi-Cal does not recognize the “street” as a location for providing care for people such as Doug, who lives overlooking the freeway, or at transitional housing such as Project Roomkey, where Louis is located.
Kamlager said the Street Medicine Bill will allow doctors to go out and meet unhoused people where they are and get reimbursed for their services, and she is “depending” on Gov. Gavin Newsom to sign the bill if it passes.
“When you see people, talk to them, look into their eyes, and hear their stories, you know that it is so important that they are treated like anyone else,” she said. “We should all be treated the same and all have access to healthcare, and have a doctor who cares enough and willing to do the steps that are necessary to get the treatment.”
Editor's Note: An earlier version of this story erroneously identified Brett Feldman as a medical doctor. He is a physician's assistant.