Down and Out at Highland Hospital 

The scene outside the emergency room at Alameda County's public hospital is a sad but telling one, as patients borrow bus fare or sell drugs.

In 2004, Alameda County voters agreed to save their nearly bankrupt public hospital system by paying $70 million a year in new taxes. Two years later, the Alameda County Medical Center is still a mess. Violence at the John George psychiatric facility has jeopardized millions in Medicare contracts and was shortly followed by the resignation of administrator Bruce Waldo. Former medical center trustee Gwen Rowe-Lee Sykes was fired in February, and has since filed a lawsuit alleging cronyism and financial mismanagement. Officials predict that the medical center will face an $11.5 million deficit this summer.

Somehow, this facility still finds a way to treat 125,000 patients a year, most of whom are uninsured and broke. It's alternately maddening and inspiring, a place where venality and incompetence coexist with nuanced professionalism. Bean counters and shop stewards make stupid budget mistakes, even as the line staff is forced to find new ways to cope with the medical ramifications of poverty. Such ad hoc subtlety was on display last week, when a Highland patient complained about the hospital's policy toward discharging indigent patients.

When Highland employees provide health care to an underclass that includes hustlers and gang members, they often have to make brutal choices. For example, in order to ease overcrowding at the chaotic emergency department, officials recently stopped collecting DNA samples from rape suspects, raising fears that prosecutions could be compromised. And according to one patient who went through the wringer at Highland a few weeks ago, emergency staff have killed the practice of giving bus vouchers to the poor, leaving them to fend for themselves on their own doorstep.

The patient, who asked not to be named, said she was running errands around town when a severe asthma attack brought her to the emergency room. She spent hours in Highland's waiting room, watching as patient after patient asked for bus vouchers. "The woman who worked behind the desk, I saw her tell everyone the same story," she said. "Sorry, the transportation budget got cut. We can't hand out vouchers anymore."

Highland sits atop a hill on East 31st Street, roughly two miles from the Fruitvale BART station. If discharged patients don't have bus fare, they often hobble around the hospital grounds and the nearby middle-class homes on crutches, begging for change. The asthma patient had plenty of plastic and BART tickets, but no cash to grab the bus, which meant she was stranded. Eventually, she begged her way onto the 62 line, but says it wasn't easy. "The drivers are very volatile about it now," she wrote in an e-mail. "Even if the person has obviously just gotten off an IV and had their blood taken and are holding their chest X-rays, they don't want to hear it anymore."

When medical center spokeswo-man Sarah Varner heard about the complaint, she in-sisted that the hospital still offers free vouchers to all indigent patients. "I talked to the gentleman who is responsible for the vouchers given at the ER, and he said they are continuing to give out the service," she said. "No one has any knowledge of us discontinuing the vouchers." But when a reporter called the urgent care center and asked if indigent patients can get bus vouchers, an official said, "No. We only do that under special circumstances, for mothers travelling with children or elderly patients."

Varner tried to clear up the confusion. "We provide transportation to you on a case-by-case basis," she said. "For example, if that indigent person is going to a shelter. ... That's not carte blanche. It's if there is no family member to help them."

What's really going on is that a shadow community of homeless people and dope fiends wander around the Highland emergency waiting room. Because many shelters close their doors during the day, homeless people pretend to be patients in order to escape the rain for a few hours, or buy cheap food in the cafeteria. Drug addicts beg outside the doors and buy drugs from patients who wander outside. They work any angle they can, and that includes hitting up the staff for bus tickets. According to one hospital employee, the emergency staff are caught between generosity and skepticism, and their first impulse is the latter. "They figure you try to work it," she said. If they didn't, they'd be played for suckers all day long.

Sheets of rain pelted the driveway of Highland's emergency department last week, and the regulars huddled underneath the awning, swapping smokes and bumming change. The nearby bus stop is just a pole stuck in the ground, and patients tried to keep dry beneath umbrellas as they waited. But who were the patients, and who were the hustlers? That's what nurses, social workers, and county sheriffs have to figure out every day.

Marsheila Dye, a tall, skinny black woman with braids under her knit cap, leaned against her crutch and bummed change for the bus trip back to West Oakland. Her foot was encased in plaster, but this time she was here for a recurring stomach ailment. Last month, it was pneumonia. She worries that something systemic is wrong with her, but says the staff just treat her and street her. "They just wanna give you some damn Vicodin and send you home," she said. "I don't want no pain pills. I wanna know what's wrong! They're assholes up here."

Dye wanted more than just bus fare; first she asked for lunch money, then cash for food. She gripped a cigarette as she complained about the hospital, adding that since the staff have stopped giving her vouchers, she's been forced to panhandle bus fare. "I been up here many times for an emergency and didn't have no bus fare home," she grumbled. "They should give it to poor people, especially. ... And it's rainin' out here, too? Shit. It's hard." As Dye spoke, she grabbed a friend walking by, and said that she could corroborate her story. Instead, the friend tried to hawk some Vicodin. "You wanna buy some?"

Nehemiah Byrdsong, a young Louisiana patient with multiple sclerosis, says this happens right in front of his eyes every day. Byrdsong has been in Highland for a week, dropping weight pound by pound, while he claims the nurses misread his charts and overdose him with steroids. Tears ran down his face as he sat smoking in his wheelchair, dressed in a blue paper hospital gown and a Los Angeles Dodgers cap. "The night shift nurses is all fucked up!" he sobbed. "They almost killed me twice in here!"

Byrdsong hates Highland. He's worried about his weight loss and says he can't stomach any more hospital food. After a few days, he said, he started selling his pain medication to the junkies to raise money for a meal at McDonald's. Waving his smoke at the regulars, he snarled, "They all dope fiends. They out here trying to beg for change, trying to get speed. They say they want a ride, but they only want beer."

Back inside, Byrdsong pointed out the junkies in the lobby. Judge Judy flickered on the TV, and a bored sheriff's deputy leaned against the wall. Byrdsong gestured at a woman in the front row. "This lady sitting over here with the orange jacket on?" he said. "There's nothing wrong with her. She's tryin' to get some drugs, blood!"

Byrdsong wants to go home, he said, back to Louisiana. "I hate this county, blood," he said before wheeling off. "I seen this guy digging in the garbage, trying to get some food, and he was really eating that shit. That shit is sad. Hella sad."

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