Patient dumping, or when a healthcare facility prematurely and unsafely discharges a patient to the street, has been in practice since the 1870’s, targeting the most marginalized: the undocumented, homeless, or patients with mental illness. Despite numerous state and federal attempts to curb patient dumping, such as 1986’s EMTALA, dumping practices are still found throughout the country.

On September 30, 2018, Governor Jerry Brown signed California’s proposed solution to patient dumping, Senate Bill(SB) 1152, into law. Already in effect this year, SB 1152 mandates that hospitals and emergency departments(EDs) identify homeless individuals and initiate a “written homeless patient discharge planning policy and process”; homeless patients must be discharged with a plan for coordinating social services and healthcare referrals as well as a checklist of items (e.g., vaccines and weather-appropriate clothing). In essence, homelessness is now recognized in California as a medical condition to be diagnosed and addressed.

However, implementation of the law is inconsistent and has yielded unintended consequences, such as worsening ED overcrowding. Since September, California hospitals have been working quickly but primarily in isolation, often cobbling together hodge-podge to meet the bill’s requirements. Additionally, SB 1152 does little to ensure the existence of much-needed community-based resources.

Nonetheless, SB 1152 proffers an opportunity to strengthen the linkages between healthcare and the community and to improve the provision of continuity of care for the most vulnerable.

(The experience of two disparate EDs implementing SB 1152—one at major academic trauma center and another at a county-community center—will be explored in detail.)