Capital Gazette wins special Pulitzer Prize citation for coverage of newsroom shooting that killed five

Long way from home


JEFFREY SANFORD was well-known to the emergency room staff at Mercy Medical Center in Baltimore. He was, like many homeless people, a "frequent flier" who treated hospital emergency rooms like doctors' offices, and turned to them for routine medical care he should have been getting at neighborhood clinics. Such facilities are desperately needed but sorely lacking, not just in this city but around the country.

When Mr. Sanford died on a cold April night last year, it was not in one of the many emergency rooms he frequented, but in a small park across the street from Mercy, engulfed by flames from a fire he may have set to stay warm.

He had been physically escorted out of Mercy's emergency room, not for the first time, the day before he died.

Hospitals are increasingly weighing when and whether to admit and treat chronically homeless people whose health is often compromised by the fact that they are homeless. While emergency rooms do treat those in legitimate medical crisis, they don't have the resources or the structure to be primary care centers or backup shelters for homeless people.

Yet every night, especially during the winter, when local homeless shelters quickly fill up, homeless people flock to emergency rooms pretending to be sick when they're actually just seeking refuge from the elements, a free breakfast or a clean bed. Others show up with serious but non-life-threatening illnesses.

Neither hospitals nor homeless people are well-served under such circumstances. Taxpayers and patients with health insurance end up paying the tab. Mercy reports providing $27 million worth of uncompensated care each year, including medical services to the homeless.

According to the U.S. Interagency Council on Homelessness, the problem is systemic. In Seattle, 1,200 homeless people tracked for one year cost the state $12 million -- $100,000 per person -- in emergency room and behavioral health care. Boston homeless health care providers tracked 119 homeless people over five years and counted more than 18,000 emergency rooms visits averaging $1,000 per visit. In San Diego, 15 homeless people made 300 emergency room visits in 18 months at a cost of $3 million.

The Bush administration, recognizing that community-based care is socially sound and makes economic sense, has proposed increasing to $2 billion federal funding for local "consolidated health centers" in 2006, up from $1.69 billion in 2005. The increase would support the creation or expansion of 1,200 sites nationwide, including 40 new centers in high-poverty counties. It deserves congressional support.

Maryland could certainly use some of that additional money. The state has just 12 federally funded community health centers, only one of which exclusively serves homeless people. State health administrators say the need is much greater.

Mr. Sanford was perhaps an ideal client for a consolidated health center. By many accounts -- including those of Mercy's chaplain, who knew him well -- he was a kind-hearted loner who struggled with crippling depression and drank to numb his emotional pain.

Though his mother and three sisters tried to help him, he died alone, under a brightly burning bush that hospital workers across the street mistook for a simple brush fire. Paramedics believe Mr. Sanford lost his footing while trying to keep warm and fell into the flames.

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