My hospital is in the middle of downtown Los Angeles, not far from the infamous Skid Row.  Naturally, as a trauma surgeon, I get a lot of homeless patients that don’t seem to realize that contact with moving cars can have a very negative health impact.  Invariably, the ones that don’t get killed or turned into Downtown Vegetable Surprise, end up staying in the hospital for weeks, getting free food, sponge baths from pretty little Filipino nurses and of course, all the free Spanish language television that they can watch.  It never fails that most of these guys become very attached to the hospital and it becomes for them their own version of The Hotel California.  They demand double portions of food from the cafeteria, the same guys that a couple of weeks before, double portions meant diving into the dumpster for a second time and coming up with another slice of discarded pizza.  They bitch and moan about the nurses not coming immediately when they press the call button.  They refuse to get out of bed and work with physical therapy unless they get several milligrams of dilaudid or some other powerful heroin like drug.  And unlike a hotel, where a bill is generated and on checkout day they settle up their bill with a credit card, these guys go back out on the street, leaving the bill for you and me to pay, sometimes a bill that is in the hundreds of thousands of dollars.  Many of them return in short order after experiencing another calamity on the street.

The brilliantly retarded city attorney helped pass a law saying that no homeless person can be discharged to a shelter, even if they are medically stable, or else the hospital faces criminal charges and huge fines. (But it's ok to discharge them back on the street, go figure.)  So in short, the hospital becomes a boarding place for the city’s forgotten homeless who played chicken one time too many with a car, a fist, a bullet or a knife.  And we health care professionals get to be their concierges, their butlers, their exercise coordinators and their activity planners.

Something is definitely wrong with the way society treats it’s “discards” and certainly here in Los Angeles, the sleazy local politicians have found one perfect way to absolve themselves of any responsibility for these folks.  I’ll bet if I hang out on Skid Row one night, I’ll see Mayor Villaraigosa gunning his Cutlass Supreme playing Hobo Frogger, laughing his mayoral ass off.