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Drop-off Debacle

David Terrill

Walter Swenson and Richard Courtney pore over a great many drivers licenses and ID cards during the evenings they crisscross the streets of central Broward County. Swenson, a Fort Lauderdale police officer, and Courtney, an employee of the Broward Coalition for the Homeless, routinely work together to help the down-and-out get off the streets. Whether they spot someone sauntering along Federal Highway or take a referral from the coalition's hotline, they hear the remarkable tales of some of the Sunshine State's most footloose visitors.

Many of the homeless people they meet aren't from Broward. In fact, more than a few aren't from Florida at all; some are put on buses by municipalities less willing or able to put them up. "We're surprised when we see a Florida license," Courtney declares. The homeless team is rarely startled by tales of homeless dumping. Take, for example, a telephone call Courtney got last week from police dispatch. A man had just flown in from Honolulu with two suitcases and two backpacks. He was broke and had no income but knew where he wanted to go: the Central Homeless Assistance Center. It turns out his caseworker in Honolulu had not only gotten him on the jet but had also advised him to seek out the HAC, which is run by a nonprofit agency and is funded largely by the county.

On June 14, Swenson and Courtney met a man whose account stunned even them. That stormy Friday afternoon, a hotline worker directed the team to the Salvation Army shelter on Broward Boulevard to meet Roger (not his real name). A middle-aged gentleman wearing a button-down shirt and long pants, Roger was sitting in the shelter's intake room, soaked and shivering. Beside him leaned his cane. He carried prescription forms for at least three psychotropic drugs but had no medication. "He was kind of disoriented," Swenson says. "He had a real scared look in his eyes." They put a blanket around him and started asking questions.

Earlier that day, the pair learned, Roger had been discharged from Savannas Hospital in Port St. Lucie, a psychiatric hospital 100 miles north. Roger rode down in a hospital van and climbed out in front of the Salvation Army retail store by the interchange of Interstate 95 and Broward Boulevard during a heavy rain. After learning that the shelter was actually four blocks to the east, he made his way through the downpour. Once there, a receptionist told him the place had been damaged by flooding a week before and was under repair. There was no bed for him.

Swenson and Courtney were staggered by what appeared to be carelessness or indifference. "You drive a guy for two hours and then can't even take two minutes to make sure he's got a bed?" sputters Swenson, a veteran cop with a strong Long Island accent. "Kinda ballsy."

The pair drove Roger to the Central HAC, which took him in.

Ezra Krieg, a spokesman for the HAC, declined to comment on Roger's case, saying only that the shelter was in the process of filing a complaint over the incident with the Agency for Health Care Administration (AHCA), which regulates hospitals.

Broward County has made significant progress during the past five years in caring for homeless people, many of whom suffer from chronic mental illness. That headway was made despite opposition from those who claimed that shelters would attract more homeless people. The County Commission appropriates more than $3 million each year for the Central HAC and the Broward Outreach Center in Hollywood. Millions more are raised through charitable contributions and in-kind services. Broward's shelters take in thousands of homeless each year and are almost always full. Counties to the north generally provide less care. The National Coalition for the Homeless, for instance, named Palm Beach County in January as among the dozen "meanest cities" in America in dealing with homeless people.

In addition, a lack of post-discharge support for psychiatric patients remains a statewide problem, says Anita Godfrey, CEO of the Mental Health Association of Broward County. "Housing is a key component to people's stability and recovery," she explains. "For a person to be discharged with no anchor or stability almost mandates that they're going to have a relapse. Even people with no behavioral health diagnoses don't fare well when they're out on the street."

Sean Cononie, who has operated homeless shelters in Hollywood for almost five years, says that psychiatric hospitals have at times surreptitiously left discharged patients to his care. He criticizes that practice but doesn't fault hospitals in other counties for looking elsewhere -- as long as it's done conscientiously. "They should at least arrange transportation and make arrangements with the provider," he suggests.

Just how many homeless people are shipped to Broward each year is hard to determine, but dumping certainly fills up needed beds, leaving local taxpayers to pick up the tab.

Robert Cobiella, Savannas' executive director, describes Roger's drop-off as "an honest mistake of the treatment team that dealt with the patient, using misinformation or erroneous information from a colleague." He adds: "Unfortunately, if you make one mistake, nobody sees the seven years you've been doing a great job."

Well, it hasn't been an entirely great seven years. In April 2001, the hospital was the setting for what police later described as a "mass murder" when Alberto Serrano, a 33-year-old patient from Stuart, beat to death a nurse and three patients. St. Lucie County Circuit Court Judge Dan Vaughn this month ruled that Serrano was insane at the time and sentenced him to the state-operated South Florida Treatment Center in Miami.

Soon after the murders, the AHCA inspected Savannas, a privately owned, 70-bed psychiatric hospital, and found numerous violations arising from lack of staff, poor training, and improper safety procedures. The agency fined Savannas $110,000 this past January. There have been staffing changes since the deaths; Cobiella, the hospital's medical director, replaced the resigning director last November.

Cobiella defends the decision to send the discharged patient to Fort Lauderdale. "The treatment team was faced with the patient's desire not to stay local," Cobiella says. "I can't give you details. Believe me, it's quite valid if you were privy to the whole issue. The patient was an integral part of the decision. He and his family agreed." There are no county-associated homeless shelters in St. Lucie or Martin counties, so the team looked to the south, he said.

The director admits, however, that the hospital erred: "Unfortunately, out of an honest mistake, the social worker assumed that the [Salvation Army] shelter was still operating, but it had just closed for renovation. My understanding was that when the patient arrived there, he waved away the driver. It was very rainy there, so apparently they really couldn't sit around there waiting for a lot of explanations. Typically the driver waits or parks the car and assists the patient in reaching their destination and settling in. But somehow, the circumstances developed in a way that was not conducive to that. The patient felt, apparently, very comfortable, from what the driver reported to our risk manager -- that everything was fine, 'see you later, thank you for everything.' The next thing we hear is that the patient ended up at the [Central Homeless Assistance Center], which was not at all the intention."

That explanation doesn't entirely square with what the team of Swenson and Courtney saw and heard that day. Roger told them this story: He was married, and he and his wife received Social Security disability benefits. He went berserk recently after learning that her benefits were being cut in half, and he tried to strangle their dog. He was taken to Savannas under the Baker Act, a state law that allows people deemed mentally ill to be held involuntarily if they're considered a danger to themselves or others. Roger told the team he did not have a say about coming to Fort Lauderdale.

Handwritten instructions from the hospital that Roger carried also contradict Cobiella's account, Courtney says. Those directions advised him that upon arrival at the Salvation Army, he should call the hotline, 534-BEDS, and wait for a team to meet him. Ask for shelter, medical care, a doctor, and medications, the note advised. The discharge form Roger carried simply noted that he was released to "Shelter, Fort Lauderdale." Says Courtney: "Nothing on the paperwork suggests that he was going to stay at the Salvation Army."

To make matters worse, the prescriptions from St. Lucie County could not be filled by the Central HAC, according to Courtney.

It won't happen again, Cobiella vows. Savannas has developed a "performance improvement team" that will look at every discharge and provide feedback to the hospital's four treatment teams.

A driver from Savannas picked up Roger from the HAC on June 19, six days after he arrived there. The hospital will have to "start from scratch" in trying to find him a home, Cobiella says.


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