‘A Clerical Error’: Homeless health care difficult for patients, caregivers

By Alex Bonus | gargoyle@flagler.edu

I feel wrong taking a cookie from a homeless man, but Tim “Dusty” Brown makes it seem ordinary.

He’s lost everything. His family. His job. His health. Misfortune haunts him. Despite trying to get back on his feet, injuries from a car accident stall his progress.

“People always told me there would be bumps in the road to recovery,” Dusty said. “But they never told me I would be a bump in the road.”

This man with nothing insists I take his gift. It’s a symbol of his trust — his way of inviting me on his journey to recovery. It’s a challenge. A test.
I accept, cherishing his faith in me.

I’ll soon wonder if my trust was misplaced.

Ù­ Ù­ Ù­

On Jan. 15, a car slammed into Dusty on King Street and crushed his right arm and hip. He doesn’t remember going to the hospital, but after almost seven hours of surgery, two plates and eight screws in his arm, the consequences of the accident are clear.

He once walked over five miles every day. Now he moves slowly and robotically. Getting out of bed is a chore. His crippled arm is confined to a metal brace. A cane impedes his shortened walks.

Despite these injuries, he considers himself lucky. The accident wasn’t his fault, so the insurance of the person who hit him covers his health care. He’s also a member of a transitional housing program at the St. Francis House, which shelters selected residents in an apartment next door to help their transition out of homelessness.

Compared to others, Dusty recovers in luxury.

“It’s not the best of situations, but it’s not the worst either,” Renee Morris, the St. Francis House executive director, said. “We are able to keep him comfortable and tend to his needs and at least he’s inside.”
Dusty’s room is humble. He has a chair, a bed and a dresser. A couple stuffed animals sit in the corner and a paper cut-out of an angel hangs in front of dull, floral window curtains. Other than Dusty’s warm smile, there is nothing inviting about the room.

He sees everything as a blessing. The insurance from the accident provides him high-quality rehabilitation. Twice a week, doctors stretch and strengthen his arm. He admits the treatments are painful, but he bears the pain with a friendly grin, even offering packages of M&Ms to the receptionist when he leaves.

“I always feel like a burden, but I know who I owe for the shelter, the food, the friendship and the caring,” Dusty said.

He is reliably high-spirited. After his appointments he gets into playful moods.

“Maybe I’ll attach a sword to it, like Luke Skywalker,” he jokes, waving his arm.

Despite Dusty’s optimism, his roommate serves as a constant reminder of the troubles he narrowly avoided. Gordon Miller shares a common room with Dusty, furnished with a couch, kitchen and television. He suffered a car accident at the same time as Dusty, but with one major difference — Miller was at fault, and he does not have insurance coverage.

“When I had insurance, hospitals tried to keep me as long as they could,” Miller said. “Now that I don’t they try to get me out of there as fast as they can.”

His leg broken in seven places, Miller spends much of his time moving between a walker and a wheelchair. He said the hospital released him too early without the right antibiotics for his stitched wounds. As a result, his leg swelled, turned black and leaked pus.

“It didn’t make any sense why they treated me like that,” he said.

Limitations at the St. Francis House exacerbate his problems.

“This is no place for a wheelchair,” he said.

When he first arrived from the hospital there was no ramp to give him access to his apartment — the shelter had to install one. The bathroom has no railings for him to support himself and the door isn’t big enough for his wheelchair, so even using the toilet is a chore.

“I’ve had to learn little tricks about how to lean against the wall,” he said.

The attitudes of the men reflect their differences in care. While Morris worries Miller is slipping into depression, Dusty is healing ahead of schedule.

Miller feels cheated.

“If you go to school to be a doctor I think you’re there to help sick people equally,” he said. “Not just because they have money or don’t have money.”

Ù­ Ù­ Ù­

Barbara DiPietro says keeping track of the homeless is one of the greatest obstacles when providing health care to the population. The policy director for the National Health Care for the Homeless Council, she advocates a model of health care that focuses on outreach and engagement.

“Homeless people have fallen through the cracks of a broken system,” she said. “They often have to ignore their health care because they are trying to cobble together the rest of their life.”

The NHCHC sponsors organizations throughout the United States that work to bring care to homeless people.

“[Homeless] often have to ask themselves, do I walk five miles in one direction to see my doctor or five miles in the other direction to the soup kitchen?” DiPietro said. “They can’t do all this in one day. We have to take services to them.”

In St. Augustine, decentralized services make obtaining care for homeless more difficult. Homeless not partnered with the St. Francis House have three options for care — the emergency room or primary care center at Flagler Hospital and the Wildflower Clinic.

Lynnette Horwath, the Wildflower Clinic executive director, says it is difficult for anyone to get an appointment at the clinic due to its limited hours and resources. Open for walk-ins on Thursday and Saturday, the clinic sees poor and uninsured patients on a first-come, first-serve basis.

“You practically need to get here when the doors open,” Horwath said.

This tight treatment window makes it difficult for many homeless to make appointments and obtain care. Because the clinic operates with the help of volunteer doctors, it is sometimes difficult to get enough staffers to run the clinic.

“I’m the only full-time position,” Horwath said. “Sometimes there’s no assistant here or nobody to answer the phone, and sometimes the doctor doesn’t show up. It’s frustrating.”

The primary care center is limited to homeless who obtain residency cards at the St. Johns County Health Department. Brenda Fenech-Soler, the public information officer for the Health Department, says the program serves few homeless due to eligibility guidelines.

No other programs at the Health Department target homeless people specifically.

Maria Mas, the director of Flagler Hospital’s emergency care center, says she does the best she can to serve the homeless population with the limited resources at her disposal.

“We’re not a large city but we have a significant population of homeless people,” she said. “Services need to be less spread out and disjointed.”

The emergency care center provides emergency treatment, food, antibiotics and transportation for homeless patients. The hospital is often able to cover such care as charitable work and tax write-offs.

“If they really are ill and have to be admitted, by law we have to do that,” she said.

Morris says the hospital does a good job of “patching up” homeless people, but they get discharged early and often.

Sometimes, the hospital has allowed the homeless to remain in the hospital lobby, sit in empty rooms and sleep on stretchers until morning.

“We do our best,” Mas said.

Morris understands the hospital’s limitations.

“If we didn’t have a place to give [homeless] to recover they would be out in the woods or underneath the bridge and that’s just the bottom line,” she said.

She recalls one homeless man who was given an ultimatum when it came time to discharge him from the hospital — his doctor told him someone would take him to the woods, under the 312 bridge or to the St. Francis House.

“We’re really the only game in town,” Morris said.

Ù­ Ù­ Ù­

Morris thinks if people knew how easy it is to fall into homelessness, they’d help more.

Dusty was a nomad. A truck driver for most of his life, he was homeless in the sense that his life centered on travelling. Though he had once declared residency with his mother in St. Petersburg, he lost all connection to that home after her death.

When he had to renew his driver’s license in 2010, new laws required he show two proofs he lives in Florida.

A nomad has no proof.

An unlicensed truck driver has no job.

“Boom!” he said. “It’s like they shot you off the face of the world right there.”

His life spiraled downward. He lost hope and started drinking. He was soon reduced to a shivering mass sprawled helpless by the seawall in downtown St. Augustine, where Morris found him and brought him to St. Francis for treatment.

Miller has a similar story. He lost his job at a horse stable after he hurt his back, and also experienced a downward spiral. Morris brought him to the St. Francis House so that he would have a place to heal.

“There are so many people out there who are so close to losing their homes,” Morris said.

Ù­ Ù­ Ù­

The more time I spend with Dusty, the more I see him as a friend. I knock on his door and he invites me in without question. We still talk about his injury and his care, but we move to other subjects.

Sometimes he talks about his goals. Sometimes he talks about women. We share cookies and snacks. We joke and we laugh. Some days he asks for a ride to run errands, other days we just sit and chat.

I’m no longer just following his journey. I’m part of his journey, and I pray for his success.

Ù­ Ù­ Ù­

Morris says it’s a shame the county doesn’t have comprehensive drug rehabilitation programs.

According to DiPietro, such programs are vital to homeless populations, which have disproportionate numbers of people suffering drug and alcohol addictions.

For Morris, this lack of resources represents the ignorance of people in St. Johns County.

“People are just so blind to what is going on,” Morris said.

If someone goes to the hospital and is deemed in need of drug rehabilitation, the County Health Department must assess whether or not they should be sent to facilities in Duval County.

Morris believes this is a waste of county money.

“If you take one of my population and send her there and release her, and she’s not a resident of Duval, they’re not going to help her up there after the rehab,” Morris said. “So the system really doesn’t work.”

Because of this, Morris has taken in some homeless with addiction problems and treated them herself.

“It’s called white knuckling it,” she said. “I’ve had people who have had the shakes for a few days.”

She says this places an undue burden on her shelter.

“It’s scary,” she said.

However, she says she has seen miracles — especially when treating Dusty. After his initial acceptance into the shelter, Morris helped Dusty start a program to end his abuse of alcohol.

She remembers seeing him a week after he first came to St. Francis — how he had so quickly transformed from a shivering blob to a rosy-cheeked man.

“I really didn’t even recognize him,” she said. “This house is full of miracles.”

Ù­ Ù­ Ù­

In no time, it seems, six weeks pass. When I see Dusty, he greets me with a firm handshake — using his right hand.

His brace is gone.

“Just got it off yesterday,” he says. “The doctors say I’m three weeks ahead of schedule.”

I’m shocked. I didn’t realize he had advanced so far in such a short amount of time. Clearly, he reaped the benefits of the dedication from both Morris and his doctors.

I later join Dusty at church. In January, Morris started a partnership with Anastasia Baptist Church to provide religious services at St. Francis every Sunday. Beyond physical and mental health services, Morris wanted to benefit the spiritual health of her residents.

“These folks, myself included, all need the hope that only the Lord can give us,” she said.

The services are quaint yet heart-wrenching. Morris sets out rows of folding chairs on the scuffed tiles in the St. Francis dining room. A picture of Jesus illuminated by two dim lamps hangs on the wall.

There are about 20 other people in attendance. Dusty sits across the room, shaking hands vigorously with friends. Miller is absent — it’s too difficult to fit his wheelchair in the cramped space.

A young man leads the group in singing. After a few songs, he takes prayer requests.

Almost everyone contributes.

“I would like to pray for my mother,” says one man.

“I want to ask for tolerance,” says a woman. By the end, the list includes prayers for patience, answers, forgiveness and cures for illnesses.

As I look around the room, I’m overwhelmed with joy. I’m amazed by the bonds between these strangers suffering unfathomable pain, by the kindness of Morris and the other shelter volunteers. But most of all I admire Dusty, not only for his optimism and perseverance, but for his openness to trusting me, and to accepting my friendship.

He would soon trample this trust.

Ù­ Ù­ Ù­

Mouth gaping, I held the phone at my ear.

“He’s missing,” Morris said.

She had to be wrong.

“We haven’t seen him in a few days,” she said.

I go about the next day in a trance. I’m concerned and confused. Two days later I speak to Sean Stone, the case manager at the St. Francis House, and I get angry.

After his doctors declared him healed, Dusty accepted a settlement from the insurance company. He went out one night and got drunk and was put into protective custody by police. The zero-tolerance policy at the St. Francis House now forbids Dusty from living at the shelter.

Now, his path to sobriety is just a dream.

“He stopped by and paid his debt and made a donation,” Stone said. “But we tried to make him realize that we thought we had a closer relationship. Even if he was going to get kicked out, we thought he’d call.”

Stone said Dusty didn’t seem to want to return to the shelter, and the settlement would provide him enough to start a life elsewhere.

I’m more baffled than Stone. I’m astonished, worried and frustrated.

But most of all, I feel betrayed.

Ù­ Ù­ Ù­

Morris wishes people would love their neighbors a little more.

“My mama always said you’ll never find anyone better than you because nobody is better than you,” she said. “We’re all the same.”

Though she appreciates the resources and volunteers available to her, she prays for more.

“My goal is to get these folks [county residents] out here to realize that homelessness is not a disease,” she said. “It’s not who they are — it’s who they are at this time.”

DiPietro says this type of negative labeling is a national trend.

“We are living in a society that places value on one’s life based on what one earns,” she said. “People think — if you’re poor you must have done something to deserve being poor. If you’re homeless then you must have done something to deserve being homeless.”

For Mas, the attitude is offensive.

“People get into health care because they have good hearts,” she said. “It’s hard to hear comments that we shouldn’t help homeless people or that they don’t deserve it.”

Dusty called it “a clerical error,” referring to obvious mistakes made when copying information or calculating data.

“We deserve some blame,” he said. “I don’t deny that. But how could you just write someone off like they don’t matter? How can you overlook another human being? It’s a clerical error. My life is full of them.”

Ù­ Ù­ Ù­

Despite my attempts to forget, I can’t get Dusty out of my mind.

I wonder where he is. If he’s healthy. If he’s found a better life. I wonder why he left without saying goodbye. I wonder if he appreciated everything that was done for him.

He was lucky.

Stone says this is a common feeling. While I sit in his office, he explains the emotional difficulties that come when working with the homeless population.

A box of cookies sits on his desk.

“Originally it bothered me,” he said. “These days, I’m not saying that I’m expecting it, but it doesn’t surprise me when someone disappears. I don’t want to sound cynical but I’ve learned in the time I’ve been working here that you need to maintain a professional boundary.”

He tries to stay optimistic.

“I understand that I may never see the success with a person because they may disappear from here,” he said. “But they hopefully will take something with them that will help them out.”

I have difficulty digesting his advice. But when I remember Dusty, I remember his kind heart. I remember his smile. His optimism.

I have to believe he’s doing the right thing. Maybe he made a mistake — but I make mistakes too. An insurance settlement for him would be like winning the lottery for me. I can’t say for sure what I would do with that much money.

I get up to leave and Stone offers me a cookie.

I accept.

While I eat, I think of Dusty.