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ADVENTURE AWAITSAT OCEANO DUNES, H1

SUNDAYAUGUST 26, 2007

KERN GOVERNMENT

Union membersagree to strikeKerns general employees voted

overwhelmingly to dismiss the latest

contract proposal by the county and str ike

Saturday evening, officials from the

Service Employees International Union

said. Contract negotiations with the some

6,000 county employees represented by

the union fell apart Wednesday.

Page B1

WAR IN IRAQ

Surge helpingin some areasThe surge of U.S. troops has succeeded

in bringing violence in Baghdad down from

peak levels, but the death toll from

sectarian attacks around the country is

running nearly double the pace from a year

ago, according to reports released

Saturday. At least some of the recent

bloodshed can be traced to militant

fighters that drifted into northern Iraq

after fleeing U.S.-led offensives.

Page A18

TECHNOLOGY

Cell phone callsslow 911 systemThousands of Californians trying to report

crimes in progress or dangerous

emergency situations are facing lengthy

waits to reach 911 dispatchers because a

tenfold jump in cell phone calls has

overwhelmed

critical parts

of the states

system.

Page A5

BY EMILY HAGEDORNCalifornian staff writer

e-mail: ehagedorn@bakersfield.com

Cheryln Williams stares out at a road

she can barely see.

Sitting in her wheelchair on a

porch at the Bakersfield Homeless

Center, Williams, who is diabetic,

explains how a friend helps test her blood

sugar because she cant see the test strip.

Her left hand, gnarled from a stroke, cant

work the machine. Showering, even eating,

all require the help of others.

The shelter doesnt like to take in people

like Williams. It isnt equipped to handle

their needs, employees say.

But Bakersfield doesnt have any other

places for people like Williams to go to.

Shes too poor to pay for a board-and-

care facility. She isnt sick enough to stay

in a hospital. Shes too sick for the onlyrespite care center for the homeless in

town because shes in a wheelchair. And,

at 49, shes too young for most skilled

nursing homes.

Shelters often ill-equipped to provide care after discharge

NO PLACETO HEAL

Please turn to PATIENTS / A4

BY DAVID LEONHARDT AND VIKAS BAJAJN.Y. Times News Service

The median price of American homes isexpected to fall this year for the firsttime since federal housing agencies

began keeping statistics in 1950.Economists say the decline, which could be

foreshadowed in a widely followed govern-ment price index to be released this week, willprobably be modest from 1 percent to 2 per-cent but could continue in 2008 and 2009.Rather than being limited to the once-boom-ing Northeast and California, price declinesare also occurring in cities like Chicago, Min-neapolis and Houston, where the increases ofthe last decade were modest by comparison.

The reversal is particularly strikingbecause many government officials and hous-ing-industry executives had said that a nation-wide decline would never happen, eventhough prices had fallen in some coastal areasas recently as the early 1990s.

In Bakersfield, as of June, the median homeprice the price at which half the homes soldfor more and half sold for less was

Real estate

Pesticides

First measured decline may

further contract the market

Please turn to HOUSING / A3

Please turn to DRIFT / A3

BY STACEY SHEPARDCalifornian staff writer

e-mail: sshepard@bakersfield.com

The number of pesticide drifts and peoplesickened by them have steadily declinedin Kern County in recent years.

In 2002 and 2003, more than 550 peoplewere sickened from seven drift episodes.

Since then, the number has gone to 18 sick-ened in one incident last year, according topreliminary numbers from the state Depart-ment of Pesticide Regulation.

The agriculture industry said progress isdue to an industry-led initiative to fix theproblem through a program called Spray Safe.

The concept is to get growers moreinvolved in each others business, said Kern

Drift Prevention Coalition Chairman DaleNicol, who also works for pest control manu-facturer Syngenta.

Started in April 2006, the program is based

Drifts down,

but activistsstill skeptical

Subscriber services:392-5777 or 1-800-953-5353

To report a news tip:395-7384 or 1-800-540-0646

C A L L U S

I N D E X

Books . . . . . . . . . .G6

Classifieds . . . . . . .D1

Crossword . . .D3, G3

Eye Street . . . . . . .G1

Funerals . . . . . . . . .B2

Horoscope . . . . . .G3

Jobs . . . . . . . . . . . . .E1

Local news . . . . . . .B1

Movies . . . . . . . . . .G2

Opinion . . . . . . . . B10

Real Estate . . . . . . .F1

Sports . . . . . . . . . .C1

Television . . . . . . .G7

Travel . . . . . . . . . . .H1

Weather . . . . . . .A22

High 94Low 73

Air quality: Unhealthy, 97

Complete weather, A22

W E A T H E R

Designers are turning away from60s-inspired mod fashions andpushing a new, polished lookthat borrows from the 1940s.

Read Wednesdays Eye Streetand have a fashionable fall.

C O M I N GW E D N E S D A Y

KERNELS OF KORN INSIGHT, G1

KERN PARENTS SPEND THOUSANDS ON LAVISH SWEET 16 PARTIES, G1

LOIS HENRYON MISSINGWOMEN IN

POLITICS, B1

www.bakersfield.com LOCALLY OWNED SINCE 1897 $1.50

Price dropsexpected

nationwide

I couldnt stop crying.I had never been in a

homeless shelter before. Cheryln Williams

Check out The Pulse, reporter Emily Hagedornsblog on health and medicine on Bakersfield.com.

You can find it atpeople.bakersfield.com/blogs/ehagedorn.

BAKERSFIELD.COM

H O M E L E S S P A T I E N T S

HENRY A. BARRIOS/ THE CALIFORNIAN

Cheryln Williams takes a peek down the road. Partially paralyzed from a stroke and sufferingfrom other ailments, Williams relies on others to help her through the day .

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A4 THE BAKERSFIELD CALIFORNIAN HOMELESS PATIENTS SUNDAY, AUGUST 26, 2007

Williams sits alone on theporch; her one good hand picks atthe black tape on her wheelchairsleft armrest.

She looks out toward the cars thatzip by on East Truxtun Avenue.

I was just brought to a placewhere I felt unwanted, she says.But I have no where else to go.

HOMELESS DUMPING?Williams, her Social Security pay-

ments in limbo, was forced to moveout of her apartment in late June andwent to the only place she thoughtshe could get a bed a hospital.

Her blood sugar was high; shecalled 911 to bring her to SanJoaquin Community Hospital. Itwas the last call she made beforecalling AT&Tto turn off her phone.

San Joaquin admitted her for thenight, and then a taxi drove her tothe homeless center the next day,June 20, she said.

I couldnt stop crying,Williams said. I had never been ina homeless shelter before.

Just because a hospital takespatients to a homeless shelterdoesnt mean they were dumped,said Debbie Hankins, SanJoaquins vice president of nurs-

ing. Hospital social workers keptWilliams overnight to securehousing, and the homeless shelteragreed to take her.

We always make sure ourpatients have a place to go, Hank-ins said. Our No. 1 priority ispatient safety.

Crisis managers at the homelessshelter and Bakersfield RescueMission, however, said unan-nounced taxis dropping off newly-discharged patients are acommon sight.

Kern Medical Center droppedoff a 75-year-old man in 30-degree weather in nothing but anightgown and wheelchair, saidRay Smith,director of the mis-sions crisis program.

If they can, the missionsemployees will catch the cab andhave the driver bring the patientback to the hospital, he said.

They get really pissed becausethey didnt get paid to do this,Smith said. But were not set up totake care of those people.

TRANSFERS VS. DUMPINGLeaving a stable patient at a

homeless shelter in the countywithout prior consent from thepatient or shelter is legal.

The law requires that Medicare-accepting hospitals stabilizepatients, regardless of ability topay. Each hospital must have awritten discharge plan, requiringsafe after-hospital arrangementsand that each patient be informed,orally or in writing, of continuingcare requirements.

Hospitals also arent allowed totransfer homeless patients out ofthe county to another medical orsocial service agency without

notice or consent from the patient

or facility.But if the transfer is in county

borders, its OK in the legal sense.(Senate Bill 275,which is currentlyin the Assembly, is trying tochange that.)

KMC is usually the worst aboutleaving patients, but consideringthey typically get more of thesepeople, this isnt a surprise, thehomeless crisis managers said.

KMC does not drop patients offagainst their will, said Toni Smith,director of patient care service.

If the homeless person is beingtreated on an inpatient basis, thehospital works to find housing,which is sometimes the homelessshelters, she said. They call theshelters before bringing thepatient and only do so if the patientis stable.

If the homeless person was treat-ed in the emergency room and was-

nt admitted, KMC will sometimesgive them a taxi voucher, but theychoose where to go next, she said.

We dont force people to gothere, Smith said. We would nev-er do that.

TOO ILL FOR THE SHELTERSpokespeople for all local hospi-

tals deny dumping patients onhomeless shelters door steps.

Greater Bakersfield Legal Assis-tance has been working on a proj-ect to assess how hospitalsdischarge the homeless, hoping tomake the transitions smoother.The program was launched with a$74,200 grant from BakersfieldsKaiser Permanente after KaisersBellflower Medical Center nearLos Angeles was singled out in theareas patient dumping scandal.

This cannot be viewed as just a

problem with KMC, said EstelaCasas, GBLAs executive director.Every hospital is dealing with thisand the poor and the homeless arenot going to be going away.

KMC and other local hospitalsare getting better about callingbefore bringing a patient to theshelters, but the homeless centerstill gets some they arentequipped to handle, said JasonMeek, crisis services supervisor at

the center.I dont want to say its a dumpjob, but we get several people whoare extremely physically limited,he said.

HOTEL KMCIn response to the recent patient

dumping scandal in Los Angeles,the Legislature passed a lawrequiring hospitals to conveneregionally and discuss dischargeplans for the homeless and comeup with a plan by Jan. 1.

In the meantime, discharge plan-ners are begging, bargaining andpushing respite centers, skillednursing facilities, board-and-carehomes, rehab facilities and home-less shelters to take their patients,they said.

Sometimes they do go back tothe homeless shelters, said Man-

jeet Riar, supervisor of KMCscare management department.We dont like to do that, but wedont have any alternative.

Many Bakersfield hospitals saythey regularly keep homelesspatients several weeks or monthsbecause theres nowhere else forthem to go.

One homeless person, a 60-something man who came to KMCfor a colostomy in February,ended

up staying for six months becauseno recovery program would takehim and KMC didnt want to leavehim on the sidewalk, said Dr. Mau-reen Martin, chairwoman of thesurgery department.

At about $1,500 a day, his five-month-three-week stay past whenhe could have been discharged costcounty taxpayers $256,500, as wellas a bed for a more critical patient,she said. In the end, the man wasapproved for Medi-Cal, but thecounty is going to have to fight toget some of that back.

PAYING THE JELL-O FREIGHTMartin puts the number of beds

occupied by people who could bedischarged at roughly 22 beds atany given time. These also includepeople who are uninsured andunderinsured, not just homeless.

KMC CEO Paul Henslerthinksthat estimate is a little steep.

Hospital records indicate aboutthree patients a dayare being keptdue to discharge difficulties, hesaid. But still, thats about $1.6 mil-lion a yearfor Jell-O days thatmay or may not be paid for by thepatient or insurance.

The bottom line is that KMC isa receptacle for a lot of underfund-ed, uninsured and homeless peo-ple, Martin said. What do you dowith people who have had theirmedical and surgical care but donthave a safe place to go afterward?

A day at Bakersfield Memorialand Mercy hospitals also costs$1,500, hospital executives said.

Mercy doesnt get many home-

less patients, but when they do, itcan take a couple days to dischargethem, said Sandy Barker Doucette,Mercys marketing and communi-cations manager.

At Memorial, four to five home-less patients are admitted a monthand sometimes it can take twoweeks to a month or moreto placethem, said Paul Chavarria, socialwork supervisor at Memorial.

Its a given we wont see thatmoney back, said Ken Keller,Memorials vice president forphysician and business develop-ment.Thats just a cost of doingbusiness that we understand as anot-for-profit facility.

San Joaquin Community Hospi-tal may see four or five homelesspatients a weekwho end up stayingabout a week extra due to place-ment difficulties, said JeanieRucks, a registered nurse and case

manager. On average, this costs$2,013per patient per day.Representatives from Bakers-

field Heart Hospital would notreturn calls for comment

SOMETHING NEEDS TO BE DONEThe hitch comes in finding an

agency or program to pay for thesepatients, KMCs Riar said. It cantake up to three months to beapproved for Medi-Cal.

Even so, many nursing facilitieswont take Medi-Cal due to lowreimbursement rates, she said.Many homeless people also havemental or substance abuse prob-lems that make them hard to place.

Some board-and-care homes which usually dont offer skillednursing care take homelesspatients, but usually they must beplugged into a county program.

California Board & Care, on

Brundage Lane, took homelesspatients when it opened in 1997,but had problems with paymentand patients left before they werewell, said owner Mohammad Bhat-ti. Now patients must be referredfrom KMC or Kern County MentalHealth and have a case managerwho oversees their care.

Several facilities, including sev-eral board-and-cares and shelters,require patients be able to walk.

We run a rescue mission. Werenot a nursing facility, said Rev.Dan Gorman, executive director ofthe rescue mission.

Most people agreed that some-thing needs to be done.

I know everyone is sayingwere going to be paying a wholelot (to create a service), Gormansaid. But were paying a wholelot anyway.

Continued from A1

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S/ THE CALIFORNIAN

Though she is free to come and go as she pleases, Cheryln Williams says, Sometimes I feel Im in jail.

Cheryln Williams struggles to read after losing most of her vision.

PATIENTS:

Dumpingdenied

Victoria Gibson, 49, feels blessed to be at Clinica Sierra Vistas homeless respite on Monterey Street. After be-ing released from the hospital, she had nowhere to go until she went to the respite house.

I was just brought

to a place where I

felt unwanted. But I have

nowhere else to go. Cheryln Williams

Bakersfield has 10 respite bedsthrough Clinica Sierra Vista setaside for Kerns roughly 900-per-son homeless population.

Homeless people can come toClinicas homeless respite pro-gram housed in a small greenhome at the Griffins Gate sober-living facility on Monterey Streetto recuperate from illness and in-jury, said Marie Wall, program co-ordinator for Clinicas homeless

health services.And at roughly $37 per bed perday,the price is a far cry from theother hospitals hefty rates.

But the center is rarely at capaci-ty, Wall said.

We are very seldom full becausethe people (who want to go there)are so deathly ill, she said. Tocome here, they have to be ableto get out of the building if theresa fire ... ambulatory and relativelyself-sufficient.

Wall would like to see her pro-gram get more funding, so it canhire more staff to care for sickerpatients.

Several solutions are being kickedaround to fill in this gap.

LARGE, STANDALONE FACILITY

Many homeless people andhealth advocates say Bakersfieldneeds a larger facility, maybe aprogram that could offer rehabili-tation and take people whoare wheelchair-bound and de-pendent.

We need something that offersthat intervention care, said theRev. Dan Gorman, executivedirector of the BakersfieldRescue Mission. Thats the holewe have.

Greater Bakersfield Legal Assis-tance, as part of Mayor HarveyHalls 45-member Homeless Col-laborative, has been working on aproject to assess how hospitalsdischarge the homeless, workingwith discharge managers to makethe transitions smoother.

GBLAs solution: A 30-bedtran-sitional facility that could handlemore complex health needs, like

monitoring IVs and dressingwounds, as well as people who arephysically disabled, said Roy Mala-howski, a GBLA attorney.

GBLA doesnt know how much afacility like that would cost. Theyplan to submit a proposal to Hallwithin the next monthin re-sponse to his call to end home-lessness in Bakersfield by 2016,said Estela Casas, GBLAs execu-tive director.

Hall said he hasnt heard aboutthe facility but realizes thathealth care is a big factor in end-ing homelessness.

I dont think hospitals should beheld exclusively liable when citiesthat do have the resources havebeen dropping the ball, saidMichael Cousineau, associate pro-fessor and the director of the Cen-ter for Community Health Studies

at the University of Southern Cali-fornia Keck School of Medicine.Thats where it should start.

HOSPITAL-ATTACHED FACILITY

KMC CEO Paul Henslerhas toyedwith the idea of a skilled nursing fa-cility that could provide the appro-priate care for $200 or $300instead of $1,500.

But KMC doesnt have any capaci-ty to take this on, and after crunch-ing numbers, the need isnt there,he said.

Mercy has a 40-bedtransitionalfacility. But it doesnt have aMedi-Cal contract, and thats notthe place where we would look toplace them (the homeless), saidSandy Barker Doucette, Mercysmarketing and communicationsmanager.

Its hard to just yell at the hospi-

tals, Gorman said. Are we askingthe hospitals to do what the federal,state, county and city governmentsshould be doing?

BEDS IN A LOCAL SHELTER

Representatives from the Bakers-field Homeless Center and the res-cue mission have said they wouldlike to see beds attached to their fa-cilities that could take on some of thesicker patients.

I think humanely we need a place,said Diana Campbell-Rice, associ-ate director of the homeless center.If people dont feel good, they cantwork. If kids dont feel good, theycant learn.

The rescue mission is partneringwith several local doctors to builda clinic on the missions grounds,Gorman said. Maybe some bedsin that facility could be used forlong-term care if the missionhired more medical staff.

I couldnt justify setting up awhole wing to do this service, hesaid. But it has to be addressed.

POSSIBLE

SOLUTIONS: